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# 14-00000N.B. REFER List these persons bring in for service in front of the United States where as to pay and who have definite knowledge of your qualifications and fitness for the position for which you are applying. Do not repeat names of supervisors listed under Item 16 (EXPERIENCE).1.  FULL NAME (Give complete current address including street and number) BUSINESS OR OCCUPATIONMaj. Gen. Wm. J. Donovan 2 Wall Street, New York 5, N.Y. AttorneyJohn C. Farrar 53 East 34th Street, New York 16 PublisherRaymond Rubicam 444 Madison Avenue, New York 16 ExecutiveINDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN25 MAY INQUIRY BE MADE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER QUALIFICATIONS, ETC.? Yes26 ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES? Yes27 ARE YOU NOW OR HAVE YOU EVER BEEN, A MEMBER OF THE COMMUNIST PARTY, U.S.A. OR ANY COMMUNIST ORGANIZATION? No28 ARE YOU NOW OR HAVE YOU EVER BEEN, A MEMBER OF A FASCIST ORGANIZATION? No29 ARE YOU NOW OR HAVE YOU EVER BEEN, A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOVERNMENT OF THE UNITED STATES, OR WHICH SEEKS BY FORCE OR VIOLENCE TO DENY TO OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS? NoIf your answer to questions 27, 28, or 29 above is "Yes," state in Item 39 the names of all such organizations, associations, movements, groups, or combination of persons and dates of membership. Give complete details of your activities therein and make any explanation you desire regarding your membership or activities therein.30 SINCE YOUR 16TH BIRTHDAY, HAVE YOU EVER (1) BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING; (2) BEEN CONVICTED, FINED OR IMPRISONED OR PLACED ON PROBATION; OR HAVE YOU FORFEITED COLLATERAL PLEDGED TO GUARANTEE YOUR APPEARANCE IN CONNECTION WITH VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (EXCLUDING MINOR TRAFFIC VIOLATIONS FOR WHICH A FINE OR FORFEITURE OF $25 OR LESS WAS IMPOSED)? NoIf your answer is "Yes," list all such cases under Item 39 below. Give in each case (1) the date; (2) the nature of the offense or violation; (3) the name and location of the court; (4) the penalty imposed, if any, or other disposition of the case. If appointed, your fingerprints will be taken.31 HAVE YOU EVER BEEN DISCHARGED OR FORCED TO RESIGN FOR MISCONDUCT OR UNSATISFACTORY SERVICE FROM ANY POSITION? NoIf your answer is "Yes," give in Item 39 the name and address of employer, date, and reason in each case.32 HAVE YOU EVER BEEN BARRED BY THE U.S. CIVIL SERVICE COMMISSION FROM TAKING EXAMINATIONS OR ACCEPTING CIVIL SERVICE APPOINTMENTS? NoIf your answer is "Yes," give dates of and reasons for such debarment in Item 39.33 HAVE YOU ANY PHYSICAL HANDICAP, DISEASE OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO WORK? NoIf your answer is "Yes," give complete details in Item 39 so that consideration can be given to your physical fitness for the job.34 (A) DID YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT OR ANY PENSION OR OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICE? NoINDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN35 ARE YOU (A) AN OFFICIAL OR (B) EMPLOYEE OF ANY STATE, TERRITORY, COUNTY, OR MUNICIPALITY? NOIf your answer is "Yes," give details in Item 3936 DO ANY RELATIVES OF YOURS RECEIVE GOVERNMENT EMPLOY IN A CIVILIAN CAPACITY AND LIVE WITH WHOM YOU LIVE LOR HAVE LIVED WITH IN THE PAST? NOIf your answer is "Yes," state in Item 39 for EACH such relative (1) full name, (1) present address, (3) relationship; (4) Department of Agency by which employed, and (5) kind of appointment.## SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCEA. If you are claiming preference as a PEACETIME VETERAN who has been awarded a campaign badge or service ribbon, or as a DISABLED VETERAN, or as the WIFE OF A DISABLED VETERAN, or as the WIDOW OF A WAR OR CAMPAIGN VETERAN, attach Veteran Preference Claim, CSC Form 14-6, together with sealed affidavit therefor.B. If you are a WAR-TIME VETERAN not claiming disability preference, you should NOT submit proof of discharge with this application. Preference will be tentatively credited to you and if appointed, you will be required to submit to the appointing officer prior to entry on duty, official evidence of separation from active service in the armed forces of the United States in time of war.37 (A) WERE YOU EVER IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING TIME OF WAR?(B) IS THE WORD "HONORABLE" OR THE WORD "SATISFACTORY" USED IN YOUR DISCHARGE OR SEPARATION PAPERS TO SHOW THE TYPE OF YOUR DISCHARGE OR SEPARATION?(C) WAS SERVICE AN ACTIVE FULL-TIME BASIS WITH FULL MILITARY PAY AND ALLOWANCES?YES NOXXXOctober 1940-October 1942Sept. 1943-March 19466- Navy- Army(Army, Navy, rating at time of separation) SERIAL NO (if none, give grade or 0-587241/97532 Marine Corps, Coast Guard, etc.)38 IF YOU SERVED IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING PEACETIME ONLY, INDICATE IF YOU PARTICIPATE IN A CAMPAIGN OR EXPEDITION AND RECEIVE A CAMPAIGN BADGE OR SERVICE RIBBON. X(A) ARE YOU A DISABLED VETERAN? XIf so, and you have not listed your disability in answer to Item 33, explain in Item 39 below.(C) ARE YOU A VETERAN'S WIDOW AND HAS NOT REMARRIED? X(B) ARE YOU THE WIFE OF A VETERAN WHO HAS A SERVICE CONNECTED DISABILITY? 1## THIS SPACE FOR USE OF APPOINTING OFFICER ONLYThe information contained in the answers to Question 37 above has been veri- 6-1 19.49fied by comparison with the discharge certificate onAgency: Title:SPACE FOR (ALL ANSWERS TO OTHER QUESTIONS. (Indicate item numbers to which answers apply)If more space is required, use paper the same size as this page. Write on each sheet your name, address, date of birth, and examination title. Attach to inside of this application.Before signing this application check back over it to make sure that you have answered ALL questions correctly. I CERTIFY that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.False statement on this application is punishable by Law (U.S. Code, Title 18, Section 80).SIGNATURE OF APPLICANT(Type or print full name in ink) (Initial or initials, and surname)(If female, give maiden name as "Mrs. Mary L.