[104-10224-10001.pdf — page 154]
ATTACH SUPPLEMENTAL SHEETS OR FORMS HEREDates of employment (month, year)| From               | To  || ------------------ | --- || Salary or earnings |     || Starting $ per     |     || Final $ per        |     |Classification Grade (if in Federal service!)Location of employment| City  |     || ----- | --- || State |     |Kind of business or organization (manufacturing, accounting, insurance, etc.)Name and address of employee (firm, organization, etc.)Name and title of immediate supervisorReason for leavingDescription of workIf you need additional experience blocks, use supplemental sheets. SEE INSTRUCTION SHEET.17. SPECIAL QUALIFICATIONS AND SKILLS.(A) Licenses and Certificates.--Indicate the kind of license or certificate and the State or other licensing authority which granted it; for example, pilot, teacher, electrician, lawyer, radio operator, C.P.A., etc.(D) Give any special qualifications not covered elsewhere in your application, such as:(1) Your more important publications. (Do not submit copies unless requested)(2) Your patents or inventions.(3) Public speaking and public relations experience.(4) Membership in professional or scientific societies, etc.(5) Honors and fellowships received.| Kind of License | Licensing Authority || --------------- | ------------------- |(B) List any special skills you possess and machines and equipment you can use, such as shortwave radio, multilith, comptometer, key-punch, turret lathe, scientific or professional devices.Photographer, still and motion cameraPhotostat machine, ozalid: all typesof photo reproduction and film process-(C) 107 words per minute in:| Typing | Shorthand || ------ | --------- |18. EDUCATION.A. Give the highest elementary or high-school grade completed 10thB. Name and location of last high school attended:If you completed high school, give dateCentral High, Manchester, N.H.C. Name and location of college or university:| Dates attended | Years completed | Credit hours        | Degrees received || -------------- | --------------- | ------------------- | ---------------- || From To        | Day Night       | Semester or Quarter |                  || ---            | ---             | ---                 | ---              |D. Chief undergraduate college subjectsCredit hoursSemester or QuarterE. Chief graduate college subjectsCredit hoursSemester or QuarterF. Other schools of training, such as trade, vocational, Armed Forces, or business. Give for each name and location of school, dates attended, subjects studied, certificates, and any other pertinent data:19. Have you lived or traveled in any foreign countries?☑ Yes ☐ NoIf answer is "Yes", give in Item 34 names of countries, dates, and length of time spent there and reason or purpose (military service, business, education, or vacation).20. Indicate your knowledge of foreign languages.|     | Reading             | Speaking            | Understanding       | Writing             || --- | ------------------- | ------------------- | ------------------- | ------------------- ||     | EXCELLENT GOOD FAIR | EXCELLENT GOOD FAIR | EXCELLENT GOOD FAIR | EXCELLENT GOOD FAIR || --- | ---                 | ---                 | ---                 | ---                 |443-16-5267-3