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# REFERENCES List three persons living in the United States or Territories of the United States who are NOT related to you 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).| FULL NAME      | PRESENT ADDRESS (Give complete current address, including street and number) | BUSINESS OR OCCUPATION || -------------- | ---------------------------------------------------------------------------- | ---------------------- || Robert Hadlich | Box 659, Grand Forks, N. Dak.                                                | Teacher                || Calmer Hovland | 521 Maple Ave. Grand Forks N.Dak.                                            | Teacher                || Kerland W Berg | 618 Cottonwood St, Grand Forks, N. Dak,                                      | Teacher                || INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | YES | NO  | INDICATE "YES" OR "NO" ANSWER BY PLACING "X" IN PROPER COLUMN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | YES | NO  || --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- | --- || MAY INQUIRY OF MADE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER QUALIFICATIONS ETC?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         | X   |     | ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COUNTY, OR MUNICIPALITY? If your answer is "Yes," give details in Item 39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |     | X   || ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | X   |     | DOES THE UNITED STATES GOVERNMENT EMPLOY IN A CIVILIAN CAPACITY ANY RELATIVE OF YOURS (BY BLOOD OR MARRIAGE) WITH WHOM YOU LIVE OR HAVE LIVED WITHIN THE PAST 24 MONTHS? If your answer is "Yes," show in Item 39 for EACH such relative (1) full name, (2) present address; (3) relationship; (4) Department or Agency by which employed, and (5) kind of appointment                                                                                                                                                                                                                                                                                                                                                                                                        | X   |     || ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U S A OR ANY COMMUNIST ORGANIZATION?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | X   |     | **SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCE** A. 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, together with proof specified therein. B. If you are a WAR-TIME VETERAN not claiming disability preference, you should NOT submit your 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. |     |     || ARE YOU NOW OR HAVE YOU EVER BEEN, A MEMBER OF A FASCIST ORGANIZATION?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     || ARE YOU NOW OR HAVE YOU EVER BEEN, A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP, OR COMBINATION WHICH ADVOCATES THE OVERTHROW FOR CONSTITUTIONAL FORM OF GOVERNMENT, OR OF AN ORGANIZATION ASSOCIATION MOVEMENT GROUP OR COMBINATION OF PERSONS WHICH HAS ADOPTED A POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE OR VIOLENCE TO ANOTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES OR OF SEEKING TO ALTER THE FORM OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS? If your answer to question 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 | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     || SINCE YOUR 18TH BIRTHDAY, HAVE YOU EVER BEEN ARRESTED, INDICTED, OR SUMMONED INTO COURT ASA DEPENDANT IN A CRIMINAL PROCEEDING, OR CONVICTED, FINED OR IMPRISONED OR PLACED ON PROBATION OR HAVE YOU FER BEEN BONDED TO LESSEN BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW POLICE RELATION OR ORDINANCE (EXCLUDING MINOR TRAFFIC VIOLATIONS FOR WHICH A FINE OR FORFEITURE OF $25 OR LESS WAS IMPOSED)? If your answer is "Yes," (ist all such cases under Item 39 below. One 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                                                                                                                                                                 | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     || HAVE YOU EVER BEEN DISCHARGED OR FORCED TO RESIGN, FOR MISCONDUCT OR UNSATISFACTORY SERVICE FROM ANY POSITION? If your answer is "Yes," Airo in Item 39 the name and address of employer, date, and reason in each case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     || HAVE YOU EVER BEEN BARRED BY THE US CIVIL SERVICE COMMISSION FROM TAKING EXAMINATIONS OR ACCEPTING CIVIL OR APPOINTMENTS? If your answer is "Yes," give dates of and reasons for such debarment in Item 39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     || HAVE YOU ANY PHYSICAL HANDICAP DEFECTS OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO POSITION? If your answer is "Yes," give complete details in Item 39 so that consideration can be given to your physical fitness for duty.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     || ARE YOU RECEIVING AN ANNUITY FROM THE UNITED STATES (A DISTRICT OF COLUMBIA) GOVERNMENT UNDER ANY RETIREMENT ACT SAY MAYOR OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICE? If your answer is "Yes," give complete details in Item 39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | X   |     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |     |     |YES | NO | 37 (a) WERE YOU EVER IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING TIME OF WAR? | X |(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? | X |(c) WAS SERVICE PERFORMED ON AN ACTIVE FULL-TIME BASIS, WITH FULL MILITARY PAY AND ALLOWANCES? | X |(d) DATE OF ENTRY OR ENTRIES INTO SERVICE | DATE OF SEPARATION OR SEPARATIONSOct. 1946 | April, 1948.Oct. 1950 | August, 1951BRANCH OF SERVICE (Army, Navy, Marine Corps, Coast Guard, etc.) | SERIAL NO. (If none, give Grade or rating at time of separation)Army | ER 17 214 704YES | NO | (e) IF YOU SERVED IN THE UNITED STATES MILITARY OR NAVAL SERVICE DURING PEACETIME ONLY DO YOU PARTICIPATE IN A CAMPAIGN OR EXPEDITION AND RECEIVE A CAMPAIGN BADGE OR SERVICE RIBBON? | X |(f) ARE YOU A DISABLED VETERAN? If so, and you have not listed your disability in answer to Item 33, explain in Item 39 below | X |(G) ARE YOU A VETERAN’S WIDOW WHO HAS NOT REMARRIED? | X |(h) ARE YOU THE WIFE OF A VETERAN WHO HAS A SERVICE CONNECTED DISABILITY ENTITLING TO ADDITIONAL SERVICE APPOINTMENT? |   | XTHIS SPACE FOR USE OF APPOINTING OFFICER ONLYThe information contained in the answers to Question 37 above has been verified and by comparison with the discharge certificate on ......................................, 19.......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 APPLICANTJarr: I Woods(Give full name in ink, write out all details and surnames. If Posen not your legal name, give also all names under which you have previously been employed. Mist Mame, The.