[124-10271-10003_multirif.pdf — page 51]
# Application for EmploymentFD-140 (Rev. 10-16-73)# FEDERAL BUREAU OF INVESTIGATIONUNITED STATES DEPARTMENT OF JUSTICEWASHINGTON, D. C. 20535DateNOTICE: Application must be typewritten or clearly printed in black ink. All questions must be answered, if applicable. If not, indicate NA (not applicable). Applications which are not complete and legible will not be considered. If space provided is not sufficient for complete answers, or you wish to furnish additional information, attach sheets of the same size as this application, and number answers to correspond with questions.Check Position Applied For:*   Special Agent*   Special Agent (Accountant)*   Radio Maintenance Technician**   Laboratory Aid or Technician*   Translator*   Nurse*   Clerk-Stenographer*   Clerk-Typist*   Clerk (See Item 4, page 2 on Fingerprint Clerk position)*   Other*Applicants for this position must complete "Questionnaire for Radio Maintenance Technician Position."## 1. PERSONAL HISTORYa. Name in full (Last, first, middle)b. Social Security Numberc. List all other names you have used including nicknames; if female, fumish maiden name. If you have ever used any sumames other than your true name, during what period and under what circumstances were these names used? If you have ever legally changed your name, give date, place, and court.d. Birth date (Month, day, year)e. Are you a U. S. citizen?Yes No Naturalized? Yes No Derivative? Yes NoNaturalization #Place of birthPlaceDateCourtExplain derivative citizenship## 2. MARITAL STATUSSingle MarriedDatePlace of MarriageNo. of ChildrenWidowed Divorced SeparatedDatePlace of Divorce or Legal SeparationCourt (See Section 13k)## 3. RESIDENCESa. Present Residence Address: (Apartment, street, city, state, zip code)Telephone Numbers:Residenceb. Complete address to which you wish mail or telegram sent (include zip code and telephone number if different from above)Businessc. List chronologically ALL of your residences in the past 10 years (include addresses while attending school if away from home and all military addresses including any off military base).| From        | To         | Apt. # | Street Address | City | State || ----------- | ---------- | ------ | -------------- | ---- | ----- || Mo. Day Yr. | Mo Day Yr. |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       ||             |            |        |                |      |       |The Federal Bureau of Investigation is an equal opportunity employer.ALL INFORMATION CONTAINED \HEREIN IS UNCLASSIFIEDDATE 1-19-01 BY SP2 ALM/RNW 88296 DocId:32989588 Page 52