[194-10004-10141.pdf — page 2]
# 11. OTHER RELATIVES AND ALIEN FRIENDS LIVING IN FOREIGN COUNTRIES (List grandparents, first cousins, aunts, uncles. brothers- and sisters-in-law, and other persons with whom a close relationship existed or exists)| RELATIONSHIP AND NAME | AGE | OCCUPATION | ADDRESS | CITIZENSHIP || --------------------- | --- | ---------- | ------- | ----------- || None                  |     |            |         |             ||                       |     |            |         |             ||                       |     |            |         |             ||                       |     |            |         |             ||                       |     |            |         |             |# 12. FOREIGN TRAVEL (Other than as a direct result of United States military duties)| DATES      | COUNTRY VISITED | PURPOSE OF TRAVEL || ---------- | --------------- | ----------------- || FROM-  TO- |                 |                   || None       |                 |                   ||            |                 |                   ||            |                 |                   ||            |                 |                   ||            |                 |                   |# 13. EMPLOYMENT (Show every employment you have had and all periods of unemployment)| MONTH AND YEAR     | NAME AND ADDRESS OF EMPLOYER                                                            | NAME OF IMMEDIATE SUPERVISOR | REASON FOR LEAVING    || ------------------ | --------------------------------------------------------------------------------------- | ---------------------------- | --------------------- || FROM-  TO-         |                                                                                         |                              |                       || Dec 59 Dec 59      | Paul Elder Bookstore Sutter & Stockton Sts., S.F., Cal.                                 | Paul Elder                   | End of holiday season || Summer 60          | San Francisco Council Camp Fire Girls, S.F., Calif.                                     | Unknown                      | End of summer Camp    || 1960 1961          | Fairmont Hotel San Francisco, Calif.                                                    | Unknown                      | Part-time job         || 1961 1962          | Foster's Restaurant San Francisco, Calif.                                               | Unknown                      | Part-time job         || Summer 1961 & 1962 | S. F. Boys' Chorus San Francisco, Calif.                                                | Madi Bacon                   | End of summer camp    || 1962 & 1963        | Madison Board of Education Rec. Madison, Wisconsin                                      | Unknown                      | end of school year    || Fall 1962          | Clark Service Station Atwood Ave., Madison, Wisconsin                                   | Ed Cutter                    | Conflict with studies || Oct 65 Jun 66      | Self-employed - musicians in folk trio Cooks Cupboard 1718 Wells St., Chicago, Illinois | Bob George                   | Return to S.F.        |DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE? ☐ YES ☑☑ NO DO YOU HAVE ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN GOVERNMENT, FIRM, OR AGENCY? ☐ YES XX NO HAVE YOU EVER BEEN REFUSED BOND? ☐ YES XXNO IF THE ANSWER TO ANY OF THE ABOVE IS "YES," EXPLAIN IN ITEM 20.SOCIAL SECURITY NO.564-58-8137# 14. CREDIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the United States or its Territories.|           | NAME (List 3 credit and 5 character) | YEARS KNOWN | STREET AND NUMBER (Business address preferred) | CITY          | STATE OR TERRITORY || --------- | ------------------------------------ | ----------- | ---------------------------------------------- | ------------- | ------------------ || CREDIT    | None                                 |             |                                                |               |                    || CHARACTER | Malvina Reynolds                     | 10          | 2027 Parker Street                             | Berkeley      | Calif.             ||           | Stephan Negoesco                     | 10          | Sonora Way                                     | Corte Madera  | Calif.             ||           | Madi Bacon                           | 4           | 1120 Keith Avenue                              | Berkeley      | Calif.             ||           | Richard Correll                      | 10          | 799 Clayton, Street                            | San Francisco | Calif.             ||           | Archie Brown                         | 10          | 1027 Brussell St.                              | San Francisco | Calif.             |NW 88613 Docld:34528582 Page 3U.S. GOVERNMENT PRINTING OFFICE: 1960 0-573450