14-00000 ‘ / : This form i is to be completed before entrance on duty. Question 3 9 fe to be answered in all cases, otherwise answer only those questions which require an answer different from that given to the corresponding questions on your application form. HH no answers are different, write "NONE" in Item 10, below. Any false statement in this declaration will be grounds for cancellation of application or dismissal after appointment. iinpereynation is a criminal offense.and will be prosecuted accordingly. . 1, Rea MARTA (etreet and number, atty and Biate) . 2.4 Oett we watA . (8) PLACE OF BINTH foley of town and State or country) a 6@ CARs OF Emtnotnc’ MaAkE Oty [Gap amanonsue [ee strat ano nuncea cory ano state [eo Texernong a, - & ones Tra ENT EMPLOY, If A CIVILIAN CAPACITY, ARY RELATIVE OF YOURS (EITHER BY EL009 OR HARASS) WITH WHO YOU LIVE OR RAVE LIVED BITES . . Feet pacr ge moet ess (“] vas fx] mo . - ot MY 00, fin ouch euch colative Ril ia the blanks below. If additional epace & necessary, complete under Ftom 16. s post ornex ADDRESS “(i} POSITION (2) TEMPORARY OR ROT . mang ., (Give vtré0t nisonber, if ang), OLPART MENT ee ie WHEN se - a . a” . . . _ i? ° ; qe es 2 . woe . - : Re. aeanceacracareenmnsacaemenws. § - - - we _ - - Pll Mee a <r as i Meg ae TD & omen wme SMITE OR AS TS Oe: : H + - ~ ’ . . . = 1 . : . ; - DATE “yes” GR °KO" ANSWER BY PLACING: tad 7 1. SPACE | AT) DETAILED ANSWERS 10 OTHER: “QUESTIONS ~ : ; in PROPER COLUMN WRITE i LEFT COLUMA AuMneRS OF (TEMD TO ad DETAILED ANSWERS APPLY ; : & APE BOE A PTEEH OF 800 YOU OWE ALLEOLAMCE TO Ted Uerreo STATES. | ; SUMO PATTE srecumoeavees ecronecceaameree sues ‘ ‘ ' MU yous anewor ia You", dive dataita in ftesm 10. raverennrerecesenacceees-rerweurarseuceraraseracsacccesesenrenonses ac eavarecacaeee 9, G0 TORE AELAIVE OMY ANMUITY PROM THE UNITED BYATES O8 CorTENCY CF - : - - ‘ ” + ‘ eA Lwes COTTER TAT UMDER-ANY RETIREMENT ALT OF ASY PEMA OR | ee ee ie ne a a rs - f G3 ALR CLAVE Seba THEO GR MILITARY OR RAVAL SERVICE), comes: coronsor acme scenccescennecececceseceeucesenaceces: . : t MN ypoar anse or je.’ ¥ea'', five in ftom 10 reascan for rativemeant, ™ eee 2 eee eeewe awe Hi thes és, o§8,. eptional .c sandy, or by reasan of walintary ee ee ete eee enn ee Eee eS * en srecdusiary ceperation aftes 3 years’ service; amount of sstisenoeet gay, and under what retiraomon’ act; and rating, , a retired deen srisbetsey oF naval sorvicg. j & hb AEYop. £VUB BEM OFSCHANGED. OR FORCED TO ANSIGH, FOR MIsoOnOUET | . 5 C2 URES EES ACTOAE SERVICE FROM ANY POSITIONT,..W. eo cenrrecrtcersercese : . U gore ascower 13" Yaa", divain fem ithe name and address , ed os phoyer, dete, and saasan in gavh case. . . . a GAO rie SETH BERTH AY SAVE YOu! EVER ATEN ARRORTED | monetary oot i Paar eee REO se Re TERRE ROS SURE ONE eke bere renee an nne En OMEN ee Heh EEE Se OaE atone Aeeunew . Seeresiees isto COURT a4 A DEFENDANT tH ry CHIMIAAL PROCZELIRG. Ga’ - | a Pan Parad Be 5 Ft LO PRISGHED, OR PLACED OM MMueBs Ti, TR MAKE YOR awwensfinwsscepescarstereseres ce uecceesudtneatbeeruned erewnn en se nenne ngs perennaseesuseeue ; ELS BLED AO ATTO TO 8 FGGIT BALL OR CLALATERAL PUR THE VILA HOt OF sr oe PRICE REGULATION, OF ORDHABCE [EXCL UNS PiRON, TRATES PAST LISS POR IGT od ATINE OR FORFEITURE OF LOR LESS WAS [MPCAEL IT . If yor answer so Was", fet all auch cases uncer tem 10 | Gre 19 wach cate: Uf} The data; (2) the nature uf the offense . oe Brtadcd 7%; (3) the name aiid locatica of the cusast; (4) the getialzy snpueed, if any, oF ether Yesporition of the esue, Ef apgenmsed, your Angecprints will ha taken. : Se ee "INSTRUCTIONS TO APPOINTING OFFICER . a mo - spemineicg "others before whom the forencing vertificete le made asbaft qa Crtusenshig.c the pope inting officer te ‘eeponsibhs for observing the ‘ r : The detersnms ts tus ows antisfaction that this appointment wraid be wa confurmuance ohaecasl.p provigods of are : ‘ie Creu Service Rulea ani (2) appropriation acts, wth ter C:vd Service Act, oppiscable Civil Service Rules arul Bagulattiungs ated Bova G1 coustiutes on affitavit for both. purposes” and is acceptable pron af’ eriveeuship sistas ie the absence of confhcting cyicence, In doubtful cases the . asts <4 Congres perusining to 2: fiment : Then tare ahead Le checked holding of office, pension, suitaiaticy ta eon aopanaimentshould net be consummated unt clearance has been accused fran FL fect wel soy record of cece, discharge of arrest, nad gerticularly for the the cernfying offices of iba Civul Seryne Comumisemma, . ‘ : 3 teowsicg: N 41} idesststy of appointes. —The appointes’s Sanature and handariting ‘ast .. (4) Members of Famile.—Gevtion 9 af the Civll Seevire Act provides that rs fa cmt cram ent witie Lhe apndinminas ambien enses pritiaah peyton The  ebcneser there are already two or more membere of s family serving ander : giyeead eppesrence moy Le checked against the medical orrufcsté., The  prchgrianal or permanent appmatment in the competitive aivae, no ober s aprcantce may aleo be quraticned va his peretal history for egretmen: with tue ember of each faimdy ie cligade for probational ue prrmaneat eppoentinent im PRETO OF HeTaeOte, abe competitive servere, The appomtnients of persons eautied to veteran A (3) Age —i! Getta age hents have been estabilehed for the poasstion, it shoukl Reece are fot oubsect to Ghia requirement, The merpberg-uf-famuly previsiont : he detxrmumed that apoheant fs mot outade the age range for appointment, Ass oot apply to lempurary appouenisnte Chmdefal cases ay be ceded co * Verd sack Getermunstien fe made, the appedatenes’ aay not be camsumemated, the appruprate office of the (7) Sesweew Commuesnon fos dhecseton. t . H - . ore, 7 °. 6. Serrds 2RAN) RCE TES SFIS 2-8 — . Hy
ener . ‘ NO Ue nee wind teeta dow eee Pyrenees are, oe RL RR at he dh aOR ODOR NASD ER NEED OOM, URE So et rn CENTRAL INTELLIGENCE AGENCY \ ' g430@ STREET.NW. \ WASHINGTON 25, D. C. \ . fate 24 July 1960 ‘1. Thie fe to notify you that the United States Covernnent as repre- sented by the Central Intelligence Agency, has secepted your. employment effective, 24 July 195. ; Position: Intelligence Officer 63-9 Base Salary: _G8-9,, $4600.00 per annum > 2.- You will ber as. Entitled to annual and sick leave in accordance vith Civil Service Commission rules and regulations, or. such other provisions of law, or regulations as may be established im dieu thereof. - >. Reimbursed for travel expenses in accordance with CIA Regue . lationé or Standardized Covérnmeiit Travel Regulations, ad amended. sc. If stationed outside continental United States, granted such monetary allowances as are preacribed by CIA Regulations. 3. Employment ie conditioned upon. satiafactory completion of thé training courses prescribed by CIA and satisfactory performance of duty for a total period of six months from date of employzent. In the event either training or performance of duty: je deémed unsatisfactory. by CTA, you will be offered other types of employment if avaliable, or your emn- ployment will be terminated. — 4, Your appointment is for such time as your services may be re- quired and funds are available for the work of CIA. Notice of termination will be given you by procedure eimilar to that vrovided by Civil Service rulea and regulations, ‘ . ULTICIEL AUTHOFIZED tS BIgn Letters of appointment I accept. the above agreement as a condi- woo | ott ae : Form Ss. June 2958 oie ~105
14-00000 Foe me. , oO : . — oe - ree v9.49 ore . . TEST RECORD. . a ; : ae ° z ‘ ‘ SAL OGRAPH A. EVALUATION OF TEST RESULTS : of On basis of theet ‘scores, subject ' appeara well qualified.for Pe} Intellie, ganes Officer utilising academie baok= © ground and pe tinent experience, Good knowledge of French indicated by reading test. : Bl re “4 It 4 - . + | , i ea voreroceaectn iemcemseriscoresenen Pane. ? ie sey ee og, t i * @. PERSONAL DATA ~ AGE SEX STATUS _ EDUCATION : ‘ MALE FEMALE Nie CMPi, ELEM. H.SCH. COLLEGE BEGREE agar: . é m © cm [a] om co : C. Raw TEST DATA ; ot . . Loe , Raw PERCEN- 2 OaTE TYPENG SHORTHAND TYPE OF TEST scont TILE : GROSS NET CRRORS : 2 3 TOT, TiME aREA INFO LAFFAIRG) AREA INFO. (PEOPLES SSHNETT LIGRARY INFO , TYPE OF “TEST RAW . PERCEA= - TYPE OF TEST Raw  PERCENe SLA CUASSIEs Vt SCORE THLE SCORE THE C28, AND EFF. OF EXP, 2Su TESt: FORM GIRECTIONS a 257 a TECHNICAL REROUNG ; Sgn nen conan ef rR re re aman fate emneres LE BATSON-GLASER: : orReeTions : Barr Cre area ~~ > " — ras - : SPELLING . . tesT , : | peuea’ 20 ed Feet ep inne nrntree gemennen arene oeeeerem ener aes a fe GEXESALE ZATIONS an 3 Fee SENTENCES - reece ti 1 WANFERENCES OO Rp &5- Benen ERICA ABs . ich A a H NSC. ARGUMENTS —~39 59 : __ABSTR. PEAS. a RECOG. ASSUMPTLORS - 25 : * SPACE POLS” nT Ee {sie teas neas. ae VEADLREAS. [SPANISH AL . CONSTSTEWCE | ams oo. ~ 1S 6.5 eee cea nnrninenaatie raminaenfaenanetnnfpamien iments “TAPP ST LOG? REDS. of ree emer a ces em ' — nee eaten amma ail — een te see nents neanenatneerseannmeinereateetate oe ad t pecmermecas, Pcmare same ow orth ap ee os eae oma ma = wr ne ee bee ete: ee a ee OU Se ‘ . stash
14-00000 EDN Mee D cents fs sommes sgn Ab ES i Meise aca gene REPOR" OF PHYSICAL. QUAL LELCATIONS* OR puTy--- - ne nds — July. 19D__ . WAS GIVEN A PHYSICAL EXAMINATION ON THIS DATE ANO FOUND QUALIFIED FOR : | ~]uimiteo uty OVERSEAS {J outy tN usa omy [x aes DUTY OVERSEAS PROFILE “SERIAL (FOR ARMY EM ONLY} DEFECTS NOTED: fee ies 37088 Pe . . . . ed Ra reegemnrrercnrnnrraansrai are sere SH SOAS ON HOEASINOS core: OO RR RES TOES PN ALR appear ASAE, % ‘ . Toe . - | . REPOF i PHYSICAL QUALIF CATON “OR our’ 1 i oo 686 ~ - 2 a ne Tl ee, - . a ~ - ~ “ oO ot Jd et WAS. GIVEN A PHYS{CAL ; { EXAMINATION ON THIS OATE AND FOUND QUALIFIED FOR | a : eas , i ‘ram uty overseas [| LiMiTED DUTY OVERSEAS [_._]oury IN usA omy | PROFILE SERIAL (FOR ARMY EM ONLY) COC ECE CE CECT : DEFECTS NOTED: , ; ‘ : ; a ; SR et Z Rone ee ; ; . ; bee tee 37-98 L ne ee : an
14-00000 (wth FILEEO Un) ee name (Cagterinsteicoie) \ emprovec wo. {2. , ees Conan SE Or ewete LANGUAGE DATA AFTER FEST orrice On OLVESEON Q™ ideas | * interncotaTe S.lent 4 > Hien ™ ZLeMtNTany N @ nateve TEST RATINGS 2. i2. stcnaTuRE 13.00 wueetr | 12622 _- 74 FETE PREVIOU ‘ Gaow 4 “e OPT : (areey 1273 tone esas) SECRET [roves ee ae -. Sree eae eae ate a wenn Tre tet sneer me = ~ ioemeememmans a . mn t j ° epee, i. wee Sa Sean er Fy totem wee te a ee ae gray come pens tg “ tone SECRET f > C hn ened When Filled In} 4, COMPONENT H 3: aRace KE: Lis ae tte nroernnat—ereer cir ew ceeteymtnne stereo *{ 8. cong (85.37) B. BAIR OF VEST. Be.5 um 1s, iso. mids THEE BOQHES READING 134) APEANING (339) UNORRSPTANOING (SAT « watriva (59) | PRONUNCIATION (26) z I I Hd n 14, LCERTIFY. THIS EMPLOYEE FOR AWARD a iGHATURE 2.25 xO, §. PERSONNEL GERIAL MO, CT-OF 15604: 606 @. DATS OF Binte Nov. ll, 1925 10. ANNIVERDANY DATE 120-391 dune 17, 2Q57 13, Euomiuiyy (39) AWaNpAgLe a 16. AMOUNT OF AWARD 18, FEDERAL TAX \X_ DEDUCTION 2Q, CHANGE ALLOTRERY Na, zoe Bic STATE/DC TAX DEDUCTION _ aa. GmPoven PATRORL ‘Pe . NET AMOUNT OF AWARD ! : _ i 24. ALLOTUINT OF asqENMENT 29. CHECK NO. _ SECRET SSS toan MRO COPY AS MNOS seratanans lot eatthon Babe mane Met gd +e Beat wal nab ene oe Bik eso stedinacth denen 23. FORWARD CHKER YO a Sg $872 vase PREvioUS apinoNs Bite te meee * gue
14-00000 “ ° . fe a _f [Whee filed ts f |. PaRmopieds, seeing, cas. ? § Bd L6oh 5 LANGUAGE PROFICIENCY AND AWARDS DATA ry Caro aly #. iB to, @. Sara oF BIRT Tove V2, bo 76. annivaneany oata 128.33 4B. peacee ¢ 7.88) 9. tienen ~ Po ote: (8P FFF DF -18 OF 180% | ureinn ey June 17 tune 27 142 {Teer evnroee | OR. aan penne wT EBL BCOMES | enna nen a EE IOIBUITY BOP awaeg RRADING THA! wriring ease PRONUNCIATION €3@){ opvanime (BP) | UNOaastasmpine 13S) AWanvABLe fuer a = ‘ os » % 7 a AMADA RE ET Brn ‘ : i . A nce cheall = | {| 5 TUPE OF AWARD enti ane in ctnfinctnteeaninan ~~~ — -roneteneeiememcmmciommtataaenes |e = cnn | Bionatune $7, 1 CONTIPY THAT. FUNDS APE AV AtLAB, OBLIGATION REF, HO. GRATE 16 AMOUNT OF AWARD 18, FEDERAL TAX DEDUCTION 2G. CisMos ALAa mae? BO. B2, BUPLETVER PAYROLA. 90, - 19, STATE/DC TAX DEDUCTION 21, NET AMOUNT OF AWARD #3. Ponwand Cuaen tC 34, ALLorMant oF AgBtonmasy ~ “SECRET "yo-asy MRO COPY COR! 14879 use previous seiTrene C . - f i 4.88 : . en Se A ae Oe toe mad wattiaetie! nitthetnuatewth ota te REEL ATR RR, TERE oe nt ten, ate mR Nae © nme mney chant at ek ss So pian mieten ai : . ope SECRET ” ona When Filled‘In) cy — 2.2 0NO.. f. PRRDONMRE GERIAL pee, 8-8) LANGUAGE PROFICIENCY 2Y AND AWARDS DATA. OGZT G. DATE OF BittTH. Move. Lb, 39S "FG. ANAIWERBARY OATE 148-5? aturets Ty Lie mente met me 13 Stiaisigity (3G) BGs 4 3B. NAME ¢7-24) A, eae courouant | i | Be %, cage (83-87) @, DATE OF TEST 7, BAMGUAGE mys cune } > ge 4 Gepren Af eerpuseoer TEST BCORES cra a f mcrae: MeADING C341) wrerine (3a PROMUMCIATION 1 365 [eine 7375 UNDENSYANDING (3G) ne cra Mohs dolis 2) Tivemeeceee eaten stweey eramttteeaa tem ietreathbetteatnte mmo. entoaninmeney weee sv tenet RIES BigwaTune 16. AMOUNT OF AWARD 17d CENTIOY THAT FUNDS APE AyAILABLE OBLIGATION HEP, HO, SIGHATUNE 18, FEDERAL TAX DEDUCTION-- - - 4 (9, STATE/OC TAX DEDUCTION 22 EMPLOYER PAYROLL 10, . NET AMOUNT OF AWARD 2S. @anwaee ontcKn FO 24. ALLOTMENT OF ABGIGNMENT | 2&. cutca no, - SECRET saass MRO COPY se 1273 Use raeviove EITCNs oe] BO, CHANGE ALLOTMRSE BED, | | DATE . ee ae
: 1 @ H hn ee Stet em meen a EE kena 2S ated Ato tat wan Hae . os "secret jp th A. gBhen Filled np _ PERFODIC SUPPLEMENT’ 2 wt LT PERSOMAL MISTORY STATEMENT ” Swe, erg Care aa July 19°7 INSTRUCT ICS tee Tase faem provides ‘the meane whereby pose offacsad pecsenne! records wili be hepe current Eves theugh df dupiie sfoe f safeeretion pow have furniehed previoucip, é¢ et8 Be necwenary foe you fo complete Sectayet £ tAtrevgh UL de th entarety. You need complete. Sortions Vit therowgh ALTE onty of those hos feoon & change aitce evw entered on duty wh dh the ergendeetion or sf you belsove the stem requires mure complete coverage than you have previeusls tepartiad, SECTICn ¢ GCALRAL a TERRTTORT T POUIEEDION ON COUNTRY TR Gal aw NOU WON EL SIM AEETDT OE Virginia oon PEASOR sd 8E HOTU LED "18 CASE OF EMERGENCY ¢) PREFERABLY SEBIOtHG 1% U; 8. ry}* tMOTCATE WAME OF PERM OR-EMPACYER, 87 APPLICABLE. Yr WOSINESS TEREPMONE ERTENSION- V weemwether, Father) way aGO 8€ WOTLETES. tf SUCH MOTEFSCATION B. BTATE, ie: * a 4S NOE DESIRABLE BECAUSE OF HLAL IN OF CINCH REABONS, PLEASE 30 STATE. NA MARITAL STATUS @ [section 141 Nl : Loe FUaANT SH OATE, PLACE AND REASON POR ALL SLPARATIONS, OIVONCRS OR ANNUL MENTS 1 mnt a PTY EPO cE EPEC ELFEN PE treme SPOUSE: EF you have heen marciad worse than ance, including annulmants, wae # separate aheet far former wife oF Gf marriage ba contemplated, peavide aawe data for Sidnes. rhussand giving data below for ald peaviaus mareioges, erry far dens those) a, NAME tfie pes LB isielley a: DATE OF MARHTAGE B PLACE OF MARATAGE (CfTy, State, COURT Ty Vienna, austria . Bi ABO LACS coal NO tncmdit bet bccubedel Meta tte, Couatey) 7. LEVENG @. GAFR OF GEATU Cause OF OEATH Mirae | [xe iA . — ere rate ‘ fO. CURRENT ADDRESS (Give fast address, gf docearedy « ‘ Ate gf ACQUIRED (es 8o eS, STAZe, QUUREFyD ACQUERED bi. Wieae Vienna, Austria : ee arg fh SaaS SESE TRAE SRE fso deve foracr empiover, of ad spause £6 deceased or HS. CUTEZeNSHip (Country ) te." GATE te, SELES RT AR TVET PRESTAT FUP TOT ER uneaployed, Laat #0 eaployera; NA . n ‘ . Housewife : _ re oer TO. AMPLOVER"S OR GUSINESS ADLRESS (NO., Stevet, Crtp, State, Countey) RA SECTION Et CONTIAUED TO PAGE 2 Foam WEXb USE PaErviqus LOITEOuS, SECRET . . a : t ; 4:57
Fon om anf TH. GATES OF MIL ETANY SERVICE OF SPOUSE (From. NA” BRANCH OF SLAVICE ; WA BETHILG OF Olaiae GOvLANMENT StEVICE, ae. u.t. aa LoLeniB Beinn Beate R bed 88... SECTION Ft1 and For OF POSE ILA SCRE] Phen “oatinylD FON PAGE A Felted fn J BY MONTH any VE aw 22 COUNTRY wife BIC WIL ETARY SERVICE APS ILIATED « Y. PULL peace Be CHTEZ fe SPECIAL ef Section ¥ erence ae ee A RTE EI 1, AHL YOU ENTIMFLY DEER YOLHT ON YOUR Salary? ANGREQED “VES.” Give COMPLETE DETAILS ON A SEPARATE FImAxCraAL STATUS Ty Tres ye 2,00 ¥Ou HAVE aH FINANCIAL INTEREST SN, OR GFF ICV AL CORDECTION with, “ONUE, COMFPLRATIONS OR GuUsINESSES OF 4% OF WETH ULS. EGRPORATIONS UR GUSINL ESET HAVING SUAS AS TIAL FOR FGM SAL ET AMD ATTACH “ IN FEREAPS? PRCGeE HGF (ll ces (J «0 th & TEALED ERVELOPE . ng SRDICAPED GY PRECEDING if YOU Have 2 TEKS, panes ae mee nenneereererremen eee 00 YOU RECEIVE AN ANNUITY FROU THE UNITED GTATES C® CISTRFCT OF COLUMBIA GUVERNMENT UNCER ANY RETIQEMENT ACT, PENSION: OR COMPEAGATION- FOR MIR (TARY: OR WAVAL SERVICE? > Bac te vOu HAVE AbSeEaeo “VES” TO QUESTICN 3 ABOVE. Givk COMPLETE OL TAILS. . MA 4 WITHOUT MEFEPFNCE TG YOUR SALARY, STATE OYHER SUCHE ES GF, RECURRENT ‘ ? 2 Ne, SECRET 2
- “~ _ SECRET we (Rom Balled tmy SECTION ¥ CONTINUED FROM PAGE 2 TMSPTTUT IONS etre weerese FOir meee atten EE ttc annniss (Cety, Seate. Country) att CUM ES Bata ine OF iMSTETUE ION hee Washington, DC. BABRAYUP TE YE Orve PaRTicuraRs, NA -?, HAVE YOU 2¥TG SLEW 1%, OR FETITIONTS FOR, @. 47 YOU WAVE ANSWZACO *VES* 1O QUEBTION 7 ABOVE, (MCLUDING COURT aANO DaTEES) a) SECTION ¥y a. Citizenpeie arquiReo BY + CHtca CRF outs isa OF CURRENT Ciitiengnie irene C7 Maen tage ame vreee (fpect ty y: HAVE YOU TANEN STEPH TO CHANEE YOUR, Give PARTICULARS | POEGENT CHTIZENSMIFT =] vey oie NA. INDICATE PREDENT STATUS OF VoUR AMPLECATION (Firat papers. efe.) 1F YOU WAVE APPLILO 7OR U.S, CITIZENSHIP, NA $e. @P SECTION ¥16 €oucation 4. cutee (Hb wine ne? btvek OF TOUCATION ATTAINED Peres team MTOM Fi HOOt BesouAtE ae Tao reane OF CoreEue ee GoaneE Boo atndot 6nagus re ve oaed ta Mi Geen pEGALe gta HHS, areo oare, ComPig tea . * (Specsty) eTUbY GEADENE eRactaye + NON Se mT IMA tT Paes Rie Yeoh ante aOR ke Oe COMMERCE AL ACMUBE “GHaDUATE aaa » #@Ustme ICCRTECTECECCACEA STC a Recere a EE EE en mermmnncenecrna OR UNIVERSE PY SstuDyY iv Subseed BATE? ATTENGED 2- NAME AND LOCATION OF COLLEGE OW UNI ¥ERSITY EAC bee ot stent ne FMT ees tates manana Spe Ae a ann ehaeae aPeCeat tiation OATES ALTONGED TOTAL HOURS STune GR HAME OF SCHOOL. MibiTARY fRAtNing (Full rine duty an spectrasizod achnela auch o8 Ordasnce, Tnretligenve, Communications, etc.) Dares ATTENDED YO Ta Rel ] te ee Fas é NAME OF SCHOOL STUDY OR SPEC EAL E2ATION Be OTHER EQGUCATOMAL TRAINING NUT UedtC aria ABOVE |
eet eee ® e SEchsOm Wine OST RILGO Boy 65 H2 Oh MECIONG OH COU TRIES OF we STulry GR woe BSS merey Giuem THA ORGAMES ATES 48 897 @t tyre Abe GF REGICH Se CoyRtay THPE OF SPRC HAL IZED BaOeL COGE YAgts, waagon Om GAPE ITECE. * VOU HAVE ANOR, UREA COL Uty FILAZIES, BAVA P OR “oatee oF REDtOENCE. fRaver, ete, GE GatwEO AD & AESULP OF RES OERCe, “¥PE OF SPRL TALI PEO ReCeLEeGE. > bm TRAVEL. OROUSTRIES, POLITICAL Peery ABOMLEOGE ACQEISED By ~ Ee Og & 3: WGICATE THe PYURPoSE OF wEEET, x $i “ce x Teawes Stupy x RESIDENCE OR TRAVEL FOR LACH OF THh REGIONS .OM COUNTRIES LESTER ABduE Residence with fently in 208 83 graduate study end tourist travel in other’ arcas, 1987-"O. 2 BORK AGS t Gre LISf stio# aBY FOE SE REGIONS On counTare’s GP aHieH YOU HAVE GAINZO weigeL eoGE ag a RESULT. OF ORGANIZATION ASSicamtny Ae Tawsts- . - = KNOL FOOT aca ret BY, . . . . . Oates OF - HAME Of REGIO® G8 CocuTaY TYPE OF SPECIALEZED KHOBLEDGE RESEOEMCE. HOOTS FIGK TRAth : a TRAVEL, BTC. - ASSIGHMEAT] ASSIGNMENT) ING ECCVIGH ix TYPTHG RRO STERDGRAPHTC SRTLUS $- tring (8.P.O. J pe Bete FAtn ol #.PH. ) ; 2. SMORYMAND SYSTEM USLO > CHECK (X) APPROPRIATE UTEM LO 4 . : ‘ [ease SPE LU eR TIRG arenatyrd [omer «Speelfyy: Ae WAGICRTE GIAE® GstieltS MACHINES wi Te WHICH TOU mAvE HAG GPLRATING LXPENTENCE UR TRAINING (Comptomoter, tHiaoos heaph, Cash Fuash, city Rone SECTION X + SPEC} AL AL QUALIFICATIONS . f. LEST ML AGREES SOS TFLETS FY GREEN YOU ARE ners CH WAVE ACHIVEGY PAHTICIPATED. INDICATE YOUR PROFICIENCY in BAO per ta (ents, golf (falr), swimaing (goed), Chosu (fair), skiing (fair hunvicg €2eirj, Cloning (fair) — mat a” oh en nn e - fe AMDECATE het SPECS SR DeBLUF CATIONS, RESULTING FROM ESPERIENCE OR TRAINING, WHICH MIGHT FIT yOu FOR & PAR TECULAR i x PCRITICN OG TwRE OF weohe ' . _ ~ -- 7s, ' _ - _ a : a Be EXCLU GIAG Kaul FwEST BETES $4 SEGTIGN HK, LIGT ANY SPECHEL SKILLS YOU PUSSESS HELATING TO OfMtd EQUIPMENT OR MA. 5 CHIYES StH £5 OF Sos TIoe OF SH IRTHAVE RADIO, MULTILETH, TURRET CATHE, SCHEMYTEFIC AND PROFESSIONAL DEVICES, ETC, None . ~ ‘ ens ~ erent ens eae _ . a IF VOU APE & Lethe Sts Sk ChYTIF ILD MEMBFR GF Amy FRACE Ge PROFEsaion (Pilut, Electrician, Radia Oparatar. Teacher, Eavryes, CPA, 2 tf FockeFesom, e8e.3, thal GATE THe wie GF LICENSE GA CLORTIFFESTZ, MAME OF FTITInS STATE, ANS REGISTHS SEE O, FF eZ iRs. : . . lic By FIRST Litknne va “Ess FITATE (Year of jasue) Ts. SATEST LICENSE O8 CERTHFIGATE (Year of igeue) ° @ . : SECRET :* ' . a te teeny $ :
Wy, erent tee oe Treat mek ete Som B90 ay sk onto we tne ates opalmeriet Hane eetenn mepene, se nye ren os : . oN SECRET “= . (hen Filled tn) StcTion-& Com fiadel Faves Maks & Rist ant SiGguifr ican? PURLI SNAP wMAaTTHEALS OF gHICH VOU ARE THe Ay trom “(oa nat awhas@ topies unless requested). acdontific artselen eneral gntereat subs WEPACATE TETRE, PUBLICATION DATE, AND TREE OF @RI TING { Yore fas téon, pects tevele, shock sicrsee, ele.) . publlis shed Thturnational Protection of Mational Minoplties, 1950 (book written/as doctoral 5 Rion TWOTCATE ANY DEVICES wHIGH YOU HAVE BNDENTEO AND STATE WHETHER OF HOT thhv ARF PATENTED a. None. . - D. LYST ANY PUBLIC SPEARING AND PUSLIC RELATIONS ERPERTENCE , None. fe aniCH YOu ARE #08 GA BEE FORMERLY & 10. LEST ANY PROFESSIOWAL, ACADEMIC OR HONORARY ASSOCIATIONS OR SOCHETIES MEMBER, LUST ACADEMIC HONORS YOU HAVE RECEIVED. , None. * SECTION Rt ORGAN! ZATION WORK EXPERIENCE - Sine LAST COMPLETION OF al PERSONNEL QUALIFICATIONS QUESTIONNAIRE 7. MCLUBI¥E DATES (frod- and Te) ‘2. GRADE] S. OFFICE/DIVISION/ BRANCH OF ASSIGNMENT J 1960-June 1951. _| GS-9 [Advisory Council and FDM German and Sustriar 4. MG. OF EMPLOYEES UNDER VOUR DEMECT |S. OFFECUAL POSITION TITLE : ‘ “ee SUP ERY E8108 re) ; ; / @ . i] lg. GESCRIPTION OF DUTIES desk case officer and undergoing training wane - |. tncuvsive oaves (Peon vend Tas) wp. GRADE 3. OFFICE/OIWA SION/ORANGH OF ASSIGNMENT (July 1951 to September 1955, | GS-12 "EDM. ar and EE Division, Austrian Station ORFICEAL POSITION TETLE Case Off cer and Chier, CE Austria 4 NO. Of EMPLOYTES UNDER YOUR OFRECT S. SUPERVISION eS 2} @. OFSCRIP TION OF BUTEES we . Snataamnnnt dcetreareed {ceeonsanmsanennarsraresnurresesconcensnspeamacsnaeeepreenacreeenetomen tat : fe. DESCRIPTION OF DUTIES p H | +; INCLUSIVE DATES (Frome and Tos} carer OFFICE/OLVESION/ BR ARCH OF ASSIGNMENT S$. OFFECTAL POSETION, fame’ 4. nO. OF ENTLOYEES UNDEA YOUR DIRECT SurERVISI gH 6. RESCRIPTLON OF NUTES Ff - t yt - “4 i fee peers ceremony nm imma sean en INCLUSIVE DATES ( Frome nad Toe > ia. NO. OF EMPLOYEES UNDER YOUR OLRECT | 5. s| SUPERVISION pom meen nrg 2+ GRADE + OFFICE/DIVESTON/ BRANCH OF ASSIGNMENT comond ar wn nee tence ne ne pee ee one etn OFFICTAL POSITION TATLE sf act. &. DESCREPTION OF BUTLES (Use additional pages sf raquered) _ SECRET § —_——
f : . ¥ SECRET , - Chom Fisted fay - @ | SECTION Aas . CHILDREN AnD OTHER DEPEADEDTS ca @ t. mln Bee OF Cool Oade (iieteding stepchildes a | 2. wYywere OF Yrnge orermog ts SPT Patina apowse, and sdopiod thiideon) wun ane Unwannieo, 1 patente, tfepparenta, ater, eee or i 4) DEP EYL Of YOU FOR at LEAST 508 surteavinen OF 45€, AWD AME NOT SELF | THEIR “SUPPORT, OF, CHILOMELN OVER EE YEARS >] 9 3. PROVIDE THE FOLLOGING (@FOmMATION FOR ALL CHILORTY AND GEPENDENTS  ~  - ~ ; * 5 H j Cote sdagn de ADORESS i i t | | i : i ! , j TADDITIONAL COuMEMT Ano/oR COMSIGUATION OF PRECEDING F TEMS . . : | | : | - - ee mee - -4 i = 5 | : | | | : . i H i | i H i | i : i i i { i i } t i i 3 j ; : $ 5 ‘ . ‘ aw oe 7 7 7 a = = 1 ‘ ~ — — 7 : ~ 7 * - . . . * e . . DATE COMPLETED j terarene OF EMPLOVEE ? . " be : SECRET ‘ Nene” 6 . an {
14-00000 - SECRET “4 * (Phen Febled Par , LANGUAGE DATA RECORD PART §“QERERAL - Be Mame (Lest-sFirete@iddie ) Of piate $28 30) Md Fe tTanaets Sate 2a 39? Fone page wean . - 1 Mave &O PROF ICI ENeY fuve Ads ma iM woncion tan quace” PART LI-LANQUAGE ELEMERTS, > ree Ae Reading (40) OF & GENERAL NATURE OM IN FEELDS fo AM FAMILIAR GITH. USING THE DICTIONARY oe gto tee abe FH Se MH UGAy READ TEXTS OF ANY QIFFiCULTY, CMRY RARELY. “a GAM READ TEXTS OF MOST. GRADES OF ‘DEFFECULTY, Or a GENERAL mature GR GN FIELOS § AM FAUILIAM BIT, usina Tor€- BVCTIONARY OCCASIONALLY, i GAM READ TEXTS oF AVERAGE DIFFICULTY (newspapers, feference waterials, @fe.), USING THe GICTIONARY PRE QUENTLYS "77 . . Sue A9 BTATER BIGHT, NEWSPAPER HEADLINES, E7C., USING THE DICT OM ANY FREQUENTLY. & CAN -REAG QIMPLE TEXTS, 3. 8 WAVE NO REAGING AGILGETY tm THE LANGUAGE. . . TE ate Oma ge Bh meee SECTiCa B. Writing (41) CAN WRETE PERSOWAL LETTERS ano SIMILAR MATERIAL WETH COMPLETE SUCCESS WETHOUT USING THE ORCTIONARY. t ¢an GRETE FACTUAL MARDATH YE ANG ECAPOSIVONY MATERIAL WHITH REASONABLE CLARITY, WITH VERY FEW GaAMWATICAL FARORG, 1% MATEWE STYLE, UGING THE OSCTIONARY ONLY RARELY, wd . r wtin COMPLETE SUCCESS. USEING Trek DPCRSONARY ONLY 2 CAN BRUTE PEA KOWAL LETTERS AND SIMILAR SIMPLE SATER EAL Gite FEW CRAMMATIC AL 2. FARECY. of CAM WALTE FACTUAL NARRATIVE AHO FRPOSTTORY MATER(AL @1TH AFASONABLE CLanETyY, ERIKS, OUT Im A ATYLE OHECH MAY NOT HE NATIVE, USING THE BETTEONAGY OCCASIONALLY, ee ae Ene Sanne ew eevee “ ‘ + o « - fi YT CAN WRITE PERSONAL LETTERS AND Simttam SIMPLE. MATERTAL, WETH REASONABLE SUCCESS 3. BLP WET OCCASIONAL WINGR GRAMMATICAL ERRORS AND th Gaviousey FORRIGN, AMKWARD STYLE, UAING SCCAREONALEY. 1% CONVEYING MY MEANING, THE OIATIONARY pesmi EE PEE As EU terse nn neptanredaeregeeewete terest wei + stin @LASONAHLA SUCCESS b4 CONVErING UY MEANING, USING THE OICTiGtase THRGUTRILY. 2 PRAT one ee te ate fg) i CAN BRETE PEASOWAL LEYTERS AND SIMILAR SIMPLE MATERIAL, a po BUT WITM MANY GRAMMATICAL ERROAS AND IN A VElir FOREIGH, AwasARD STYLE, oman ca antennae taetnnan agente tte SB. & CANNOT @RITE fe THE LANGUAGE. ‘ : section j "Pronunciation 4D eee ne wo BBs SY _PROMYNCHATION 13 GATIVE. ee . . : : — ! " ee -" 3 . IN MY PRONUNCEATION THEY HAVE AQ DIFFICULTY UNDE RSTARGING WE. 2. WHILE NAVEVES CAS DETECT an ACCENT 3. WY PRORUNCEATIC’ £8 OBVICUSLY FORLIGN, BUT OfLY AAAELY CAUSLG DEFERPCILTY FORD HATEVES TO UnSEGSTANG. pot tan ee AL ange et pen . . ( *} WY PRONUNCEATIO’N 15 GECASTONALLY OVFFICULT (GR NATIVES TO amObes tana, : RB. 2b SAVE NO SKILL $Y PRONUNCIATION. ‘ . . CONTINUE ON REVERSE ‘SIDE ee ey UNG . SECRET : ¢asagh rae u fe
he, Confinyaticn of PART HI-LaRGuaGE ELEMERTS =~ . Section 0. Speaking (43) # PPCAR FLUEMTRY AND ACCURATELY 1% ALR PRACTICAL AND sccm SUTVATIONSS & CONVERSE FREELY AND EDT OMATEC ALLY arr wer srie Tarte’ weice § AM FAMILEBA, ‘ 2. $1 GPE aR FLUENTLY AMD ACCURATELY Ph NEARLY ALL PRACTICAL @&D SOCTAL SETUATICRS: F Cah COMREREE 8% WOST FITLOE Sita waite t AM FAMILAR AND § TMPLOV BOWE POFULER SOU IMGS, LETERARY QUATATICNS, AND COmMoy PaQUERSS. 1 GET ALOWG QUITE GCE #M BETUATIONS oF DAILY LIFE AND TAAVEL ANG Can CONDUCT BOUTINE BUSINEES te Paaticus 4@ FIsLOR 4.) ft MANAGE TO GET ALONG 6% Tee WHET Faewoy FETUATIONS OF CATLY LUPE AND Taavea, e . : t @ NAVE MO ABILOTY TO USE THE LANGUAGE tM ANY OF THE ABOVE MESPEC TS. StCTiIOn E. Understanding (44) BOTH FACE TOORACE ANO ON THE TELEPRONED § UNOEOOT ABO 4nB LECTURES, be 6 UNDERSTAND MON’ TECHNICAL CONVERSATION GN. ALL SUGIECTS. a meaRiy SYERVINING 4 HEAR OW IME RADIO AND-AT THe WOWIES, PLAYS, BOTH FARCE TE FACE ANG ON Tot TELEPHONE! § PLAVS, AMD RECTURER, INCLUDING MISE FORTY AND - i UNDE AS TANG WON? TECHMICAL CONVEFREATION O8 REARLY ALL sugsicrs, 2. UNDERSTAND MOST OF WHAT 4 HEAR ON THE RADIO AND AT THE wOwles, Fund, 3; P UNOEASTAND NEARLY ALL CONVEASATIQN™ ON TOPICS OF DAILY LEFE ANG TRAVER, BOTH FACE: TO;FACE AnD ON THE TELE- * PHONE? | UNDERSTAND MUCH OF WHAT 1 HEAR OW THE MADIO, AND AT THE MOVIES, PLAVS, ANG LECTURES. 1 WEAR ON THE RADIO ANO AT THE MOVITS, PLAVS, AND LECTURES. @) 6 UNO ASTANG THE SIMPLEST CONVERSATION, BOTH Faces TO°FACE AND ON THE TELEPMORE’ | UNDERSTAND Bows OF wwal ~ a g i AM MOT ABLE TO UNDERSTANG THe SPOKEN LANGUAGE. BEFORE CONTIBUING ~ CHECK PANT 11 TO ERSURE THAY YOU HAVE CERCLEO ONE RUMBER PER SECTION. PART IT IEXPERTENCE AS TRANSLATOR OR INTERPRETER (45) : f. t WAVE HAD EXPFRIENCE ABD A TRANALATOR. . 1 53 2. b HAVE HAD EXPERIENCE AS AN INTERPRETER, a 3. BOTs OF THE ABOVE ATATEMENTS APSLY. . a H . ¥ — . : < erara * MONE GF THE ADGVE STATEMENTS APPLY, - : . . . Py ’ . ; PART IV-CERTIFICAT I OM 3 ‘ : Ea = Es fe 7 £ t a ’ : 2 5 2 + . 1 CERTIFY THAT THE INFORMATION GIVEN ABOVE 35 TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE anh aELteEr. ‘ THIS CERTIFICATION CONSTITUTES NY APPLICATIQN FOR A MAINTENANCE RAO PROVIDES | aw ELIGIBLE LASTS THA TERME OF : REGULATION HO. EEO ENS. PAR, ICS). 1 UNOYASTAND THAT f MUST, PASS BH OAUEGTIVE LANGUAGE -PaAOFicegecy: tes? arroge 1 . cen ES -  aeCOME ELIGt MLE FOR AT AWARG, AND THAT PRATSPECTIVE OF THE DATE OF TESTING, ANNEAL MAINTENANCE M4329 BELL BE ¢ CUMULATIYE Ad GF PME ANNIVERSARY CATE OF COMPLETING THIS FORM, : . . i “ :fgerenteerrenemeneeeterstestetirtrtet ates oo 3 DATE SIGNED Sttin 2 1 : iT Ntene . F . . q : i : i (46) — i - 2 J “- . Try > . . ee
a En rots kaye SEMAN Locate Pewee nem a Tne ERM ETHETEEY HP eeMnOnenEWhe ean AMDAEY EE Sum vee ae = a: iad SECRET: om Kibfed Fay LANGUAGE DATA RECORD PART t~GEneeay $. mawe Cheat Firatetsddie) $724) 2. Cate OF Brats fF oe wee 1 RAVE BO PROCIESEOTY im ahY FOREION Cameeed * PART Limwanduase GLentaTs ‘ Secrica A. ) # CA% READ TRATS OF ANY DITKSCULTV, GY A Sema ea OMiy GAMELY, z. 1 CAN ACAD TEXTS OF MOBT GRADES OF OFFHICULTY, “MIC TIONARY OCCASIONALLY. . § CAN BERD TEXTS OF AVERAGE DIFFICULTY (Hews pap 3. pagoutwrny. . Reaties (40) WARE OR IM PETLOS §€ AM FAMILIAR BITH. USEND Tad BFC Kisheee | Of A GENERAL NATURE OF 1% srenos £ AM FAMILTaR BF fe, ‘utsas fas J ora, reference materials, ofe.), USING THE DICTIONARY i Gale ACAD SIMPLE TEXTE, BUCH AT STRETT SIGHS, NEWSPAPER MEADLINGS, ETC., USING THE DICTIONARY PAT gure tar, * AL @LTM COMPLETE SUCCESS WEPMOUT USING THE DCP OVaAae. A Tey WETr SEASONABLE CLARITY, WiTh VERY FEW GRAMMATICAL ZaaeseS, 0 MATERIAL, BETH REASONABLE SUCCESS FN CONVEYING MY wesases, O Fe OBVIOUSLY FOREIGN, ABHHARO STYLE, usthe Wat HCL isss Ke r S$. § HAVE MO READENG ADILETY I Fe Lawhuace, SecTiow &. Writing (41) F CON GRETA PERIOMAL LETIERS AO SiwiLaw MATE 2. WRETE RACTUAL NARRATIVE “AND EXP GESTOGe MATER AL . WATOWE SYVLE. USING TH DICTIGHARY DaLy AaARELY, 1 CAN GRETE PERSONAL LETTERS AND SIMILAR GIMPLE MATE WAAL atin CUMPLET® SUCCESS. USING Inf DIDTIOWARY Gate RARELY. |b CAN BHETE FACTUAL WARGATIGE AHD FRPOSITORY WATLATAL WET HEASONABLE CLAQLIV, Abin Fhe Chasse ge aL ERRORS, BUT IN A STYLE WHICH MAT WOT GE ATIVE, USING THE DICTIONARY OCCASIONALLY, 1 CAN BALTE PEASONAL LEFTERT sno SimsL ae SEMPLE 3 GUT WEPH OCCASIONAL MINOR CRAUMATICAL LERORS an GECASPUNALEY. @ CAm BREVE PERSONAL LEPTERS ANH Tie ee 7 — IN THE LANGUAGE, . 004 SANNOY B4ETE SECTioOn €. 4 1. MY PRONUNCIATION 13 RAaTEVE, ear te FRAP A EEF A A 4 SEMPLE MAIC AEA, BUT Git MANY GRAMMATICAL ERROGS 495 EM A VERY FOREIGN, AENGARD STYLE. UGENG Fr OCT EGmaARY eos IN CONVEY INS WY Ese soe, FUTQUENTLY. Stl REASONAMLE Success rt TR er APE te e ear tr NEP Pronunciation (42) DENG we, FL Re WD. UBS 2 Fk oF MY PRONUNCIAT ICN nrenee—teentinennerenenpe rt annie gr AeA cr aad rane arte ALE hp ey tneterrent ese meeetyn ster eet Hinenemntnereemehtremrsnrineceat Ai $& GOWEOUSLY FOTE1G%, Bul GRLY BASIL y TALSES GETP ECOL Py FOR NATIVES 10 UNSlestawd, CONTINUE Gh REVERSE SIDE SECRET tO- ess fae ae emt ve 2 om eee A ye neem eet arene eae se
14-00000 1 SP Arata en crnedesinem ae lkatinanteh smth amie BIBAD Ref. May Bie ep RMAF ethene * . CONTINUATION 06 Pal? 1)- anGuact Crewents : Speeking (43) ¢ JPEAR FLUERTLY AMO BCCUMATERY FH SLL Baacticar Seo GOCTAL TETVATIONS? § CONVERSE FREELY ANS POTMMAPECAL EY a "UN ALA REPLOS @ttm unten § Aw PAM IL oe, - fm APAOLY ALL PRACTICAL amg gaCr aL Situatecuse @ Cam Comesase te VOR PeeLes $ SPTAR FLUENTIiY 440 aCQuPaToLY RTTAMARY QUGTATICNS, AND COmmey SacEseed, % “ETM Beles f am fAMIL Gee ANE 4 fF Coy SOWE POPULAR Sar IAGS, 1 GFT ALOMG UUETE BELL EN SETUATIONS GF OAELY RAPE AOD TAAvEL ASD CAG CONDUCT MOUTiNE GUSIVE ES IN FARTECULAR Fetes 4. 1 MANAGE 76 GET ALONG 1% THE BOT Common BETUATIOS OF GALAY KREG BNO PasveE, me tem ae 1 HAVE MO ABILETY TO ae tek LemGuaed Ih ANY OF THe SeovE RESPECTS. . st . * SECTION E. Unterstarsfing (44) — f UNDERSTAND WOM TECHMECAL CONVEOEATION O% ALL SUBIECTS, BOTH FACE 10> FACE AND OM THE TELEPMONE ¢ UNDE METANG “ HEARLY GVGRVIRING 1 HEAR OR TH @ADIG AND AT THE wOUTES, CLAYS, -aND KECTUAES. GOT races fee face aeO ON Tat TEL ePm OME: § @ UNDERSTAND Hone VECwM AC AL COW YERSAT IO OM EARLY A414 BUBITC TS, UNDERSTAND MOOT GF wAT Ln HEAR Of THE MADLO AMD AT Toh MOVEES, PLAYS, AND KLECTURES: INCL UO Ins erst JOntD. ant PuNs. . : a . - : 1 UMNOERSTAND EARLY ALL CONVEMSATIGN Om TOPICS OF DAILY LIFE AND TRAVEL, GOTH FACE TOCFACE AnD OY THE TELE PuOnMhs 1 UNDERSTAND MUCH OF BHAT § HEAR ON THE RADIO, AnO AT THE MOVIES, PLAYS, ANG LECTURES. 1 UNOLASTAND Tet siweuest COMVERSATEGH, BOM FACR< TOK ace aNd ov THE. TELEPHONES | UNOERETAND SOME OF WHAT f WEAR ON WHE RACIG AND AL foe? MOVIES, PLAYS, AWD EEK TUALS. . PART 1S I-EXPERIENCE AS TRANSLATOR 08 tMTERPRETER (85) 1 § HAVE HAD THPCRIENCE AS A TRANSLATOR. ste oe 2: GOTH GF THE ADOVE STATEMERTS APPLY, ; Ae NONE OF THE ABOVE STATEMENTS APPLY. PART AV-CERTI FICATION. . vais y 1 CRATIFY Tok THE INFORMATION GivEt AGOVE “PS PRUE BNO ACCURATE [0 Tk GLIT OF MY KMORLE OST ann SELTEF. FES CEATIFICATION CONSTETUIRS My SPPLICATION FOR & MAINTESANCE AMARD PROVIOLG $ AM ELIGEBLE UNOS? Tae TEAMS oF HEGULATION NO, 29°999. PAR, Clade f UNDE RSA Teal § wuST Pass an OBILE TE WE LANGUAGE PROFICEENSY TEST seroag t ! BLCOME ELIGIBLE FOR aN ABARD, AND THaT (eae dec rive OF IME OATE CF TESTING, ANNUAL MAINTENANCE BOAKOR BILE BE CUMULATIVE AS OF INE ANNIVERSARY GATE OF COMPLE Pind THIS FooM, . _ 2 DALE Stonia 17 Yteme (45 of 2 4 ° ant ae ene 2. @ AVE HAD SRPEREENCE AG AN fH TLEPRE TCH, - -
te sm ecuancgroume Setarntte nay naiivonentia satin 2s Lay ges aammatsin 4, rd, of se Tt AAA h an Sead mS manera Aetoiele oftub dared ned AETRATS LF @ Santbvhtn cain ase ev ten A tet ae } « {teat 6. wate pLoat-FiceeoViddie 3 cee ry . qate SECTION A. "T CAN MEAD TENTS OF ANY CIFEECUL TY, ts Jomiy Aaaeiv. i) 2. DICTIONARY OCCASIONALLY, t CAN MEAD TERTE or AVERAGE Cire icusry {mowspepere, <3 pee guEnTEY. - 4. of GAw afaD GIMPLE Tents, . a SECRET ° (Ghon Poised Fa “ LANGUAGE DATA RECORD PART (-Giatea, a. Date GF grote 49* ga} . OOaT’ Ss GATE Ba 388 June 47 IST] hes see pint H-tasouase Lodets Renting (49). SuCM ag fae? SIGHS, MEWTPAPLR we eOL 9OC 9, S. 8 WAVE NO READING ARILETY $1 THE LARGUAGE, SECTION 8. 4 Can WRITE PERSONAL LETTERS AWh SIME AR MATERIAL GF fo COMPLE TL SCCESS BETHOUE USsOd Fee WHETE FACTUAL NARRATED AND CHPGSITGRY MATER EAL with PLESONASLE CLARETY, Writing (41) MATEVE BIVEE. USING THE BEICTEGMsY GHLY RARELY, GARELY, | CAN BRITE FACTUAL HARA ERAOAS, BUY Ih A STYLE ehicw MAY HGF OF HATIVE, W919 ATIVE AnD CAPOLITOSe WATER AL CAN READ TEXTS OF MOST GRADES OF DIFFICULTY, OF # GiREOM SatueR oe roterence.antarsata, no Baten rere ote. py, £9 %- b98 $ MAYE BO POET EC isacy PORE IER 6 AH GYRE OF A GENERAL WATUSE Of 1 FFELOS § AM FAMILIAR 5TH, YOING Tek OSCTIDBARY im FEELOS F560 FRAIL IRD BIT, YEIEG THe USIeS fel CICTlossav €9C., USING Tee OFC TISHARY FOF Bree tiN, 4 PCT aD PR EP BC EE EERIE OP 1 CaN write PERSONAL LETTERS AND Sitlse FIMPLE MATT RIsL, MINOR GRAMMATICAL €#AGAS AND 6H OSFIOVTLY Foes iam, 3. BUT WET CCCASTONAL ‘OCCASIONALLY. g. | CAN WRETE PERSONAL LETTERS Ants "BUT LWETN MANY G@AWMATICAL ERRDiCS 3. 2 CANNOT WHITE FN Tod LanGuace, SECTION C. f. PMY PRONUNCTATION 99 NATIVE. | 2+ WHILE NATIVES CAN DETECT Aw aCciix seeneneare nvm tnntnanengatranvaientegnanea Arye steetanshtEvenee fg ie SSP APE Ae PEE TPCT eA TLE TEE 3. MY PRONUNCIATION 15 OAVIOUSLY FOREIGN, BUT ORLY MADELY COUEES GEFFICELTY FOR 4. wy PRININCE ATION PS GOCAPEON ELEY t BF MAW NO SKILL I PRONUMC LATION, fata eG, uu 1 FER 37 AML AD SIMPLE WATEFIOL, wife Of AToRAOLE SUCCE ST SnQ th A VERY FORELEG, ABN MABS Bl ent Prommcistion (42) erie snes eset nna AY A OEE To fM MY PROMUNC OAPI Se BIFFPCULT FOR MATINEE FO ustedes "ans. CORTINUE Of REVERSE Sine SECRET ith viRvy Faw t Cam WRETE PERSONAL LETTERG AND GiMILAR GhAPLE MATERIAL Oi Ye CowMPLETE SUCCESS, BiTA PEASONABLE CLARE Ty, % fet orcriassy occadionarty. AGKFARD STYLE, en eos MATIVES FO Crag GIlVviseser, $F € des THEY hel MO GEFPICULTY UNDERR TONS ING nal ue, cy 4 Sb SMMATIL SS ra BEeTes, . USIRG Tet GICTiCessy aeie ita Faw Sanda TIC AL Bits OUAGCHABLE “suceess §R CIGSLTING We MES ePES, LE18G Tat Seeficesey ty LvsvivinG wr wi sesas, UsinG TH OIA etaeer Sete tetis, £a° 3438 ee
Met ghiedae te FOE et on wet ComTIMUAT ION OF PART li-can@uaGe ELEMENTS SECTION D. Spenking (43) COMVERSE FREELY OND FOSOMATEC ALLY $ SPTAR FLUENTLY AND ACCURATELY 1% RIL PRACTICAL ANG BUCP RL BE fUaTIONS: oe ALL FURL ORS Bite asst £ ane PawEL EAA, ? 1 SPEAR FAUENTLY AND ACCURATELY [RM NEAMLY ALL PRACTICAL ANU BOCTAL BITUATIONS) 1 Cam ComDrane iy WORT PIEASS “wile Beetle 9 ant FAMIRTAR ABD fF EMPLOY SOME PoPuLaR SAVINGS, Lifisany QUOTATCONS, AND COMMON FROVER BS, Be § GET ALOMG QUITE BELL im SETUATIONS OF DAILY LEPE AND TRAVEL AND CAN CONDUCT ROUTINE BUSINESS tn PaRTIiCULae FIdLos i MAVE HO ABELETY TO USE Ted LANGUAGE IN AnY OF fat ABGWE areeacte, Unlerataniing (44) t unDeee rane GOTH FACE* TO°F ACE AND Om THE TELEPHONE? PLAvG, AND LECTURES, 4 UNDERSTAND WOM’ TEEMMICAL CONVERSATION ON ALL SUSsECTS, NEARLY EVERYTHING 1 MEAG ON THE RADIO AND AT THE MOVIES, BOTH FACE? TO" Face “AND Ow THE reLePuones é INCLUDING MOST Jones aa { UNDOCASTAND NON* TECHN ICAL CONVERGATION OM MLAMLY ALL GUBJICTS, 2. UNOERSTAND Mou OF wear ft wEAS Gh THE RADIO AND AT Ing MOVIES, PLAYS, an LECTURES, PuUNS. 6 UNDERSTAND NEARLY ALL CONVERSATION ON TORICS OF DaiLy lire and TRAVEL, BOTH FACES TOsPACE AnD ON THE Yéade 3 PHONLs @€ UNDERSTAND MUCH OF HAT § HEAR ON THR BADIG, AMD AT THE MOVIES, PLAYS, AND GEC TURES, BOte PACKS TO FACE 4eO ON THE TELCPHONE! § UNDERTTAND gvOMe OF HHAT E UNDERSTAND THe TimPL RSF CONVERSATION, PLAYS, AND LECTUMES, § HEAR ON TINE RADLG AND AP fee MOVIES, AM ROY ABLE TO UNDERSTAND que SPOKEN Language. BEFORE CONTINUING’~ CHECK PART 41 TO ENSURE THAT YOU HAVE CIRCLED ONE HUMBER PER SECTIOR. PART {{i-EXPERTENCE AG TRANSLATOR Of, INTERPRETER (85) INTERPRETER, B HAVE MAD EXPEREENCE AY AM s BOTH OF Yet AWOVE STATEVENIS APPLY, MONE QF YE ABOVE STATEMENTS APPLY, - ree TENCE) PART (V-CERTIFICAT ION § CERTEEY THAT TNE INFORMATION GIVEN AQOVE 15 (ful AnD ALCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. Trad CERTIFICATION TONSTITUTES My APPLICATION FOR A MAIMIFHANCE AGAGD PROVING F Au ELtGI@Le unora WEGELATION NO, 25.168. PAR, TCL). f° GHORANEAND THAT § MUST PAGT AM OOILCTEVE LANGUAGE PROFICIENCY TEXT OrFcan f BECOME tL tar Bhs FOR aN AWARD, AYO THAT ERNESPECTIve OF THE CATE OF TESTING, ANNUAL SAINTEMANCE AWARDS @ILt BE CUYULATIVE AS OF THE ANNIVERSARY GATE OF COMPLETING THIS FOnw, GATE SLCHED 17 § MANAGE YO GET ALONG EN THE MOT COMMON SITUATIONS GF BAILY LOFR AMO TRavd,. TRE TERS oe gH vote ts Nena ee nan oe Ms area te menine
omen e ~~ SPannaiy rou BY mow tear UG TEVIL RI AVICR COMMISSION ot een oie er ESE BRST RUCLTIONS fn onder ty prevent deteg bn erarevtevatean ef peur copies eaten, ahemee every questi ot thre foe cleovlg mpd esanpletely, Yopes writs oa peintio INK, In apgdving fer @ epee sfc Unaiod Beatles Civil Serve geaminatum, gent the etanunetiion Ramounes ies? eaeetatiy and Eolew ait diresteaie, 2 yea are applvang for a WET TRAD exesination, tidlew the RAUL We LAAMINGTW UF BING A Pirie BPTI LD FOR at i ann en mination arenes nenty Dur ionsy CF ment: ia V FACE GF CUMOVEiNE APPLiiD Poa (Cay and State g E “A te the ies tec in the anni emient BPG thee forse pac uised by the anmamerment, prea bbe ceemennecmcthentys ° sates BATE OF Ths ALA A on tA PLICATION FOR FEDERAL EMPLOYS, iT . frrete or Seen can te wteriveleat card regeching diewaltion a€ thie mpglie weiras, foe on UNWRITTEN eeernnetion, mend thre agepdes mticnt Whe eure'tes man te fhe amene eater Ratify the office with wtiie he ap ete of pny  bertge ot vene address, DO NOT WRITE IN THIS BLOCK Foe Use of Civll Service Commission Onty MAT GHiAR, . SUBMITTED, Uf pres wee ogeedron $4, «Ay HAVE YOU EVEN OER CMPLOVEO BY THE FrEtesL oootossent? (J ves [no @) (F 80: GIVE LAST GRADE AND DATE OF LAST CismOe im GRADE . 15, (0) WHAT 19 THE COWEST TNTRANCE SALARY YOU WILE ALLEITE 6 nec pcnwwneuwncns oF YEAR . - . You will net be considered fer any position with ao ower entrances aolary, . 2) GHEE IP YOU WILE ACCEPT SHORT-TERM APNOINTUZAT LF cSTERED, FOR: Ci § 703 MONTHS O) 370 6 MOMTICT $ TO 12 MONTHS NOTH, Arcantance ot rofuant of a tumpotary short-term enpoint mane wiih aot atlect your oppurtunity te eblain a probarsonel appontment, 603 IF FOE ARE WHALING TO TRANTL, SPECIFY; | rma ge —Elecvcromy 16, gureairacd: Us lapurtant for you to furnials af iefarmetion requested Seaview, Crcrnieion ord the helsas in euinetene detail ts ceatde the Crys Gpgeaniing uliwers of Agenelca tO give youu stl ereccse bg determine your ae BS acyante bhek for eh geastec;. Btart with yong Gualbraiina, U. r - ¢ gacernt geaition and work tok, eaplaiung clearty the pene pal fouks which Feu terhesimned in cath paaltion, acounting fe all geyerie A voesployinent. Beegnners geinecl ture than 35 gears qu whirh je tere peoriae Cia the sos for winels yes Ore apphang may be summarised in we ra rote of the blocke. If seat dutice changed materstally whale working fe the osne employer, ust May (790 i iarions. ‘APP. REVILW: r APPROVED: - casero. | privca. | avout, orrtom GRADE | naring | ance | raring cenentantnaencntnmansnt, | enmamnmnvars |e _ : . § aensencapasencsccee: |annsecceal coansecaes|f{_] POINTS | sannmoe " = GENTS ; te jocenaeceranaeereensse|racnmmmn|voneenens<|E] points froreree P . BLiNg TIGATED seesezeces | osssenvezese| amwouse. IMITIALS AND DATE fi Eten SF F682 OL ACCEPT APPNIMENY, iF OFFERED: LJ 19 wassnerstem, 0, ¢, oO ANYWHERE IN THE UNITED STATED CO evrsece ree veereo stares 12D FOS GUL SELAPT LPPOINL MENT 1N CERTAIN LOCATIONS ONLY, GIVE ACCEPTABLE LATION, SLOPE Un HO ett hn ithe fen SOL reiigeoss, Ciel, wetiere, of csgonizational artivity which you haye ‘performed, athe witti eons  Canpensation, showing the mumber of haure per woe set werss gar gehen which you were onset in eueh ortlvity. Riitary CSTE stan wet Gea sibed in the opti ce ts low in ite pucper aeguence, fap Tf yess were ever einplovyed In any pualtion ander a name chffercat from Bhat ettverts yt iret 4 A tue appllation, give under “Dem nptios af your win” Sot ods pom twa, Use Bau Und, fi) Jf yos care paver been employe’ of are now swiemployed, indiceto thet fort the epee provided below fog “Present Posttinn,” @ eeferate bio to dearmbe rach position. Vesa my Meclade any pertinent ce mame is Rene pe nae comme feettenen oe were fete een aetna tran aoe pee nee . PROSCNT POSITION » nn wee ps oo wm GATS Ge PUTDYMUNE (month. yoath (Ose TNE CE vou FORT CHALE CP | CALANY O8 EARNINGS ; in gor att Perfaral Service) STARTING, § PER ‘, eER YO PRESEAT Ysma 2e,- CMPLOVEINE (erty mend Seate) emt ae ew cen armament pee STC PRPTERDUEEREET PP aeanaNT eat tier essere tanertochatt ae” BEve AKG AUNE SS OF EMPLOVES (herd, Os ganisstind, or gerian; # Poderal, tiie GF nema dapsrtinent, burcau of catabhanment, e203 2icisi, a) PS a isg) Bawe dhs WE A MP EAATE SUPER AION eer i Ts GIRO Ce. §, widleaala alk, iviautance agency, miarutartire of lache, cit.) IB — bale 9-@ {CONTINUED Oh NEXT PAGE)
odes emigre snap re oe ee eree ge ney PEN og ect treats Pte mei earth nee at emai atam teh oN ditt. neem rtp Breen + ee . Vee ete eee aimee 2th eereetenytrantient ae ase vitae te 16 CONTINUED “PRY OATES OF THAD IRN Craath, a re) i") (ef in Federal corerce)| granting § Lal La we . 7 * | Gxect TITLE OF WOR POTION CLANUT CATION GRATE SALARY OF BARTINGS, - Rika ANG TITLE OF IMMLDTE SUPERVISOR aad Md TRACE OF EMMOTHERT (crey and Stare * RIS OF BUSINESS OF ORGANITATION (@. ¢, wActesale alk, inaurance agency, manufacture of ducke, e¢a.) sooner ng epeegi ee ec sere een yt pe NAME AND ADCRESS AW LUNCTIN (ire, oeganipation, of porean: df Federal, Meee department, bureau or setableA ment, and siviesa) AUMEER AND GUND OF EMFLOY LES SUPERVISED GY YOU REASON FUR LEAVING OC SCTUP TOs OF YOUR WORK eenae BOC ec coupe ceasberemnEns earatesuseaasaen na hana nnaceneasereceneeecssanecnencomenecenentecrenshe kenncensreagon see naeas bas on Deen Lennanennnnneneesenosenashinaheseneanannemaneenaccencranenenenceessouamserscenssacceees wn eaeen ane qemmseneneetbenanassenechententeenecotentinhasthent SLAs SE ERCSEDEERERASAESUAN ASEAN SHRORRERES BORED HARES eLASnmanneeRnmNenRn ae Deananmnannnnarenenwnenconsenscoce saree A102 tere tanatmartednnaratsse re raenceneennenbnhnnnercananasacnenessaseoOshendnhan ans hihbenrnhanintiaehaneernnsarnerntnntnrsarinesnnenneheng>sarcaneresesnenenansaossesesseger: AARNE RORNLE A SEAL RC ORHAN OAR ER LLORES SAAT LOREM ATARI ALE he MEME RADARS sTooee 2 te 20 08 Oe ROE ONS BOO HA TES CERENLETRERERIREREERERMEE HEHEHE ORIEN HHS Y: SES CLAS OETORE AER DEER ERELES OLE NE HHH EREREHGROEENAI EET eRe EOE A OEROECEREAT DE RER EDINA ERGDEDRAES OER, Seo SOSDCRRALL FOES TOE TEP ETOHADESSHEREESE S RIEEEALE DOSER DERE RE REAR MEE ER: Avesenesesnaoccasoenale CHUSCSASRS RODE TSHCEOPERIELE COS ut RE RETE TORE TGEEESEeT CEAdeecaraces paeenaaenEETew: catedersseceme Coen nant CTERTACCET EE OLEEROEEES £8 MOOR ORES: 2 anOOGH eos ARSEE AES PER wRecornnesn mene ee anewAaneTsenreneterencuaesseeetaceebonc cen 0G ewemee nen sacwannos chenneoets coemenesencneoner ses am. ARRRAOE oo oee Sahih EpoEt Leben OESee EeOE EEA ThNe NESTS IOLOESS SOETSC DOES OU RTOLESTOSON BO THEAATHeDeArNeseEnsegasosereseeed: 12 PONEE TE EDD On RR AEEE NS CO LEMTSERA TENT TRAAEEOE Ho SE EEEELESADSESERISNSSE LESROD MAOTEE TAT END NONG EN SESTT USS HA RN ADEAE NSS ENANKE SED ETONs HSUSDeEAODNEAMeSesasRTseEesensOEae «| , ‘ GHAG 7 TITLE OF YOUR POSITION CLASSIFICATION GRADE} SALARY ON EARNINGS! <.- : . ef in Podetal etevica)| granting 3 Ped : PIRAL 3 Pen 6) SAUER OF EMPLOTMENT (month, sear} RANE ARD THTLE OF J MEDIATS SUPERVISOR FROM TO ‘ t , LAGE OF EMALOYMERT Coley and Sta . der &, RIND OF BUSNESS OF canary o. g.. wholesale a auTanoe agenay, Md AND. ADDRESS OF EMPLOYER (firm, organisation, or eee names dopastenen}, buroau of estabkishtinent, and division) ; manufavture of fooks, S@UMBER AND KIND OF EMPLOYERS SUPERVISED BY YOU . - "REASOR FOR LEAVING . HL ee CESCRIPTION OF YOUR WORK OR Ne OME ER ITE SL EMET RENO TE RAEN STS OTE EE ESE TRARN ETON CASE TERETE EOE AAO LAT OOTP AEEERSERURTEOEENE RES HNSA EN EHEN CHOSE ONEE NE EER NENT ER HERE EERE URNA HE REREAD em Ame ete e sensi HAH SORE ROR ANEE TR TET ERO TREE DETR ETEEER AHEM EAS ORE SEE HEME H EHDA AH EEN EEN D REWER EES HONS LOS FO RUNG ERED SOFEEON TS OLET OE OEE TOS eROTSS SORE LOND TOrerLOERLOEAE OER SE BERS, en eee Serre ne eee pn ST rrr erry rr rrr rrr rrr eetrrt cel ree ortret Cte rercrrerelicti ri (Ott oc ot cetnt ly St hier re lec et iii it te Cetrit Ure mn tamennneres Perrrerrr Serettr tTttce tear e tt TTet etal te Terese ert errr ttt errr ritr ert Ti rtrrerrrer eel Otte lo Sreol Corot i onte lore lo Los Sobre aan alee reer hier Pee te eter ee Steen eee re Tee TS e nr rt tt Serer TT ere Serer. hee rer homer ere een rent nena rere See ewan neses ten smeecae se cepactonsensaeaa sane sangeenseaumeReeenarees SALART OR EARNINGS STARTING $ CLASSIFICATION GRADE Uf in Poderalsarvico) eae ameter “oer - ‘) DATES OF EHPLOYMONT qrnontaé, your} PAACT VHGk OF YOUS POM TAN e Rom: TO TL 7 ee FAL 8 : PER PLACE OF EMPLOYMENT Coity and State) NAME AND THLE OF IMMEDIATE SUPERVISOR to en en cre eee ne mee ee te a a eee eee RANE ANG ADDRESS OF EMPLUYE? (fees, ereantaatinn, or gorsan; df Federal, | MRD OF BUSINESS OR OAGANIIATION (6. 4, wholesale alk, invizance agancy, Racw dspartment, busocu or establishment, and deataon) niaaulacturg of locks, ote.) - ee eT meee speaerusmmaraiy. HUMDER ARQ KiND OF EMALOTECS SUPERVISED BY YOU REAR FOR LEAVING TISCRIFTION CF Youn Wonk . : 7 . |p eeewnmman nents tn ae a eree sewn se reece. a eaee new ene eee tens songs cemeewesecen, pe cewen ae recat eerste an ees een em ee nee eee eee pom enteanenenatewereeneeeee ao cene, aeetee ete ens c een eons eae eee ‘he 1°75 anarsdtpeersteatentntetnaeentenelinensenneeneentenneteesatenseteteetnttintet. arte 2o—oD ts 2
: * f ERACT PILE OF YOUR POSITION Cease anrae TAPED 6 OD TARMIAGS ad Gin es" aeredoop |] Srarring § rem. ® DATES OF ENFLOV MER, ue ent’ pansy ms en, ae 7 | ee ae HE rea MAME AND TITLE OF (MMELIATE SUFFAYIIOR : ve OF EMMOYNINT (osip and State} RIRD OF BUSINESS CA OPGANIZATEON {e. ¢, wholesale atik, inateanca nger. ®. manufacture of kwks, 810 ) enn: if Federal, ivieion} AME AMP ANOerss Or FerLOvEr (Ae ee, organiaation, ese name epartawee, bureaus oe eatedblahment, aad RRASON FOR LEAVING AUMOER ARD RIND OF EMPLOYEES SUPTAVIEED BY TOU DESRAIPTION OF TOUR Word rere fete rer tei treet etet et mrt ot? tel tt rere Se rete Societe coer oy 94 OF CEG OGLE OS AF LE DED IHS O41 SHOE OLED IL ET BOO oy BESSA HAS EERSORE RO: AA Ad oO nAOO HU TE LE DELELE EDEN HE AUR DAE AE LORER DORM HH HAR ERSES SUS POEOHOMAEEA OH OED URELOTSEEG LOROS TELE ROLE OSCE SOS ESESESSEOTIE IES SOLE LEE HE OLOL ELE DOSS $4 UE OH DAD UAL OR EO HEE EEDAHR RED OY POLO ERED SOHO MEOH LOMA LEAD REORDER EERE DSOLAE OG OS POISAESHO RU ROM RE LAER HARET OSES! LONOEPEPERSE ses ©5602 CFSE REDERRERTE STL OSA DOLE LS FRET ODETONE ASHE E SOLOS EOSD HBR OG REEL EACLOEOES OLSEO LS SOL 0 OS OTESPESE LOSS OTE DELS IZOL DL DLL LE ENE TEEH PH LA IED OE ELAS ADEE DLE DEERE AHS Ow] Cu SCS CSE SLL SO TLS AEH SEHD AL RD AR DA he ARM DMO wo} atoersezerecoce ses. FOE 2 PEL EOS OED ISLE OSIL One. 71 FE SDEL DL EELUR NOOSE SODA DARERHELS OO w| oP PO UE TS AO0ES HOLA EOS LEONE RUSSERT UROREE OT OR IROE TEED EE AOSHI SOS LEO DSTO DES EAD EG ECSIOSOSORLO PAS Hes SUODEHEHEOSS BEES OLITOOES EDEL HSSOEE LODO ED! CHEE O SRG De DMO EO AEE RE DEERE OHEOER EO MOE! pamadonnvaccsranssnes pas seeeanenaes Hetene Dees Ce asne sna raedretate saan Dans DD DEOGES EEE DELOS AS AE UERTESAILHO TOE EH DOS OS HEEL0S2IE2ESISSUEPDD TOLD ODES DIRE IRL EOD DALARED ORES OM REED HASH] if'more epace ta wenatreds 199 & Continuation sheet (Standerd Form Na, $8) or a ahert of paper the sane mee a0 this pege. eine on each sheet your same, adidreng, date of tuth, and examination tile, Attach to inside of thie application. 47. MILITARY TraHang “Te the epare beivw, describe any framing teretvend ta. uf Qealndewg received, puth a6 bursee gore weeks. Letaded infurmatlon regeed- the Armed Bervices (not diveady tered “uruter item, 6) thet would anaist ing any agreelal seryleg tetonle yen attended ie eepecially imputtant. (iiatea appointing o omcere re it placing you must ellectively,  Judscate ectual amount peyss may be weed to Biv Suit devcrip? uaa.} OELPIPT OM CF TAL ase f anqunrns nae ee tbotenen ye sete Prod AAO A RUE MOR HOES ETH LE ROE Ae TEM RSET Ae METREHOLPLOLOLELOLE DORE ROR AT ETO e SA PHOS OE OSCE CRU EO LEOTHROESES es On eee Reeser Ce kero o NE Oe EOE De tHT HD Hes Rees DPOR UA OER OE mH t HER ERNE EHO neHOnEMeDOn OnE EDP ees ng aren Deener perme tenes 88, LOUCATION. (Circle highest geade cumpiated): 4 a a 4 $ € 3 @ 9 1% 3) 42 MANK (X) THE APPROPRIATE SOX TG INDICATE SATISFACTOR? COMPLETION OF: OO CLL HTARY CCHLAH, C): ARGU HIGH ScHOoL Cj LOR HIGH SCROOR — ~ MAS (C) HAME ALD LOCATION OF COLLEGE On UNIVERSITY ang BRELIALTY. GA) GIVE TAME AND LOCATION OF LAST etiirt Gcntsd, ATHEMELO (B) AUDJECTS STUDIED IN HIGH SOA, GHICH AFP TO POOITION DESIRED DEGREES conrennea [pees fans coseirteg  t DATRS ALPERGLS ue ens IOUeT PRE OTE Fin TILE. iat | wane et (0) Lie? YOUR Cine UNOTAGRACUATE COLLEGE SUBIZETS QQ OTHER TRsbanG SUCH AS VOCATIONAL UUTINEST, STUDY COUN S GIVEN . THROUGH THE ARMED FORCES 1nsTETUTE (show nanie and jucaron SUBIECTS GFUCHED of aud) ORIN ULRVICE BRAINS Hts PUBLIC Of Pitt CATE RR PLUYMCNT . G | dL Ad 1Ou OH OF HAVE YOM EVER EEE } FUSION (such as pilot, oiwttiec: WAL EA BEEN A Lt ENSED OR CEOTIFIED MEMBER OY NY TALE Of PRO af, 1ad19 aperator, teacher, lawyer, CHA, ot0.ft 19, IBEKCATE YOUR KNOWLEDGE OF : fOWLIGN LANCUAGES. i art i | oat — inn . C) ves “fa fo Sik KING OF MCECE AND STATE: ig FIRST LICEASE OR CEATIFCATE (Lak) Ieate ATS | Lares LICeNLe Oh CEGTINCE“E C164 By TYINS tes SOURED ELIE ERE UE YOUR APPLICATION 20 PE YOU RANT TRAV CULO OS BEE CED IN ANY FOS! IGM COUNTE DVOATES AND LeDGTH OF TIVE SPLNT THEPE, AND “h. GINS ANY SPECIAL Qt aLiFt Sars SE RUTH uw G2) REASON OR PURGE Co g, aniditary dervics, business, oduct c el (2) FOUR MOAF peeCaTATE PSEA TIONS Gio nv’ auhimul Cupieds Uhlvea sequerte-d) Hy YOU PATENTS CR aN 7) Lil PELATIGNS ESPLRIENCE vith iM PROFESS AL OR SCUESTIFIC SCCETIES, ETS. BONES AND FELLL de eetliS #ECER EB, 3, 2}. Uist ANY BAECIAL SILLS YOU FOSTESS AND MACHINES AND FCLUBMENT TOU CAM LSE DUH AS OPERATION OF SHORT WAVE RADIO, MULLET COMPTOM, ( a) EYER, ALW-PUNCH, TUNRET LATHE, SCAENTAFIC OR PROFESIONAL OLVICCS APPROKEMATE AUMEER OF WORDS PER MINUTE IN TYPING... SKORTHAND . Brn tardd-F
ve meee STUUTIONAL MEARS, Poe ae ~ Peuch deharmarnt in fens Jv, 2é RIPE REMC T's Bont theve preeons hong em the Untied Stetea ve Teetorece of the Unitest States eho are WIT relatet te ve aad whe have definte kacwledge of your sualifc olione and fitness for the poecdies foe whe yout ae arrive, LXt nod repeat names of tupceriecdt bern under trem 16 (KX PRRIRNCED PRESTNT By ME we MME, A, CRE INE SS oF ~ PATION FuUL Hane / Ae swunglete current sidiore enviiefing atreed and nue Rumbor) BUSINESS OF OCCU PATIO! . 4. : ’ -taue SeewenecseenarnmacessennenrasteenuesseRnunennesOe ern AWAneL eine) -aWAAMMONOORCOUDGSAGnarennne iusensweeeeenAreseenersnranerarcnagensmamuscs| eases eensnenehasten oamnnenme.nn sm 0 one momtacesernsaremmennnrennenccn ss ee ee RRA RRR OTRO A MALO TLAA Dn LEO TROUSER Leos Hn LET EHD MMS LOOT SSDS Y \ 1 INDICATE “YES" GA “HO” ANEWLA BT PLACING “RY Um PROPEA CO gwR i ¥t8 = ag INDICATE “TES” OB “WO” ANSHER BY PLACING °R” Ue PROPER COLUMN ves | HO 23 MAY INQUIRY BF MADE.OF YOUR PRESENT eurvonn RUGARTENS ¥ wet | 3S ARC YOU OY COFICIAL OR EMFLOVEL OF ANY STATE TERRITORY, COUNTY, . CHARACTIA QUuALIFHATIONS FTC t : OR MURECIPALITYE oo eke cee ee eee tem eee eee eeeae . nano mm} OF euuer answee ie Ves,” give details in dtecn 39. 26 ARE You a CTE OF OR DO YOU (OE ALLEGIANCE ro trae were | BOWS THE CNETPD STATTS GOV CRY UEYT EMOLOY IM A CHYILIAS CAPACITY, ANY RELATIVE OF FINIRS (OY BLO OR MARRIAGE? WITH WNOM VOU LIVE OR HAVE LIPS WITKIS Fee PANT 3 MONENS? | Prererer sy 27 art YOU ROW OF HAVE YOU TVER BIEN, A MEN BER OF THE COMVINEST | th Uf your anwwee ww Yes,’ show in tiem 98 for RACH suck PARTY.U SA OM ARY COMMYUPSS UNGAMECRL ME: seiagie ib dude are, Oe weaer€addrest: (2) rplacnsmeabine " @ Department or Agony by wareh employed, and (3) Aind i AprsMereeE tee 26, ARE You now. oR Hav vou EVER BIEN, A MEMBER OF A FASCIST CRSA = = " x SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCE FZATION? . . ns eee . H eat J8, ART YOU NOW, OR HAVE YOU EVER OFTR A MEME A OF ANY ORGAN TRATES, ASWCIATION MO OT MENT, GACUP, OR COMBINATION OF FT ROAS BSTC AS YOCATES Tf OVER THHOW OF OUR CONSTI UTIONAL FORM G8 COLT NET, OR OF AN ORGANIZATION ASGOCIATION MOVEMENT, GROUP OR CORNET IS OF BTR ns WH TW HAS ADOPTED A ROLICY OF ADVOT ATI OR APPR THT COMMISSION OF ACTS UF FORCE OR VIOLENCE TO DERY OLE 8 M1 SONS THE Ee RIG OEE IE Fock CONSTELUTION OF THI UNITED STATI OF OF STE A. fNG TO ALTAR THt FUMM OF COVLRNMENT OF Tre UNITED STATES SY 4 we &, Uf you are clauming preference aaa PEACE TIME VETHNAN who hee been awardal a camipmgn batge oo service hive, of ae @ DISANLED VAT. “RAN, of eo the WIFE OF A DISARL ED VETHRAN, or ae the WIDOW OF A WAR OR CAMPAIGN VET ERAN, attach Veteran Sretecence Claim, CSC Form £8, teacther with prot apeerhest thesein, 1. Uf yoo are a WAR-TIME VATERAN out claiming dlesbility preference, ehouls NOT submit your discharge with this application, Preference sell pe tentatively cemkctal to you amd if apreuniodl, yuu will be cereal to eubnait te the appeauing officer poo to cater om duty, official evidence of ar: ‘ata> ton fan acter serstce an the armed forces of the United! States in thine of wae. |  atnteaernnannnnnernemtemtnneteetntttntinhintteetrenttirtt terete toner ther anata arn eset Coe 3? co WERE Yoly EVER IN OME UNITED STATES MILITARY OR MAVAL SFRVICT DURING LIME OF WAR? 4 eet et Pt OTE NCI SOO Af youse anewoe tor guestion 27, 38, of 28 above sa Cres,” srare fn dein SY ¢he namen of all auch offaniza liana, anercra Pir movements, groupe, or combination of persons and arene wt momiership. Give complete datas of pour acti rvss fheresn and make any erplanation you estes Pegarcrrg our rmicnihorship of activitiey therein HO 98 THE WORD MHRONCK AR EY OR THE WORD + Sang acrony usre le rer OF YOUR He YOu DISC RAR LOR BE CARATION PAPERS YO SHOW TH MACHaRal OF LER ARATIONS aC) WAT SEN” PEREGUMED QA AN ACTIVE Fu ue Tse DATS, WITH Fuue RHILITARY FAY ane SALW ANCES o . 8 (OP DATO OF GRY OR ihikiis into spice tale oF we iwation BR ores ALATIONS n ) Mar. 19Y3 Ze June 194G PRE AF SERVE W Cdririy, Weep, ive giade ar ‘SERIAL Fa HO. G ar Prapeie, “pone, Rive fiade ar Adare Cospay Coat Guard, ete Re 3B, SINCE YOUN ISTH BIRTHDAY HAVE YOU VER BLM ARRESITS ROL, CR SUMMON DATO COURT AS A DI PENDANT 1M A CiPeIRAL PRAT AS OR CONVICTED, FINED, OR EMPRISCNG 2 OR PLACED ON FROBATION Of SOG YOU LVEH BELLS ORDLNED TO PTnOty Bait OR COLLATERAL FOR Te UA TO OF AKY LAW, POLICE ARGULATION Of GIIDINANCE GENCE LONG BYR TRAFFIC VIGLATIONE POUT WHITH ARNE OR PORPAITUAL OF fIOA La GaAs UPOSE DIT 0? onewmen ence Ff your anawor ta Vea,” fae all guoh cana winder ftaaa s hetaw, Gre it anch oven (8) tha dato; (7) the natura ar te ofenze ot violation; (3) the name and locqan of rha sort: 44} the penalty imposed, if any, of other wiepsattion AF Te Ta98, apnoaped, your Angecprriéa wed? he tadon us MOAT EP Woo STRVEDIN THE ONITED STATIC MIITARY OFF PAVAL SFUVICE MA's HIE VER ist FN OFA LO OR FORCE ETO REGS, SGA DY 0 a - bane mye Bh aM hNGat 7 FACTORY # ainviel fa ats Poserie . VOR PEACE EVE ONLY DO VU BAR TICIPATE EN A CAMPAIGN OH EXPL Tf your answer ts" ¥e9,"" give on drei 38 the pads TION AND RECENNE A CAMPAIGN BUDGE Oe SERVICE RIUBOHT eewesvase addreas of einplayer, dato. and reason in aavh caw, — Ws {0 Br ARE YOU A OS ABLED VETERAN | Tf ne. aon? vou Pate Pot lated waue ais enon Trons 33, expiun i tem Jy galow. ARE YO! ACTER AN S WINGY WHO HAS NOP REMARRITDT. Wee 4 soreeetme iM ARE WG Tak WHE OF UVETFR AN AO WAT SERVICE covtcrep i TORRE ET Dok PE VERA MME Pee CHIL EAI AD PIN EAE. THIS SPACE FOR USE OF APPOINTING OFFICER ONLY The infermmatha contained in the anawers tu Question J7 above haa been veri- 32, MASK YOU EVER DFEN BARRED BY THE US CIVIL SE RLICL CoM Ey PSTN PARING PR AMUMA TION: OF ACCE DE Have CEVEL SERVICE ATRMSNTE STS? ff your neawer fa Yes,” give daioa od add taasins wee BS, HAVE YOU AMY Pe¥SICAL HANSICUP RITA 2 Oe OTHER Piseety } WHT SHOULD GE COND ERED IN ASSIGNING YOU TO Sats? s df yout anavasr ie Yas," give completa detariaia lisa So ~ | fhat comgderaiion ean be gisen tu yuur gitey wvad PL e300 soo i fhe joe, bi steearees LPenees 34 Ge YOH RECEIVE AM ApHNTY PROM THE CXITTD Seat Ged hy roimpartson ata the diwhorce certiticate on ., OF COLUMBIA GOVERNMENT ONDER ARY RETIALNE ST ACT GF OTHER COMPENDATON FoR MITT ARY OR wae ah SERIA E, eyaur anaes ta! annette nant teeth tnt Ate ROA tama Asm ors sely} wrth, ond @xunanatioa gle. Attach to lealde Fe nare apace a8 KO quired, use peper the aams sire ae eh of this apphcation Before signing this application cheek back over 8 io make gure that you have answered ALL questions conectly, I CERTIFY that the statements made by me in this applicanion are 2acn arrest tothe bait of mms watledge and behef, and ure made in good faith, False statement on this appheratian SUSAATURE OF APPLICANT is pumshable by Law (U.S. Codey * SGT SSNS (San your nad suale, ‘Citle 16, Section BU}+ . Q eek Mua ae fualey eee ee rt ees Senet eaten BA Mestaaanl paetlad Os7ik | FA
q ou Cates DUE l eal Rtaca aba ae eee te ee hee eee a te eee ae eh nee oe 8 8 36447 PERSONAL HISTORY STATEMENT ee Instructions: i. Answer all questions completely. | If If question does not apply write “not a applic able.” Write “unknown” only if you do not know the answer and cannot o' the answer from personal records. Use the blank pees at the end of this form for extra details on any question or questions for which you do not have suffl- cient room. @ Type, print or write carefully; Ulegible or incomplete forma will not recelve con- sideration. HAVE YOU READ AND DO 0 xou UNDERSTAND THE mernucnions? SS B. NICKNAME - WHAT OTHER NAMES HAVE YOU UGED? UNDER WHAT CIRCUMSTANCES HAVE YOU EVER USED THESE NAMES? - HOW LONG? sd A LEGAL CHANGE, GIVE PARTICULARS e-em Where? iby. What Authority. ne ee C. DATE OF BIRTH bLace OF BINTH a te UD! D, PRESENT CITIZENSHIP _ WAL BY BIRTH? __ _.. BY MARRIAGE? _. Counuy end ATION CRRITBICATE § cennennen—aee ISSUED snwreaee ES comenirarns aneemomainamsnanies . Date Court ss aay — A PREVIOUS NATIONALITY? ——————— eee ee Yea ar No Country ' WHAT DATES? _..._ TO ______. ANY OTHER NATIONALITY? __... a iuebry * seveamer stm neon eon ARG ene ° i STEPS 1O CHANGE PRESENT CITIZENSHIP? _No_ GIVE PARTICULARS: i
14-00000 ( g. ir BORN OUTSIDE U.S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY? -nenmmemnemnesmecnmnn PORT OF ENTRY? On PASSPORT OF WHAT COUNTRY? EAST USS. VEGA Number Tyre Place of Issue Date of Issue SEC. 3. MARITAL STATUS i - DIVORCED . . WIDOWED . A SINGLE ie MARRIED STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS (IF YOU HAVE BEEN MARRIED MORE ‘TIAN ONCE -—- INCLUDE ANNUL- B. WIFE OR ITUSBAND MENTS —~ USE A SEPARATE SHEET FOR FORMER WIFE OR HUSBAND GIVING DATA REQUIRED BELOW FOR ALL PREVIOUS MARRIAGES.) NAME OF SPOUSE First Bivhtio bdatden test PLACE AND DATE OF MARRIAGE * HIS (OR HER) ADDRESS DEFORE MARRLAGS et nas neces econ me ‘ St. & Mo, city Stats Country LIVING OR DECEASED women DATR OF DECEASE ecm CAUSE new ernn ne — Aaa —emmermematit See CA USLONREO YET VRESENT, OR LAST, ADDRESS St. & Ne. City State Gouutey “DATE OF BIRTH Hane PLACE OF BIRTH 2s . . city ta CSCS”””:*C OE ce . ‘ ; LF BORN OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY —. B r CITIZENSHIP WHEN ACQUIRED? were? * Be . . City Stato Country = - OCCUPATION — ee LAST EMPLOYER ee = , -EMPLOYER'S OR BUSINESS ADDRESS ne Rs: 1 St BRA City Stato. : Country MILITARY SERVICE FROM TO _--____..__. BRANCH OF SERVICE Dato COUNTRY _._._--.._-_- -_-. DETAILS OF OTHER GOV'T, SERVICE, U.S. OR FOREIGN =e wy 3a oF tte % pug 27 9
SEC. 4. CHILDREN OR DEPENDENTS (Include partial dependents) ; SEC. 6 MOTHER (Give the sarie information for stepmother on @ separate sheet) ° HAMB . RELATIONSHIP _.. AGE Crrizensiup ADDRESS : ; St & Ho. a re Countey Mase _ RELATIONSHIP BOB conn CITIZENSHIP ADDRESS : , Pirss Midele Lees LIVING OR DECKABED emer DATE OF DECREASE CAUBE PRESENT, OR, LAST, ADDRESS Bi. ds No, City . State . Comantry DATE OP BIRTH .W:- a PLACE OF BIRTH Cy State Counties I” SOHN OUTSIDE US. INDICATE DATE AND PLACE OF ENTRY CITIZEN SHEP mere nme WHEN ACQUIRED? oem. WHERE? . City ’ State Country ’ GOCUPATION . LAST EMPLOYER RIUMPLOTER'S OR OWN BUSINESS ADDRES cm emo te. & No. city Btate County MILITARY BERVICE FROM anne TO wa BRANCH OF SERVICE Bate ete : CETCE TE on einen ee DETAILS OF OTHER COV'T SERVICE, U.S. OR FOREIGN. PUI RABE er pn eer enon fer eran nsec panama — First ~ Biddle , Laeg, LIVIEG Of DECEASED ___.—-..---- DATE GF DECEASE ————-. CAUSE PREEENT, O LAST, ADDRESS 82. de to, City * State Camry DATS OF BIRTH WWW. ~ PLACE OF BIRTH x. — NM 21 8 | ne 25207 | 2 75 Senne Ee CITIZENSHYP __.-__. WHEN ACQUIR' ? Siig peas = IF BORN CUTSIDE US. INDICATE DATE AND PLACE OF ENTRY ——_ 8 START MARE cin ertorie move on state Sues PUPIL ORS SiMe int tne Miah Rite thy etc - se | ROE LLL OOHERP ATM ETTUANT: RICE Ik fH ’ . ‘ ‘ t LTT VE Wrenn enn et theme cies eet sectenrn gets tt mee WANE POEM NETO RAGE ate Merwe totem ae oe
ee wee RENEE WE Se newchi ee SECQU13. EDUCATION ELEMENTARY SCHOOL ADDRESS xa cup State Countey DATES ATTENDED GRADUATE? HIGH SCHOOL ADDRESS negate DATES ATTENDED GRADUATE? COLLEGE ADDRESS DBI REE. Ouuntey - Berics Raak REMARKS: : ‘SELECTIVE SERVICE BOARD NUWER - ADDRESS IF DEFERRED GIVE REASON INDICATE MEMBERSHIP IN MILITARY RESERVE ORGANIZATIONS SBC. 14. CHRONOLOGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT FOR ALL PERIODS, INCLUDE CASUAL EMPLOYMENT. INCLUDE ALSO FERIODS OF UNEMPLOYMENT, GIVE ADDRESSES AND STATES WHAT YOU DID DURING PERIODS OF UNEMPLOYMENT, LIST LAST POSITION FIRST. wae AO @ nuplonncnl Am Vhew 1947- my as ne 5 0) Sy | | eh Aaa EMPLOYING FIRM OF AGENCY —.. Btate . ° County . NAME OF SUPERVISOR ADDRESS 2. &t. ds Na. City KIND OF BUSINESS , 2; SALARY 2. TITLE OF JOB ..W. YOUR DUTIES REASONS FOR LEAVING pene TO) cecieeeeeneneennerer mene ne ene ane 2. FROM WWW. EMPLOYING FIRM OR AGENCY nee rernmeet resentment ene ie a te wate BE Der Sar ne Bene
TMS eee oe cre a, neater obits: t i i z a i SEC. 18. . FINANCIAL BACKGRGUND” c. HAVE you EVER Brew 1M: OR PETIL ON ED FOR, BANKRUPTCY? GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCES IN THE U.S, — (Give residence and business addresses. where possible.) . . Btrect ané umber Ca Bete 1. BUS. ADD. : RES. ADD. nn 2 BUS, ADD. $$$ ——_—$—$———_—_-._ ___— 3. en IF NOT, STATE GOURCES & ARE you ENTIRELY. DEFEMDENT oN YOUR SALARY? 8. WAMES AND ADDRESSES. oF BANKS wiTH ‘WHICH YOU HAVE ACCOUNTS nimentanen at co O1vE, PARTICULARS, ESCLUDING COURT:, —_—— Seen eee D. GIVE THREE CREDIT EEFERENCES — IN THE UB. J Lo NAME 2 ADDREBS " : Bt & No. cay Beata 2 HAME ADDRESS . St. & Ne. Gtty Blate ADDRESS ce erence rere erence netomat ett at. SEC. 20. RESIDENCES FOR THE PAST - 15 YEARS FROM et mi, 10 June 260 ¥ROM May 969 TO Lf AY . . &t. Ho. * City. Mate . ConUz FROM —————ee TO ee rae 7 a <\* rs 1" es oo a PROM —- TO Be. Ba. ciy ate —Gouatry FROM TO Bt. to, Gey mate County — FROM 5 0 a 8. Pe. ; city State Country PROM ee a _ = : 2 eure Sorecepene _— _ sapere Sieaiel ~~ —- | me ee SEC. 21. RESIDENCE OR TRAVE.. OUTSIDE OF THE UNITED STATES _ in ‘ a From Sehiyg roSuns 1759 ‘ : * a meee — FROM TO a Elty or Bactlon "Suna Purpose PYUOM cue TO en ne er ne ee cn ° City or ection Counwy Pures 9
14-00000 . ~ ean MOE HE TALE a . . — eee - ae ™ crore peel news + Tan SAT . “ae rere nem ee -- ae ee tema em me a Tyee a@ FROM by 5) penne empresa EESTI AES ‘ City ov Bectiog County FROM Purpose Oly or Serta Cruaivy Purpose FROM a . City or Beetions Country B. LAST_US, PASSPORT — NUMBER. DATE. AND PLACE OF Issue HOW MANY OTHER US. PASEPORTS HAVE You HAD? AOWAR Give APPROXIMATE ' SEC. 29, CLUBS, SOCIETIES AND OTHER ORGANIZATIONS. _ LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCISTIES, PROFESSIONAL £OCIETTES, EMPLOYEE GROUPS, ORGANIZATIONS OF ANY KIND (INCLUDE MEMBERSIUP IN, OR BUP- ee i PORT OF, ANY. ORGANI ZATION. HAVING 1 TEADQUARTERS OR BRANCH IN A FORZIGON GOUN- TT. 7 TRY) TO ‘WHICH ¥OU, BELONG OR HAVE BELONGED: _ one tas wey A Pe 6 Name and Chapter DATES OF MEMBERSHIP. Country : ae Name snd-Chapter &t. & Ko, itp State Couniscy . DATES OF MEMBERSHIP: 3. . _ Namo and @haptoer St. & No, . Cy State Country DATES OF MEMBERSHIP: Ld. ence senate . Nante and Chapter 3. & Na, City State Countsy _. DATES OF MEMBERSHIP: a 3 . Name and Chapter Bt, & No. city . tate Country ‘ . DATES OF MEMBERSHIP: 2 : 8 : . ~ Name and Chapter &t. & No. ° Chy Statec -  Comniay _ a _. “DATES OF MEMBERSHIP: -22 2 é . ie . ~ . a ; : . i - , ° _7 ‘Naine and Chapter a. & No. City “Rate Counuy * : DATES OF MEMBERSHIP: .
14-00000 SEC. 23, GENERAL QUALIFICATIONS re ut A FOREIGN. LANGUAGES (STATE DEGREE OR PROFICHYEY aS “SLIGHT” “PAIR” O8 . . eae Ey 6 4 t t i LANGUAGE B. Lisr ALL epdRTS AND GORGES WEICH Dirmnser You: mtucare. DEORE OF FROFT- CIENCY. IN EACH: ALATA INN epee re area RES > ane whoo. PLE TEN lass Aaa ERE Ry aaah Ghermcametenet nine Meer } \ I C. HAVE YOU ANY QUALIFICATIONS, as A RESULT OF TRADING OR EXPERIENCE, WHICH MIGHT FIT YOU FOR A PARTICULAR POSITION? a, En ony np tebe d & * a Fe E TERRE east n “ * 4 EF SENATE ea ‘D. LiST BELOW. THE NAMES OF GOVERNMENT DEPARTMENTS. SSENCIES OR OFFICES ed WHICH You HAVE APPLIED FOR EMPLOYMENT SINCE 1938: ; set Rveeny ’ * ' Hs paeAROAT perth e : “i ; ” yi ’ : 5 4 B. Uf, TO YOUR KNOWLEDGE, ANY OF THE ABOVE HAS CONDUCTED AN INVESTIGATION OF; ‘ , aE . YOU, INDICATE BELOW THE NAME OF THAT AGENCY AND TSE AFPROXIMATE DATE 4 aL _ t. . PHE INVESTIGATION: - -----~ > 7 oF! | _ : < : : it i i if . 4 Me