14-00000 ett tee a DECLARATION OF APPOINTEE . . By This form.is to be completed before entrance on duty. Question 3 i>: fo Bé answered in all cases, otherwise ; answer only those questions\wisch require an answer .cizérent from that given to the corresponding quéstions on your application iczm. It-no Sriswers are Qdecot write "UWONE’ in diem i0, below. Any false statement in this declaration wit be grounds for cancellation of application or dismissal atter appointment. Impersonation is 4 Griminal offens= zal will be prosecuted accordingly, _ 1} PRESENT AQCATSS (atreer and muniber, ety and Stace) } ' a (A) Wh CASE OF DutmeoReY PubAce ROTIFY GD seaTonsse @o STREZT ano moxecn CTY ago staTE : > | Oar zHce a @ 0008 THE UNITE STATES GoveR wer? EMPLOY. OY A CULIAN CAPACITY, ANY RELATIVE GF YOURS CTR SY ELOOD OR MARRIED WIT HNO FOU LIVE Om HaAUE Liven BITE Tee past za montase {lyes [7] xo ' . et If 20, fot each such redatwe 2 inthe blanks bse If additmonal space io Hecate, cxmpiete under tiem 13. : tT Rt FPOSTOA OI) TEMAGRIRY OR too POST OFFICE anceEss i CG} ARENA 0) TewAnRARY O8 KOT SIRGLE AE : (8 PAA MENT Of ASORCY In WHICH : Kate serves aumder, if anp) ; LBPLOTED . 7 ” an a - &-(A) DATE OF Bie . [OO SSE BREW ete a town and Seats or coun) . . ° & Ct anmeenne saanae ie Bere een oe nemecna eee ne Be resonate net ee rte owen te tw toe wanes: _t& SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS FO. | WRITE D4 LEFT conuan arwOERs OF TEMS TO WHICH DETALED ANSWERS APPLY al ne a snetaneceenneeu aneeneeee INDICATE “YES” OR “NO” ANSWER BY. PLAtIXS <x" YES | IN PROPER COLUMN eee teeter ee scatterer, @ ARE VOU AN OFFICIAL OR EMFLOYES OF ANY STATE, TERRITORY, COUNTY, OR FA URECEPALI TV oo oe erence erenneeneneee. . Wf your answor is “Yea”, give details in Ftern 7D, | & ARE YOU A CITIZES OF OR BO You CWE ALLEGIANCE Yo Tee cama Staregy_! 3, BO YOU RECEIVE ANY ANNUITY FRO THE UNITED STATES OR DIST EE COLUWEIA GOVERNMENT UNDER ay RETAIN 3 OTHER COMPENSATION FOR Mrs TARY OR NAVAL SERVICE? ff your answer ia*' Yea", §:re in Inecn 10 reason faz Pecuemerten %, that es, ago, optional dizadslicy, of by reason of warlentarr or involuntary separation afeer $ ¥oate’ servecn: amaene of retiremen! pay, and under what retirement ect, anf rating, if setered from military o¢ aasal service. & HAVE YOU EVER BEEN DISCHAASED OR FORCED TO RESIGN, Fo wsccasucT O& UNSATISFACTORY SERWICE FROM ANY POSITION? { your anawee is *' You’, Bore in from 10 the Ramee aod eddiresg | ere ee of employer, date, and reasaa in sech CHE8. SS mnenen narrates terete {eam ata & SINCE YOUR 16TH BIRTHDAY, MANE YOU EVER BEEN ARRESTED TOD HITED, OR SUMMONED INTO COURT AS A OES EMSANT IN A CRIMINAL PROXSETING, O8 CONV. STEO. FINED, OF IMPSS KER Of PLACED ON PROBATION: Da aut vies Evin Beth URDERED TO LR ROT Bae OR COLLATERAL FOR Tee vc anon OF ANY LAW, POLICE REGULATION: of ORONANCE (EXCLUDING RRCH TRAPPERS VIOLATIONS FOR WHICH A FINE O28 FORFEITURE OF SOR LESS wee PeROSED 4f your answor is “Yes, de: al? such cases uncer fran 10. Give in each case: (1) Tae dare: (2) the nature of ree edense ar vinlation; (J) the nate amd lowazion of the crust- (4) the penalty imposed, if any. ee other ispoaitiom 1f the case. if appuinted, your fingerpmets will be taden.. INSTRUCTIONS TO APPOINTING OFFICER . ‘Tbe- appointing offieer befere whom the foregaing cercivare ip made shall (3) Cisisenahizn —~- The popointiag officer is responsible for the determine to his own satisfacnon that this ap: tment woud Le im conformaace gitzessis> promises of (1) the Ciel Service Rutes and (2) eppropnenom acta, With the Civil Service Act. sopSceble Civil Service Ruke acc Reguipnona eed = Form 61 ceesttutes an sfidevit for boeh purposes and is aeceptahic. pron of acta of Congress pertaining to eromatment, ~! - . citizenship starus m the absence cf conNiicting evidence. In doubeful: oases the Thea form should. be checked far buidiag of office, perpen, suitability in con. appointment shouki aot be consummated until clearance hes been serored frou pection with any record of recent chochuege of arrest, amd garticulariy for the the certifying ofSce of the Cavu Service Comunission. . Q) Identity of appointos. Tea sgpciatee'e signature amt handwriting ave 4) Mosbers of Family.~ ‘Section 9 of the Civil Service Act provides that be compared with the appicetiun and/or other yerznent pepera “ The whens there are airemty two ar more membere of a family serving wexter physical appearnoce may be esevired against the suecteml certibcate, The Probehenal or perpenent appointesent ia the competitive service, mo Gther sppantee may also be queatioand og Ris personal histary Jor agreement with bis tee ur of such faesig w chgbie for probatianal op permanent éppectment in previous statementa, the compentve service, The appointments of persons entitled to vererss, (2) Age.-—lf definite age Kenite have been established jer Tie position, i¢ sloaid preference are mt eabevt ty thee requirement, The tnem bers-of farsi y prow be determined that applicant ie sce outside the age range fcr Spypraantmeet, | does ace anny wWrempUrkry tppuotments. Doubtful cases may te rederred to Until such determination is made, tac appointment may are he cummeennuted the approgeate office of the Cie! Service Commuismun for decision, & % ROvEVAwALT KesATIRA arc 2e—BIRNS-8 vat aw!
! Py SECRET ge 604 baie ~ - , chen Fabled Yay ene didn ALLA 5k PERIODIC SUPPLEMENT 7 This, BATE Suz GJ ca PERSONAL HusTORY STATEMENT. - QA 7 Aust 1957 GO INSTRUCETONS ! “Sven thowgh af ‘duplicates This form pruvedes the apans shereby your of fseial personnel, fecarde will be hepe curren’. Secteons f through ¥I 2 their tnformetson you have furneshed prewaousty, it eld be mecoseace: for. you to complete You need compiere Sections VIE" through NEGE onty af there has Been @ change sance you entered on duty @6 th fntareti. the erganeteflaon cr atten && you Gelseve the ates fequiros eore complete coverege than you have previously repotted. Zone, State) 3. PRAMANENT BODRESS (No., Street, Cety, ?. CURE oie ° a Lat ; Box &88 APO. "500, . “| | Street . . AIOXS reinia Sar Francisco, California STATE, TERMETORY, POSSESSION OR COUNTRY IN WHICH YOU NO@ CLAIM RESIDENCE 4. HOWE TELEPHONE wom eer 3. cinda eCTUON aa __ -FERSON TO BE MOTIFIED th CASE 01 “S F EMERGENCY fy Bae Lace-Farste tadd! 5 f RESIOING ff U.S. 2. RELATION Sale , . Father-in-=law Street, City, Zone, State, Countey). Street, Alexandria, Virrinia fone,. State, Country ye 3. HOME anoRess (Vo. , PPLECAQLE TNDICATE NAME OF Fi RM OR FMPLOVER, FF i n . Washington, D.C¢ Fe BUSINESS TELEPHONE EXTENSION 4. SGUSTRES OORESS (¥o., Steeet, Caty, _ Couneil of State Governnents, 1025 Connecticut Avenue, S- HOME TELEPHONE NUMaca BUSINESS fELEPNONT NUMBER “TEmple 68506 “Y EXeeutive 36715 Mother, Fathec) way aALsO BE NOTIFIED. iF SUCH NOTEFICATION @- tM CASE OF EMERGENCY. OTHi® CLOSE REL ATEVES (Seeuse, . tS MOT DESTAABLE BECAUSE UF MEALTN OR OTHER REASONS, PLEASE SO STATE, tt te woh n fey 8 (Brother), | _____Ptrost Mi, Mashington, 06S. (it3-6093) MARITAL STATUS oon ais . FURNISm DATE, ne And REASON FOR ALL SEPARATIONS. GIEVORCES OF ANNULMENTS Pf you have been married more than once, including annulmenta. wae o separate sheer for farwer wife or SPOUSE: husband gaving data below for afl previous maerieges. ff marriage js cantenplared, provide: same data fer fiance. 3. NAME eFeraiy (#iddley . (¥vrdemy (base, 2. DATE OF MARPLAGE $- PLACE CF waRaiace (Cic¥, State, Country) ‘o ot Street, Céty, State, Country) ADDGESS OF SPOUSE BEFORE MaARRI ASE (No... 4. d- CAUSE OF OLAIH y. RIVENG &- SATE OF DEATH Nae Sane 1G. CUARENT adDERESS (Uave ant addrees, if deceased) tt. Dare OF BIRTH 12, PEACE OF BIaTH (City, State, Country, — ty" PR. TF SORy OUTSIDE U.S.*DATE OF ENTRY ["* PLACES OF ENTRY 1s. “Crt penaw iP (Country 5 : | #6- DATE ACQUIRED 1?. WHERE ACQUIRED aT State, Cauntey) - t@. occur arian era PRESENT EWPLOVER (Also five former employer, or +f sor is deceased o¢ . + . uneeployed, fast? two exployers) iO. EMPLOVER'S OF BUSINESS ADDRESS (No., Street, City, State, Country) : SECTION 11 CONTHMUEO TO PAGE 2 FORM UUYb - aE CEOUS Eat TIERS. : SECRET . , oo {4}. ae 3?
14-00000 : SECRET pBher © lee fat ‘ i SECTION TLE CoaTeageO FROM PAGE a TAT ANN YEAa vo zt. OATES CF MiLtTagy SERVICE OF SPOUSE (fror- art Fo- , gids COONTAY BEEN BHICH MILEFARE SERCICE AFFIQUAT T2- BRANCH OF SEAWICE ere Ta. CEVAILS OF OTHER GOVERMENT SERVICE. U.S. OR FORE TS -@P SECTION iv "RELATIVES BY BLOOD, M4RRIAGE OR ACOPTIGR LIVING ABROAD OR WHO ARE HOT-U.S. CITEZENS : (Ds RELATIONSHIP. t. PULL NANT Chaat Eicstewiddley : . . oe. ees) . ot Mme Hemry : : Mother's, aunt ‘ eS BLS. a COUNTRY 1% BNICH RELATEVE RESEOES . Sdith Cavell, Nice, Alpes Naritines, France eo FRESUEERCY OF CONTact About 3 times a year, by mail S- CiTecensmep (Country) France . May 1957 ; OR COUNTRY IN WHICH ATLATIVE @ES1THES Grencta, Faris YII®, France FREQUENCY OF CONTACT Onee a year, ty mail Christmas, 1956 77 - Z- RELATIONSHIP 3. CHTETEMSHIP (Countey) é- France uit nawe (Last-Fiest-diddio) ADORESS OR COUNTRY IN WHICH RELATIVE RESTORS CiTizensnuie Country) S- FREQUENCY OF COWTAcy y- FuLL name (Leathe Firat-Widdle) 2. RELATIONS TP ADDRESS GR COUNTRY IN WHICH RELATIVE RESTOES 5. SPECTAL REMARKS, {fF ANY, CONCERNING THESE SEL ATIVES Tt have met each of the above relatives only ence in my life. © FinanCaas STATUS @] SECTION ¥ : ARE YOU ENTIMELY OLPENDENT ON YOUR SALARY? WAL VES [__ [xo 2 WITH U.S. CORPORATIONS OF BUSINESSES HAVING SUBSTANTIAL FIREITGN INTERESTS? { ]ves me. ite ANSWERED "YES." GIVE COMPLETE DCTAILS ON & SEPARATE SHEET 84D ATTACH IN A SEALED ENVELOPE, 7. DATE OF LAST CONTACT nen eee, etane nacan Hc RS STAD ED | 7. DATE OF LAST CONTACT LD0 YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTION Sita. MoM US. CORPORATIGNS OF BUSINESSES OR IN OR te YCU HAVE - 3,09 YOU RECEIVE AN ANNUETY ROM THE UNETED STATES C8 OPEteier CF COLUMSIA GOVERNMENT UNDER ANY RETIREWENT ACT, PENSION. OF COMPENSATION FOR MILITARY O& NAWAL SEaWICe? ves [2X4 xo f & IF YOU HAVE ANSWERED “YES” FO QUESTIGH 3 ASIVE, Give COMPLETE OL TAILS. 4 . S WITHOUT REFERENCE TO YOUR SALARY, STATE OTMi® SOURTES OF BECUSRENT INCOME NOT FNDTCATED BY PRECEGIAG EF Annual dividends on redest investments in stocks, credit union, and cooperatiyv > 19 PAGE SECTION ¥ Cha Tim SECRET . : é Tansee eMS,
fBhea Felies Bay eo jl “SECTION ¥ CORTINUEC FREM PAGE 2 G. RANR ENG PME ERT P EONS GET om cre eG AWE ACT OONTS KAME CF INSTITUT EON T.| AgHRiss (Crete, Stuce, Country s 6 : Clarendon Trust, Compary arlington 10, Virhinja Gave PARTIC ams, THCLUBING court AnD DATE ESE tM. OR PETITIONED FOR,: VES" TO QUESTION 7 ABOVE, % WAVE VOU EVER Whi @..0F VOU HAVE ANSWERED 4 @) SECTION Vi — : Citi ltnsaie 1. COUNTRY OF CURRENT CITIZENSHIP 2 CHTAsE SHEE ACS TREO BY + CHRCA (EP UNE: USA . [XJ overs [J wseavess (Ll) orace (Specityy: 3. MAVE VOU TAWEN STEPS TU CHANGE YOUR 4. GIVE PaatecuL ans ’ PRESENT CHTUEENSHIP? © T“Ders EX] xo . . i : ANGICATE PRESENT STATUS OF FOUR APeL Lato (Faese papera,’ cert ete. } Vf yYOy waved APPL IEG FuR U.S, ZENSMIF, @} SECTION VEI EDUCATION 1) CRC FOR Meter ok Livet OF EDUCATION ATTACNED . . po fees TheAN MEGH ZoMGUL BRaAviAatE [ewes ter re hes Gh eke EP eM HP EeEE KOU FL AOe GRanus PE 7 {4 Sevres uare OF Gare annerait [ frrace. Oval So, GR COMMIT ELE AL SFHOOL Gea ATE [XX] ence ae SENET READ ENE TH WECHA Bs CHER ED CORTES CURTIREREES is A STEROLS 2. COLLEGE Ow ENE AST EY STUDY Sum sel? DATES ATTINULTD Mae wesis baum te SEM OTH URS, COMPLE TEO (Speceéyy) NAME ANC LOCATION OF COLLEGE OF UNTVERSETY Graduate School, Georgetown Fniversity notlt COMMER TAR ANO SFE aL ide SCHOOLS TRaADl. NAWE OF SCHOM GW SPEAR ET ATION stupor @. Mi Ta@e TRALMING (Full gine duty in specialised achoods such a8 Ordnance, Intelligence, Communivativas, ete. regi ten Ne PP . * DATES ATTENDED NAME OF SCnOok STUDY OR SPER PALS 2 ATION ~ es ts bee FRAIRING ACT ENDICRIED AGOVE &. CTHER EDUCATIONAL oo SECRET —_ 3 i ogee wr a r i TERE Bo as
inoacate & aay bivices wm Parra yoy een tent PNMOUCATE Tere, CMe Filled Inj . CVaTUMUED FROM PAGE & ant tei AuTHoR (On nat Yyubeat copaee aalese regiesred), genecet interes? seb F REST AMY SEGMIFECANT PUBLISHED BATES ays CF werd wy PUBLICATION BATE. aad WEE OF aches (hone fie tian, avaentifia artecles, eects, nevele, ahort storaea, ete. 3 WAVE UNVENTED AND Stary SuETHTA OF NOT TwEv ARE PATENTED REST ANY PUBLIC SPEAKING AND PUBLIC RELATIONS -EXPERLENCE ar an experienced intel lizenee briefer. ACADEWIO OF Papaenaes ASSOCIATIONS oe SOCTETIES img ome icH vou ARE xoe on WERE FORMEALY a + LIST avy PROFESSIONAL, WEwVAT a. LEST SCADEMIC wONORS BO, waARE es ‘eriber, British Interrlanetary Sec vesoeiate manber y Arerican Astronautical Association, ! SECTION Xt Ke ORGANTZATIOn WORK EXPERIENCE = Since AST COMPLETION OF A PERSONKEL QUALIFICATIONS QUEST OWnATRE ety 9: the ordome |. weeicaes DIVIS1ON/ BRANCH OF ASSEGNMENT i- TCLUSIVE, “paTes ‘(Froa- iNoy 1¢h9 = Oct 1951 ya. NO, OF EMPLOYEES UNDER YOUR rec | i SUPqRvESeON i Ge DE SCRIFTION tarpets. = U. OPE Ss /3 = Desk intellirence officer . SPECIAL SIsrvign Pama _ Soviet sesk officer é 3 3th CSCEESEE, ereraticnal plans arainst S$ Far Eastern Trepared, conjol ntly wi pivess ia? URANCH OF ASSIGNMENT it. INcuusive Bares (From: and Yoo} (Ost 1951 = Dee 1953 3 doputy chief, t then chief Dreier am Fas PoSiTion Fire ba. NO. Cf EMPLOYEES UNDER YOUR DIR i SUPERVISED! eer 7 Branch ceputy eh ehief, thon Tranch chief DESCRIPFION OF CUTIES i : i t { ' ! 18. Surervised and directed SA rians and rrojects tarveted againat. Soviet Far East, ae T SFEFCE/OIVI STON/ RANCH or ASSIGNMENT 1. INCLUSIVE DATES (Frome and Fos) SSR Iooe S/PR ~ Chief A Jan 19S) = Dec 195) 1 i i : i i SUPERVESION Cal FIFLPION FOTLE 4. NO. OF EMPLOVEES UNDER YouR EreEc? j special defector | roject LO. DESCRIPTION OF DUTIES re H 3 } i i SUPERWES#On EL9Q. SFRICE/OtVIStUN/ARANCH OF | Der/Sr - NA/SR . OFFICtaR risttiog YORE ; Chief INCLUSIVE, DATES (Fram s94-Tos ) | Feb Feb 1955 = Mar 1956 NO. OF EMPLOYEES UNDER YOUR OLRECT ce : ¢- CESCREP TION ssects based in | Direct and supervise field p i acainst Soviet Far Eastern tarsets. pt tMCLUSTWE DATES (From aad Too) Mar 1956 = dun 1957 f t , [Soviet Hrahch Deputy Chief QEFEC T&L POSTION TETLE '@ NSO, OF EWPLOVEES UNDEA yOoUR DIRECT SUPERVA SHON Cl. Deputr chief of branch @. DESCRIPTION OF DUTIES ssist Branch Chief in. gevelorrent ane >=araronont of all [}based | (Use addi tional ‘peges if vaquired) creration 2S against | ard Soviet iy
14-00000 SECRET . re ! (Wren Fitied in) @ | SacTiow Kil [oF i LPI . : » NUMBER OF rrr BAP EMCEATS cancluding apouse, ete etm acme wUMBL® OF CHELDREN (including stopch's tdrer ‘ : F and edipted chiidrony end af MARR : parents, efeppaerents, sretet ) 4 , E unmannred. WMO ORPENG ON YOY FER BT LERST 306 OF TEER SUPPORT, OH, CHILDREN owed a6 wean wROTR 2h YEARS OF AGE, an aR BOT BALF* SUPPORTING. ve OF AGL.anO_ ARL.BOL PROVIDE THE FOLLORIN saebrasonsate SAS RG LIS RAT ‘ . . Papor T1OwAL Comment ANO/O8 CONTINUATION OF PRECEDING ETEMS . ' : ry nd : - Z a —_ _ DATE COMPLETED a . SIGNATURE 5 Aurust 1956. ; . 4 a ‘ ° Loy a SECRET . ed 6 » * ee : oh ,
Rea 8 0 MG yA PEE EE ANE el 6A ARISE PAS MEPL REI SES ETS OT a Ta an oe . : Ne tame at, wt Eh 4 - roe tage ra ers “pews ee i" fe anal aye pte oyun te 8 . OE I ees APs aes ie Ue 5 1 8] i Hk its li wl LEE ream wo, +: ape 1048 903 ae SEALE mar stem at " PERSONAL BACKGROUND « A PULL HAM bar, LU oh - B, 0, B ney. ~ a 4 S Pan a te aL Answer all questions a apy If question does not apply write “nat able.” Write “unknown” only [¢ you do not know the engwer and counct the answer {rom personal records. Use the blank at the end of this form for extra details on any queation. of questions for w you dé not ‘have sui : ’ ve . Me Me ’ vepead vee ee mm tes AHN gn hone ae Sess ebrer ion bs daha ae < “Aaieas} : whee “area we aE PRESENT ADDRESS a 4. Pu NICKNAMH — weuk? OTM Manns HAV You vssor OME __. Lageeyett oF i a pare or wars 20 lit Mitsace or ame BALTIMORE, Hh, USA. ee rarer — 6 — me mee YES. oy wae Sie cane Nor. ALE CA BE coun rititase, pe BY NA ra i . 16 ds KRG Babe pe . ae TORALTZATION CERTTS TCA’ Bate ap, ORES ore at — teen HAVE YOU HAD A PREVIOUS NATIONALITY? HELD BETWEEN WHAT DATES? wor, GIVE PARTICULARS
ne EN CER SORRY TERETE TG . H | ' Pa Tie do cetenens aaa ea Ca: ee ee oem as Ne = Ngee ee Ae 27 “wt os _— RAAT VERA .. a. - % : ed, Sapaw “BEC. a. PHYSICAL DESCRIPTION | ma ten 98 eH pees SEC. 3. MARITAL STATUS a swore YES - manny —s prvoncan : ° CF YoU HAVE BEEN MARRIED MORE THAN ONCE — GLUDS ANNUL- B. WIPE OR HUSBAND MENTS —~ UGS A SKPARATS SHE2T FOR FORMER WIFE OR HUSBAND GIVING DATA REQUIRED BELOW FOR ALL PEEVIO US MARRIAGES) NAME OF srOUsH Nor Appice PLACE AND DATE OF MARRIAGE BIA (OR HER) ADDRESS BEFORE MARRIAGE ee : fa & Rea Gay Gute Guaairg LIVING OR DECRASED DATE OF DECHASE PRESENT, OR LAST, ADDRESS Dave oF mort PLACE OF BIBTH - “erent nine recep i a Ip BORN OUTEIDE US, INDICATE SATE AND PLACE OF ENTRY _ £ CXTIZENSHIP WHRN AOQUIRED? emt j OCCUPATION —- : LAS? RMPLOYER EMPLOYER'S OR BUSINESS ADDEzsS nc ; MILITARY SERVICE FROM —_____. TO BRANCH OF SERVECH - | COUNTRY _ DETAILS OF OTHER GOVT, SEAVICR, US. Om FOREIGH i ta eat wecenparneavenmeiveta « 5 OTRAS AGT URE bed a, Re ert saat alate ee
14-00000 SEC. - 4. CHILDREN OR DEFENDENTS. Cactude partial aependenta) AGB. CIYIZaNSHIP _ ADDRESS ___- —_ 2 NAME . RELATIONSHIP rm BEE anomie LIVING OR DECEASED LIVING DATE OP DECEASS | PRESENT, OR, LAST, sons 1 $F, BALTIMORE=/9- H- USA St & Ba DATE ov amr 2 HOV 1993 prsce op meee ADA poms ovrame va. peproata nara ano Pisce or mwray — 0/4 ornare USA __ wien acquire? BigtH WHERE? — OCCUPATION Auto DALE? user EMPLOYER Gast END AVID co- RALTIMOSE f  RMerLowne's OR OWN BUSINESS ADDRESS 505, qh AS KL WY, BALTIMORE ty WsA. A , MILITARY SERVICE PROM j4Us_. To 4g BRANCH OF SKRVIO8 Agty AVIATI cal COUNTRY oA, Gt Beran DETAILS OF OTHER GOV'T SERVICR, US. OR FORZION, axc. 6 MOTHER T (ave the pase snort TOF TEpOOT 4 FULL es . a ae Te ee So LIVING OR peoeasebDeCEAREL pare TR OF DECEAGE 5 Det MIcause “CANCER  pRESENT. OR LAST, spread — AV, BALTIMORE Hh, sa DATE OF BIRTH WW Ay 4 1900 mace OF BIRTH Bonavs, DeAME, FRANCE G rCZkNSHIP oA wires ACQUIRED? _1921(2) WHERE? BALTIO. HD, Vea : 17 BORN OUTSIDE US. INDICATE DATE! “AND PLACE OF ENTRY NOV. Ki9 - =H YOR, .. a ‘ meh : : ste - od te ee Cet at Cae etch eae des #
"y fe annes wee oem te OCCUPATION MLLINERY LAST EMPLOYER emecelve wud MILL coe : BUYER EAPLOvIR'S OR OWN BUSINESS ADDRESE NOW Abt: MILITARY SERVICE FROM | ON To BRANCH OF SERVICE ——————— _ DETAILS OF OTHER GOVT SERVICE, US. OR FOREIGN. FULL NAME __- First "Misaia PRESENT ADDRESS ener ae SG Ne. aay “diate Grantey Civiexaablp FULL NAME ee __ - First BMiddie Laat PRESENT ADDRSSS —__.._-___--_ ct SEC. & FATHER-IN-LAW : 7 FULL NAME ii PPLICAL oe First Midcke Lass LIVING OR DECEASED DATE OF DECEASE cats® —_________—_- PRESENT. OR LAST, ADDRESS aoe Be. & Ma. Onmere ‘ DATE OF BIRTR PLACE OF BIRTH ee ‘ If BORN OUTSIDE U3. INDICATE DATE AND PLACE OF ENTRY ee CITIZENSHIP WHEN ACQUIRED? OCCUPATION —_——_—__— LAST EMPLOYER = t ' a ode fi wl we eet Set 1 oP! Rete Brag Be sg ED ge AP tee SEE .t _~ amacrine mes nse are Ait Treks aart senate nal ae 4
Z OR "ADOPTION, wHO EITHER LIVE re ABROAD OR. RELATIVES BY BLOOD, MARRIAG WHO PETE nga UNITED STATES: ee a _HENE pt nate romsrie GREAT: COLE GB ft) ‘ . * i .4 { 4 : i y MOTHER-IN-LAW FULL NAME _NCT_ —H PPL CABLE — sr ee ee . LIVING OR DECEASED ____.-____. DATE CF DECEASE Cause ' : ! PRESENT, OR LAST, ADDRESS ~-—.. = ee : at. & Bo aneg . Seats Couns y. DATE OF BIRTH _ PLAGE OF BIRTH — a F* i Iv BORN OUTSIDE U8. INDICATE. DATE AND PLACE OF ENTRY pune en ae oy ot ' CITIZENSHIP _...__.... WHEN ACQUIRED? _. WHER? . 4 cig Gsate" Gvuntry a. ats ee tae bec A Wie Gave Blan PO Sas. wei & nanan erate > ty :) re : CUYRLBCMEP - 3%. NAME ee ee nce __. RELATIONSHIP = AGE — CITIZENSHIP _.-....—~--—-- ADDRESS — a nn rene Bt. & Ne. city arate Counter? 7 Sere FeSO ST RELAT TIVES BY BLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE OF¥ ‘ THE Uesfor OF A _FORKIGN GOVERN MAT. i. ANE eimpe | ONSHIP CONEIN AGE ,3Q USA anuness NOB, NORFOLK, | ALBIN. b, sab Nat Lea Senn tle lt . — CITIZENSHIP An . & No. : TYPE AND LOCATION GF SERVICE UF KNOWN) | 2. NAME ~~ — RELATIONSHIP am AGE q . . : ' : CITIZENSHIP 0 ADDRERS ea i : . aR. f te. _ Oty. ' €iate : TYPE AND LOCATION OF @ERVICK UF KNOB) nen enee —. RELATIONSHIP —..__---—_ 3. NAME ! au i CITIZENSHIP —-—-— - ADDRESS ne ene ee et : as & Re. our + AEE hs ankle sees VR able So TYPE AND LOCATION OF SERVICE oF KNOWN) -. ~ $ 4 -&B pe dem te ab eee nme ee net rece cela gale earn mnt nena ina! eee Redan ree elt dies Sakae ates Bison neat saittne caters Pann BR Ty here opti les wae eel die wt
14-00000 ee Mita ete ‘Pp Ps Bs oy eda eee Tm aT —_ 7 Ser ee | Ss egpis ag De #43 . BALTIMORE, nd, U4 SEC. 12. “EDUCATION oh |. ELEMENTARY sree He Nes D6H Se. spac Pr HK eS VILLE, Ad, A ot OF DATES ATTENDED Nb0-34- 3)" _ oRaDUATS? YES — wan SCHOOL Lowa Hiak, How CacH, ADDRESS MONTREAL Ove, CANAL v ADA DATES ATTENDED —31- M4 GRADUATS? ES _Ofo Wiults COU, spores HONTREAC, Giie CANADA, i DATES ATTESDED Avo: Quy ‘DeOREE “NONE : 7 oe a vee ee Ha eae ae t p coumar = 12. ot bo “SEC. 13. MILITARY, NAVAL OR OTHER GOV'T SERVICE — U.S. OR FOREIGN , oe __U2A gy ____L/\T FERNS: “per us come gec.[ | _:431300 HONORABLE xe: Ice _Evsred, 21a REMARAS: RELQUTIVE SARVICE ROARD NUMBER _A- A __ appauss HAR TFCR' >, CONN. i et 1 EP RAN EL: CUVR AB AMON REC. 14. CHRONOLOGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT FOR ALL PERIODS. INCLUDE CASUAL EMPLOYMENT. INCLUDES ALSO PERIODS OF UNEMPLOYMENT. GIVE ADDRESSES AND STATE WHAT YOU DID DURING PERIONS OF UNEMPLOYMENT. LIST LAST POSITION FIRST. prom [SAVE ro 20 SEP ug . EMPLOYING FIRM OR AGENCY __ DEPT / Any apparss SCD GHG FEC Aro SEC PUstr DosTHa sre SAN FOANK ISCO) Us ‘eb? ke smmere oe Gainey KIKD OF BUSINESS CIVIL CENSOR See NAME OF SUPERYEIOR sa KURT. SPAULDING TITLE OF JOB LLAISiN ‘a CFFI ICEX suany 25) yea MONTHS YOUR DUTIES INTEL LintNCe Ay NALS ak Stents Coopbinatoe a lib wren Cert a ne KA Fee SF eg ésings awh, rowed (MiL7AR REASONS FOR LEAVING 2 RE HM rrom if if “2 HA. ro 5 AVE Ly . EMPLOYING FIRM OR aGENcy ———DEPL / ;
14-00000 __ KIND OF ‘nusinss ¢ Scly vl iL _cENSoasH Py p. NAME OF BUPERV nes lags  eca~ oF } TITLE OF sou DEPY ITY CHLEE,. Neus Ase haLany 25. [__ Per _MONT) H- YOUR DeTiEes Hest. hie? _& fo SYA ps Al fred. PHS vn Sepa "REASON 8 POR LEAVING LENDERS HIP SECTIDAL - tL HUINATED "FROM ee Noy at To. >) a 2 ar ee "EMPLOYING FIRM OR AGENCY Pe PT ¢ Mery i - ADDRESS J f ‘ De ARLCFEL A reo BO = PCSTM: Here’ cB SAS FRANC SED ae ITAL ) KIND OF BUSINESS Chik. CEN HD NAME UF SUPERVISOR Roar.) Pau de Vi a TITLE OF JOR ¢ Hits ENSCESUIPS SuB-Srpsatany s2L pen AYONTH voun owras (perted fda censorship suavei lide we detachment nrasons you Leavine TEAMS CFEMPED TO HR IN 70K YO reow /2 HAR Fea JS. a ~~ “EMPLOYING PIMM OR AGENCY —— DEPT fd) rear ETRE . | ALDHENS ALHY . LAMAVE AGE _ Sete. piaastbyne L&E. Spain Enea ed a stu yraty] KIND OF BUSINESS CVE. AFEAINS ING NAME OF svemvitha ALIAKA. EIUNAKATA, " . NNTLE OF JOB - ese, Agu EDITOR. gacanys. Bing. PRR sgt. a your vimms Revise) Ary Manivacs, Regia! en Aas , REASONS FOR LEAVING COMbisSiONED, TaAKKFERkED 7 o AAP RAR ; rao HOV Ml t0 a ed _ BMPLOVING FIRM OR AGENBY 1 |. CATON CC CO ), LTD ny ae fs aopnnss OT. CATHERINE ST, HONTREAL , Live Es CAN BAW. KIND OF BUSINESS -DEPT._ST STORE NAME OF SUPERVISO. Bich y t - TITLE OF JCP » PloToat APA SALESHAti 52D... per WEEK | your pets 9 CL. _LAMELAS AN dd Pore SUPPLIES RRABONS FOR. LEAVING eter alae ie Hew. Wo B__ Acc EpTE b AD LLEae et ene meres wanton ate { nears i _ sammy on ge Enea OE a ah Sea: Fa Ay Rectan aT ttn ARE aL RAO otal ei sinners ae anc enmaseiatattmcatesdetl i i 4 . :
hs mance ES since Desmesea cea a Sate oe pitta menace \ : : 4 -- . 3 Set re To a anaes dechen wes tnepate ta et es . SEC. 18. HAVE you EVER BEEN DISCH ARGED oR ASKED TO RESIGN FR HAVE YOU LUF TA POSITION UNDER CURC UMS’ TANCES WHICE - EXPLAIN? GIVE DETAILS: NOT _APPUCABE _ oe OM ANY POSITION? 1 YOU DESIRE TO _ SEC. 18. “aive FIVE CHARACTER REFERENCES —- IN ‘THE US. -- WHO KNOW you INTI- M O/ (OIVE RESIDENCE AND BUSINESS ADDRESSES WHERE POSSIBLE.) 1 i ae Fitba ALLAare By “ap. aise Pees ibrel Moarerey Gab Rés. app, ZLbO COMbSds Pawo Alto. CH. Vfos fe eet ae. Mende ays. avo. ule At LiFe age axel, CAL ne ADO, WORTH. & KLAND.. Vv. ~ dd Touu CHEATHAM me oarayy JWR CREATHAN RGR. ADD. aes TAKA F repnedicw, Md... DE ees app. LELE: © "WUREA £ “REDEMICK,S iD. \ : fs a _ BAIS ‘1QcQeL Bus app. CULKSE. Nees wh a 4 Li ae A AS App. 105.3. KGVAL ALEXANDRU « Fido KY UN LMA see ann. UE. ByREAY. HOF _MoMes LOWs Semen: RES. ADD. annem SEC. 17. NAMES OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THRE UNLLTED ST ATES — NOT REFERENCES, SUPERVISORS QR EMPLOYERS -- (Give residence and business ad- dresses where poasibie.) Btrest sad Number cu state V4 ee 26C_E INE AF WSHINGTON bee. j* ie -_ 2 no St, AUKANDE:) —VAL— J a HOR (RAW eo DL AbEUH PA. - % : ‘to! SANE! BUS. ADD. BALTH CLE AY PRA f if PAL ES. ADD. ce een pearance el ce ce wrene naeeee germane eet ae em a I AS acer, a earemrertintt a LC FuAREN BIMEROHRE So NOE | : ee ADD. it AR ROU iHARTESED, SENAL. 8. kul oo ANTHENY.. A. \ BUS. ADD. a AK __ — nt rE mart NS ae wes. ADD. O83. ELFyte BALUIGRE, fib. ’ BRAYLORD Scene CLINE vs. ADD ERLISTE. WisHiNeroN DE.
74-90000 moe nate oe TSP RSS oe 2 gh ee egyee + SEC. 18. GIVE THREE NEIGHBORS at YOUR.LAST NORMAL RESIDENCE IN THE U.S, -» (Give : Fesidence and business addresses where possible.) ; , i ane of Street aod Mumiber ci Otate _ Y arf FRANK Dunner wagon, HARTFCRD, CONN, | : ve HARE bus ap. be tiliEy” HR KD, "QNN. EEE . No ite inne 5. KNOY sus ADD, &., FORK fo. HARTEORD , RATA: | SSE arg AnD. Coo <4 Abs Lous. _FRANKL She tet TT me nam enorme ohn a bates dies, atenar se, f any, act Beer STEGER), AATEC D, CONY! } i em ENS BOD ADD. Le CHK. Saieeeeeee vate -| ’ CORNET IS IES th ere 9 priate ea RESTS NRE oe, pecgeeee me y SEES TREE RIE Ys 2, sarmunrnetenanee FNRI, Toe Rate y Settee MAST Chis SEED , SEC. 19. FINANCIAL BACKGROUND A. ARE YOu &N: TLRELYy DEPENDENT ON YOUR SALARY? LES ie NOT, ETAT BOURCRS OF OFHER: INCOME Totem econ ates cot atte ren teen er cece TT on ene arse geese eer ee H. NAMEN AND ADDIZE3E3 OF BANICS WITH WHICH You tava accounrg BAL HORE MALU “ine OF RS TOWA. BAA A, —EALTIHOLE, PLD. c. HAVE YoU EVER REEN INO OR PETITIONED | FOR, areca ‘Kone ns 5) in OW? PARTICULANS, INCLUDING COURT; i RPE aetna ew etme nero nent erent th seen peony . OLVE ee CREDIT REFERENCES —. 1N THE US, Dd Lowame LCE'S ING | —— ADDREAS 249. te WLASTELN AY WALT: Move Mp. i. a name MONTGOMERY. laen anonzss HHI, C4Ky. ab He, Cab * NAME To ADRESS NN: Seem aed SEC. 20. RESIDENCES ¥OR THE PAST 15 YEARS " rrom 1933 ro 1934 yo, PeessTHAN Se BALINO be ub - _USA_ Gousuy . FROM 37 TO 234 4861 HARVARD Ay — V= HoNTREdL -0 E- CANA ba. f rrom 1939 ong 44h bi) _fOUNTAIN é& MONTREAL ~ QUE - CAN AG . Coantry i FROM 12y po Ha ue HLL EY. AD- - WHARTFERD. CONN. USA : cay @emere : ~ grom (44) ro 94D _ aie TARY SERVICE E ~¢—-— a rno UR no Peeoeur £908 $5 PAUL ST BAL LTIMCRE, HYD, Sacco ' PROM — i TO aC Ra Teg re eee sooieeeonteacrmemsartortee sau oermastaneteee ee enone omnnnen hase &rc. 21. RESICENCE OR TR tAVEL OUTSIDE OF THE UNITED STATES A. rromV/N EL po SEP ITED. ~PARIS. FRANCE —— VT Pals sy Pure we rioxllL Mel no JUL Ai AREAS Pevwsua_s SAMNDA 0 HIT | 4 neal Net ai? oy Pew 6 37 40 dul Me NALTRRR A—_cAa Ree aN Lo : Ais Se end RS AE ras Ener nat bis wipe: TENE i asad
prom OC ed ro Jaw {gus ' ' re etapa de acy usar ant a &o t ot | f ' “prom SEP Hels ro COLNE preren een eNNnAL AE EA TIES, eee nena emt ‘PASSPORTS OF OTHER NATIONS: —.— AND OTHER ORGANIZATIONS ADDRESSES OF ALL LZATIONS. OF yIna HEADQUARTERS OR SEC. 22. CLURS, SOCIETIES. ‘Lier NAMES” AND EMPLOYEE GROUPS, ORGAN “PORT OF, ANY ORG ANIZATION. HA FELT ETTES, PROFESBIONAL BOCTETIEA, UDE MEMBERSHIP IN, OR guUP- PHANCH IN A FORKION COUN- vee AT LARGE) Ranges CAs ob | o£ HE DATES OF ATES OF MEMBERSHIP: NOU dug - AN J4Ue, . 2 RESERVE creicety_ gis wus De — EA — | DATES OF MEMBERSHIP: OCT ug - PRESENT: —____ we ene _: me a Mame aad Chapter oath ah thin ae As tase th ental aE, Uc Pat Ee 5 Bl a aM ek Ae Li 3 ea ke Sor: : . oS acten SS hate tat -s sees 2 - inewiiinc BA site Wi te B or a 0 eek ate ea te eat ale ay nee ae rate eee
14-00000 - SEC. 23. ‘GENERAL QUALIFICATIONS A. FOREIGN LANQUAGES | (STATE DEGREE OR PROFICIENCY a8 “eLIOUT” “FAIR” OR: “FLUENT”) LANQUAGE ft VENT __ axap FALL wrrre FAIR LANGUAGE SPEAK Fe FLUENT psap- ELUENT VENT warre ELUENT _ - e LANOVAGE ——____-----— + BPRAK — READ _.._.____. WRITE — i LIST ALL SPORTS AND ROBDIES WHICH INTEREST YOU: INDICATE DEGREE OF PROFI- CIENOY IN BACH: | SUIMAUNG, SUNG HCCEMAN Hie FOCTBALL L- steR, POSEAAL ICE HOCKEY LAcROsoe VoLLevedt, BARHNTON: FAIR, HAVE YOU ANY QUALIFICATIONS, AS A RESULT OF TRAINING OR ZXPERIENCE, WHICH MIGHT FIT YOU FOR A PARTICULAR POSITION? Have AN ABNITY To were, Crue? EEPORTOLIAL ae CR SPECIAL REPEATS _WeltNG. . LIGT DRLOW THE NAMES OF QOVERNMENT DEPARTMENTS, AQENCIES Oft OFFICES 10 WHICH YOU HAVE APPLIED FOR EMPLOYMENT SINCE 193y: _ NONE OTHER THAN pEPr OF  ALMY Fok. o COMMISSION. _AS OFFICER. a TO YOUR KNOWLEDOE, ANY OF THE AHOVE HAA CONDUCTED AN INVESTIGATION OF You. INDICATE BELOW ‘THE NAME OF TUAT AGENCY ANT THE APPROMIMATH DATE OF TUE INVESTIGATION: MILITAQY INTELLIGENCE Dd iV, WAR dEP age +BY ConbucTEnD LOYALTY chton SOMETINE _Berwetn a A atl eee oo FER (Qu1 AND JUN Wud. - ee : ve bach fet fag att Pi cae aad Ea med rte Hs BARTER AB iui alicia be IR abn ltid Riel i ER al ad star Pena oe Agee see sod ateta” Fuca te DtheteVinaates ” asta Sere spe Eg Be ie tte Teeter it peateti fy oe
14-00000 ° ete Ae ah SEC. 24. MISCELLANEOUS A. DO YOU ADVOCATE OF HAVE YOU EVEN ADVOCA EVER BEEN A MEMBER OR, OR HAVE YOU SUPPORTED / ZATION WHICH ADVOCATES THE OVERTHROW OF OUR ' ERNMENT IN THE UNITED STATES? NO ~ TED, OR ARE YOU NOW OR HAVE YOU | ANY POLITICAL PARTY OR ORGANI- CONSTITUTIONAL FORM OF GOV: tence res ALE TA EES if “YES", EXPLAIN: ——---— L erephaneren DO YOU USE, CR HAVE YOU USED, INTOEKICANTS? __ NES ©. HAVE YOU EVER BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION? JF SO. STATS NAME on gore CITY, STATE, COUNTRY, NATURE OF OFFENSB AND DISPOSITION OF CABE: _ is _. If 80, TO WHAT eed seeoce eye oy ees asenanmontin e eNerreatNn te cnet ene cn armament . D. HAVE YOU EVER BEEN COURT-MARTIALED WHILE A MEMBER OF THE ARMED FORCES? If ANSWER 13 “YES,” OIVE DETAILS BELOW: yO SEC. 35. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: |____ RELATIONSHIP PATHER NAMB ADRESS Sy, BALTIMORE MD __ USA . oR. & Ba. Oey . Attar Coumizy ce A AEE SE eons eA SRE EATS SEIDEN ETT mae EMENTS MADE HERE- SEC. 26. YOU ARE INFORMED THAT THE CORRECTNESS OF ALL STAT IN WILL BE INVESTIGATED. ; : ARE THERE ANY UNFAVORABLE INCIDENTS IN your LIPR NOT MENTIONED ABOVE WHICH MAY BE DISCOVERED IN BUBREQUENT INVESTIGATION, WHETHER YOU WERE DEAESCTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EXPLANATION? IF 6D, DEUCROUB. if NOT, AN- SWER “HO.” . perce 8 ESSE Rhge ag hohe glare BA panwrets .- seem ate gy . etn ne
7 Bo 8 74-90000 : SEC. 2%. I CERTIFY THAT TRE FOREGOING ANSWERS ARE TRUT anp CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND I AGREE TRAT ANY MISSTATEMENT OR OMISSION AS TO A MATERIAL FACT WILL CONSTITTTE GROUNDS POR IN. MEDIATE DISMISSAL OR REJECTION OF MY APPLICATION. sO ; LEXENDRIA, VIRGINIA —~—dy and Stare = aw ac : ar, . > i US THE FOLLOWING PAGES FOR EXTRA DETAILS. NUMBER ACCORDING TO THE N UMBER . OF THE QUESTION TO WHICH THEY RELATE. SIGN YOUR NAME aT PSS END OF THE ADDED : i MATERIAL, IP ADDITIONAL SPACE Ig REQUIRED USE EXTRA PAGES THE SAME SIZE As THESE AND SIGN EACH SUCH PaGE . , : 4 covep ar A 3 Cs i- | HAVE NEVER HELD (A FULL-TIME civil AN JoR SINCE 1 ENTERED THE ALHY Dikeerty FROM 1 l= 1 HAVE NEVER = BOUGHT ANYTHING EN. CREDIT, THEREFORE, {HAVE LisTeD «THREE concede a —LWATH WHICH ot HAVE TRARK ACTED NOR AAL BUINESS, | | ; | [he~ 2 Aseurkey SUFFICIENT CREDITS Féoy THE a | | $e AT THe y HiCHIGAN = fo Receive A BA dE GREE, IN ABSENTA, WHILE STILL ON Acre seruice. oo Co : FLOM SEP up TO DEC 194 iL { COH- ») : PLETED ONE = SEMESTER AT TRINITY CoLLesé, J HARTFORD» CONN z “ 3 ° : i? . \ . . & 4 i ~ = a a me ete Me ndee Pe ee cate BT Se ot annmmeementinemtionne . we it: lt RelA cnn me RH Ce et ne nee st mn we en rena
* Instructions : | Nope: Information ggateined Aeféry i 4 . PERSONAL HISTORY STATEMENT a Answer all questioris completely, Tf. question does not apply write “not applic- . able.” ‘Write “unknown” only lf you.do not know the answer and cannot o , the‘answer from personal records. Use the blank pages at the end of this form for extra details on any question or questions for which you do not have suffi- cient room. . ; 2. Type, print or write carefully; Hlegible-or incomplete forms will not receive con- on. , ; : ' sidera HAVE YoU READ AND DO YOU UNDERSTAND THE INSTRUCTIONS? = = ; ; j . : . : es oF No. SEC. 1. PERSONAL BACKGROUND soaw HO. sep 1848 A. PRESENT CITIZENSHIP Telephone; - .~ rou, nance SL — oan: LE glo ee AME Mr. First Middis Teast t. Keaitiols) urs: Home: PRESENT ADDRESS —..___-. ‘St. & No. cay State Country PERMANENT ADDRESS S. & No. city Btate Country NICKNAME WHAT OTHER NAMES HAVE YOU USED? UNDER WHAT CIRCUMSTANCES HAVE YOU EVER USED THESE NAMES? HOW LONG? If A LEGAL CHANGE, GIVE PARTICULARS _ Where? By What Authority . DATE OF BIRTH __-____.. PLACE OF BIRTH . City State Country BY BIRTH? BY MARRIAGE? Country . BY NATURALIZATION CERTIFICATE § _._______. ISSUED —_______ BY_ ____ . : Date Court AT oo Ch : Bare . Country rs HAVE YOU HAD A PREVIOUS NATIONALITY? —____- . Tea or Ho Count? TO ___.___.. ANY OTHER NATIONALITY? ————___ Country HELD BETWEEN WHAT DATES? OIVE PARTICULARS — meen ntti ene GIVE PARTICULARS: HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP? i
Peete setae et Tet a a wetted | XSEC. 3. MARITAL STATUS 2 . E. UF BORN OUTSIDE U.S. WHEN DID ror FInst ARRIVE IN THIS COUNTRY? : La PORT OF ENTRY? mornin ON PASSPORT OF WHAT COUNTRY? ee LAST U.S. VISA Pace of tue SEC. 2. PHYSICAL. DESCRIPTION WEIGHT 2 AGE sex HEIGHT EYES aie ~—-— COMPLEXION _____ gears ee BUILD wd OTHER: DISTINGUISHING FEATURES —_ : ne . . WIDOWED Scene en A. SINGLE MARRIED __“S___ prvorcep STATE DATE, PLACE, AND REASON COR aL SEPARATIONS, DIVORCES on ANNULMENTS eye . ay (IF YOU HAVE BEEN MARRIED MORE THAN ONCE — INCLUDE ANNUT. , B. WIFE OR HUSBAND MENTS — USE A SEPARATE SHEET FOR FORMER WIFE OR HUSBAND ain a welsh ae One GIVING DATA REQUIRED BELOW FOR ALL PREVI: NAME OF SPOUSE — 1 ; 25 JUN 194q HI6~<OR HER) ADDRESS BEFORE MARRIAGE 105 S. Roy, > ALEK a ND : 8. & Na, reg Stare County vA LIVING OR DECEASED LIVING DATE OF DECEASE =... CAUSE — PRESENT, OR LAST, ADDRESS lelg 2e Le d. ESSE x fu Ne DATE OF BIRTH IZJu 25 PLACE OF BIRTH ELINNEAPOLIS, -M INN. ~ . Ry State County PLACE AND DATE oF MARRIAGE ALEYAND IF BORN OUTSIDE Us. INDICATE DATE aND PLACE OF ENTRY i ct ee, CITIZENSHIP US. WHEN ACQUIRED? a. WHERE? reg . . City State Country. . OCCUPATION HOUSEWIFE. LAST EMPLOYER = ee EMPLOYER'S OR BUSINESS ADDRESS Se : . St. & Na Cry State Coaniy . MILITARY SERVICE From — ~~ TOs BRANCH OF SERVICE Date Date COUNTRY DETAILS OF OTHER GOV'T. SERVICE, U.S. OR FOREIGN ee rs? mA
14-00000 AMO A mt Nini a eee Fe tl Monga octets * SEC. 8. PATHER-IN. LAW 4 OCCUPATION. eee. LAST EMPLOYER a ee ~ . ri. EMPLOYER'S OR OWN BUSINESS ADDRESS 5 : St. & No, City State =| Country . ie : MILITAR © SERVICE FROM TO BRANCH OF SERVICE seen COUNTRY ee DETAILS or OTHER GovrT SERVICE, US. “OR FC FOREIGN, SEC. 7. BROTHERS AND SISTERS (Including half., step-, and adopted brothers and sisters) 1. FULL NAME ; ( “PRESENT ADDRESS ete _ — _ Gt. & No, City State Country Citicenship 2 PULL NAME oo 5. ‘ago First PRESENT ADDRESS Ta ey es eg 8t. & No, City - Btate Country Citiransnip ‘ 3. FULL NAME ie fo Firat Biiddle PRESENT ADDRESS ce ees me St. & No. City : State reer Citinenship 4. PULL NAME Se re AGE PRESENT ADDRESS RR a ate re | Citizenship: 5. FULL NAME wg fag P ENT ADDR. erect teen RES ESS: 8t. & No. City State Country | Citieenship LIVING OR DECEASED ul vi N DATE OF DECEASE CAUBE PRESENT, OR LAST, ADDRESS Cane 1 IF BORN OUTSIDE US. INDICATE DATE AND PLACE OF ENTRY WHERE? City Hats County occupation PUBLIC. ipgr EMPLOYER _C L_OF Sj VTS, ADHINISTRATOR 1131. "K" St, NW, WASH Dc. CITIZENSHIP .. Us WHEN ACQUIRED?
\X.gE¢, 9. MOTHER-IN-L y.SEC. 10. LIVING. OR DECEASED LIVING. DATE OF DECEASE RELATIVES BY BLOOD, MAR 1. 3. NAME 3. NAME __-———_—_——_—__—--~ - FULL NAME . . “Fine —n PRESENT, OR LAST, apress 10) Se : : at. & No. ony — i DATE OF BIRTH 13 APR O0riace OF BIRTH LF BORN OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY et WHEN ACQUIRED? een nme, WHERE? “an anannomenenageremantare city State County CITIZENSHIP - OCCUPATION House wi EG cast EMPLOYER —————————— RIAGE OR ADOPTION. WHO EITHER LIVE ABROAD OR THE UNITED STATES: soroneseartert WHO ARE NOT CITIZENS OF ADDRESS TTT ae Btate Cuuntey . Bt & No. Cur AGE CITIZENSHIP —— RELATIONS HED ceerrnentermeremmrerstnineenennres ceamevennee ne “serena ADDRESS ee County CITIZENSHIP .———— Bt. & Noa. RELATIONSHIP meen rrr AGE ADDRESS ne Ter Terr al State Country &. & Na. Cuz - CITIZENSHIP RIAGE IN THE MILITARY OR CIVIL SERVICE OF XSEC. 11. RELATIVES BY. BLOOD OR MAR’ THE U.S. OR OF A FOREIGN GOVERNMENT. N ONE t, othey Yhau y Weed, RELATIONSHIP ~—-__---—- AGE 1, NAME = CITIZENSHIP ADDRESS —_....___——————-- &. & No. Cy ree ee te '“’YPE AND LOCATION OF SERVICE ar KNOWN) RELATIONSHIP —_—__-—_—-_-— AGE - 9. NAME $$ CITIZENSHIP — ADDRESS ee ee _ 5. & Neo. . Stare Oo TYPE AND LOCATION OF SERVICE ur KNOWN) - sneer RELATIONSHIP ——_______-—~ AGE _ ADDRESS erent Si. & NO eny ee en A OE I 3. NAME CITIZENSHIP ————__—_—— TYPE AND LOCATION OF SERVICE (UF KNOWN) .. $ NAME NONE othicth bag Nie RELATIONSHIP ——————__—--—— AGE ~-——-—-
~ ‘ MISCELLANEGUS —__ co A. DO YOU ADVOCATE OF HAVE YoU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU! EVER BEEN A-MEMBER Of, OR HAVELYOU SUPPORTED ANY. POLITICAL PARTY OR ORGANI. ZATION WHICH ADVOCATE THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF Gov. ERNMENT IN THE UNITED BTATES? OIF “YES”, EXPLAIN: ___ ee 'B. DO YOU USE, OR HAVE YoU USED, INTOXICANTS? Jee 80, TO WHAT _ ©. HAVE YOU EVER BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION? IF 80, STATE NAME OF couat, ‘CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE: : ene ‘ ttt Re '®B. HAVE. YOU EVER BEEN COURT-MARTIALED WHILE A MEMBER OF THE ARMED! FORCES? IF ANSWER IS “YES.” GIVE DETAILS BELOW: . . i See errant eepenaa cadnentternerenteiane: ‘sentra enptererine tro — “SEC. 25, PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: RELATIONSHIP WIFE avoness 16/9 _ ___/ £ OAD, ESSEX, | Hye D THAT THE CORRECTNESS OF ALL STATEMENTS MADE HERE- SEC. 26. YOU ARE INFORME IN WILL BE INVESTIGATED. ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE NoT MENTIONED ABOVE WHICH MAY BE DISCOVERED IN SUEBGEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EXPLANATION ? LF SO, DESCRIBE, IF NOT, AN- BWER “NO.” asp
14-00000 ° Pe ME mttaer caren nee Fon re ani RI OST me pena Oat greene: “¥ Prsec, 21. 1 CERTIFY THAT ‘THE FOREGOING . ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND I AGREE THAT ANY MISSTATEMENT OR OMISSION AS TO A-MATERIAL FACT WILL CONSTITUTE GROUNDS FOR IM- , MEDIATE DISMISSAL OR REJECTION OF MY APPLICATION. ‘USE THE FOLLOWING PAGES FOR EXTRA DETAILS. NUMBER ACCORDING TO THE NUMBER OF THE QUESTION TO WHICH THEY RELATE, SIGN YOUR NAME AT THE END OF THE ADDED MATERIAL. If ADDITIONAL SPACE IS REQUIRED USE EXTRA PAGES THE SANE SIZE AS THESE AND SIGN EACH SUCH PAGE, lh. tine & dager 2M, hit, rr A Que thee —_ Seat id Ley Sst sea a 13
®t gag MILITARY RecoRD ann REPORY OF srPaRATNS Cennricave ar seevice AOD IAB, . . ery ated are ewe oa ue ‘ one | SEPARATION CENTER, FLOCT Ma row uaran, wamduatos 7 Severna Fe Beale hee 2 meta nee we weg 780 sam 2 [ew tnene, ee g tact 2 eee foe nl ene eno eras 510 CC ee 6 ocanc) OT orn seven ana a at sneer ae coven ct lary e3stx ti, wan” —{EE8S) censcranie orricen 9335 $9, Set065 te sednecany PP A Tre te te rtm eae 10) erase rma coo tora Tete seen oath e Oe aerate We an viet 4 . Cg . ied t HRM ASY INTEL toence sevice i anon vauiag wae sertenes TE corres Ta sy aa SHOCK, #7 BELLING, MUDD! te SEP b6 JAPAN #9 ep & 18 Oeetenn on0 eycenenre bao anes tn i 9 ety aS juga “ase S08 a me ine TOUTES Ta yn toe Rane “Weresaa toower ~ see + ANOS met ee ee wea GE © yp aesnoe ia a: ui CERT FfCarE ar SENVICE , ‘thus a be lf hal 1b Ts Eat RULSTARY aeteee rat med SECTion, Geernad stare Aonernbly oeved tn webbre Pitted 6, Arve on the Somy of he Wrath dl Males srr 27 se 86 a7 cer bg: . SGrive ok ol ersnet ion CENTER, FORT Lawton, vasmneaten ta fhe a day ff Ot tosen 49 48
74-90000 thuerco RECORD anon , REPORT OF BePaRATION ff HONDRASLE Omchargg 2 SOD Come smescostion 4 5” we [ATE eee a S hewh ee be te seeeme ram Ponorable DHisebarge Thi th hs ceolilp Chat PE gay Fe a Aenby He ncrally i = ad freee Ae anita svete of lhe Maile Mirbs of emceveien Shes wlfiratt 6 wcaritedl asa Osh imeoos tied S Menuet and Balifat Serwie th thes vamloy, Grice se of ee Chad te da
ee COPY oe, STaxuary son 57--8Ov, 1947 US Ziel SEPVICE COMAEESSION TIONS: In order te prevent cei te cumaderatwon rf srur applie arly and eneiglersiv, °F En apylving for a spcehe Uauad § tr ret ce mee dy if you are appising for a WRITITUN esamincim, fellew the RAME UF LAAMINATAM UR Ail, GF Myotl hay APPA FOR . cic LG = OPTIONS) Gf mentaned in eee, sheact eyeey question an thre feres WII CH oeottim EME, Ptatiasyem, read the exemvtiation sano dises* pee BMH OM announcement) “PLICATION FOR FEDERAL EMPLOY NT Serseeeeerenennenenar rs eel mivtema oa the adime aicand myanting dienoutis af thre ap peacetoan, seu are applying ocean UNWRITTEN efamination, mat tine ap icenas Ro the ovhee oimet in the anticumeiment, Re sure to mad te Rbe same otice any of ber toems required by the anhouwnements Notify Use ofhce with wiack you Ble this. epgdication efane change in yeois adtreas,- an 60 NOT WRITE IN TRIS BLOCK Far Use of Ciel Service Comatssion Onty ¥ . . gq MATERIAL QRTERAD Ra Gstaad TARCE OF EMPLOV MENT AvruisD FOR (Clty and State) TA DATE Uf Tid PRION C] svewsrren . & : . : (wre sree: RETURNED a aap nd NOTATAM ES. APP. Rha. & wee tfesat cate) (Aficio? adfaden, af any) thease) Ef} Se a wr) Rai Weralbaw tan Fors Est i CY UF paar gbenoecke vy ioad, | ANG STATE orrres | Grane | EARNED | PREFER. | augue we : RATING EME | RATING ° . Gears Althea) aE ote k Mita, Gr OTS REMAN Coteros | 8s OFbICE PUNE | cbr UAE Pk averecececen anccennce| ance sancent{_} POINTS x | _aryland as een San Bn g CATE OF BMT (oionth, day, wear) 16. QO mannice ; | z te 4 gos ¢ at ests ae |e enemmensteenenanec! ce g ine we bOuery £0, 1924 og ep ees we, Cbewcee US itt z 4 02. PLACE OF BINTH (cuty and State: if buen cutaide U. &., name erty and countey) { . —_ , verylend ; [sims QS nail ation SHOES: (Br WEIGHT: settenennaeeeesencee ns ene ee CJ oases. ju. jo nares Pa fet LO. menes De drowmes | $4. th WAVE “PAE CER DEEN EMPLOYED BY THE FELERAL GOVERNMENT? KT veg CD ng Tats AN, : | 6 1 AD GIF LAST GRODE ANN METE C8 LACT Caney te cence tnt DATE ° | | | Cprand Thly 19 . : ~ 1S a) mar 13 THE LOWEST EMSRANCE SALARY yOu was ACcoPTE $2 73Q.. | cos cher IF YOU WILL ACCEPT APPOINTMENT. IF OFFERED: ER ESP + , Vous will not Le considered far any positien with a lower entrance Gd 8% WASHINGTON, BC. k) ANYWHERE IM THE UNITED STATES salary. i] corse rar unirra sais Be CAEL A UF 1G WILL ACCEPT SHORT-TEAM Abinni MONT 1) OFFERED, FOR: P99 9 BONTHS BYO € MONTHS 8 70 13 MONTRHY NOTE. Arceptence or refusal of a temporary short-teem appointment will not affect your oppo.etuniwy (a obtett a probatianal appamtment. Gm IF VOCAL ARE WILLING TO TRAVTL, SPECIFY: Cj CFLIE TYONALL Gc) ervey oY O CONSTANTLY Tt je important for you ta furnish ell information requested wot detel to enable the Civil fervee Commicuca and the ove af egencies to give you full croht in deteemising your Use separate Blwk for each peattion. Start with your vet end work beck, explaining plenty the princijal taake which perioda of unemployment. 16. By PT RATS presen . ou pertarmet in each jasition, acvounting tor all agenence geced mare than TS years age which re out pertinent te the works yrs Ore srgtying may be sumimuriecd in ote of more of the Blocks. pace matenally whole working fer the same employer, use describe euch postion, “You may incite pay pertinent tar ® Hf yenot cates eh @ arparaie tee & CERTAIN LOCATIONS ONLY, GIVE ACCEPTARE UD IF YOu WiLk ACCEPT APPOINTMENT IN LOCATIONS: asiigious, civic, welfare, ce organizations! activity which you buve porfortass, either with of without compensation, showing the munther of Sours ang eecks per in which you were engaged in’ such activity, ezpenence elmuht be deac fin the s,aces below in its proper erqquuence, fa) Uf yeu were ever emplovet in any position under s name different, from that shown in fem § of thie appicution, give under “Deacriptran of! vos worn’ for tach position, the mame used. “ (o) Tf you have never been employed of are now unemployed, mdicece that fact in the space provated below (or “Presene Pention,” : PRESENT POSITION [73 tH LWPDIUENT (month, veat) ree _10 PRESENT TIME EAACT VLE CF YOUR PHcuENT PUSTION TT ELASSIFICATICN GRADE GF SALARY Of EARNINGS: 1 in Federal Seivwe} : PRESENT. 8B PLAGE OF AMPLOTVENT (city and State) cies pe ot en ~ NAME AND TITLE CF IMMEDIATE SUPLRUEISIR RAME BRD ALLPESS GF EGALDYER (lem, organization, of person, if Federal, Ramee cepertment, bureau of oatabhisahmant, and divison) huwéeR AMS 0 -NO GF EMPLOYEES SUPERVISED GY YOU COS EPTIN AF YOUR WORK LENT. (CONTINUED ON NEXT PAGE) Kita OF ESS OF ONG ANIEATION (a. sewem [TBP Sum eine Gartner pemmact renee eee a. wholesale elk, insurance agermy. ‘manufacture af locke, etc.) . : . REASON FOR OCSIRING TO CHANGE CXPCOY MENT.
14-00000 @ BATES GF EMFLOR MINT (anantah, year) - op CAASP PLE OF YOUR POST ik Cla ICATION GRADE SALAD foe Lames, 18, CONTINUE . S CATES OF EMALOVNENT Caionth, peard PRacT Vue oF vauR POSITION cA EATON ERIE SALARY G# EARN, ae a WK . . : afin eralservice)| srantiws § 1a PLR _ Ga 2D. le & PAE OF EMPLOVMUNT (cety and State) RAME AND TITLE OF IMNLOIATE SUPER ann ae CU enero ae. anges ener RSME ARO ary Sf, sca EUR R Crim, cedanstatron, OF person: ih “Fececal, Rina GF BLSINE ny ro ro 8. wholesales glk, insurance agency, ame department, bureau os establishment, and diriason) manufacture of loc fosat stre. : . Pes hA-w an 2 - we iP fates aS pe} — ted GeoRTBnent BAC men an oF -&Ss,,4 te REASON FOUR LEAVING © Nor : 2 : on iSs pesca ; ee ee ees “Selea=an.of 1) tyess plotozrentic naterials 1 ena equigacntsie TONS bor, ol). types hisckesndetBite 2nd colar coticnp chure.ecuipmemte occ ennawveee=4 Gat in Federal service)| srautive § rat Ocha 10 tun 194A)... Fhotos chic tectnintank ack UF EMMOVMENT Coty 25 Stare} NAME ABD FITLE OF IMMEQATE SUPERVISOR “ontreal, ee Ee NAME AND ADEE OF 7 ‘fem, offanieastion, of person, if Federal, “YGNS OF BUSINESS OR OR ORGAN ATICN (9. g.. wholesale 2114, eneurance agency, name departinent, bureau or establishment, and diviaron)} manufacture of locks, ate.} Crescent St,ioatreah Pim as shotsoeorean Ame acoby PROTO FTE St een ames WoMaEa AND sun de EMPLOYEES SUPERVISED BY YOU . REASON FOR LEN ARG aed — .Darkneon ont anbiea, cot Aty..Ayus DATES OF EMPLOYMENT (manth, year) BAACT WILE OF TOUa POSITION CLASSIFICATION GRADE SALARY £4 LARRINGS. Ulin Fedoralservice)| staRtiss $ 10: cunt, FEAL Face OF EMBLOWMENT Canty and State} : NAME AND TITLE OF IMMEDIATE SUPERVISOR FROM: aon cnn eg re ge te A A BAME AND ALDRESS CF ENPLOYER (firm, organization, or person: ef Fudoral, KIND OF BUSINESS OF GPRGANITATION. (o. g.. Wholesale esx, insurance agency, name deparemen?, bureau or estahhiahmeant, and dis tason} manufacture of focks,e eee.) ean voor -erieemnnenenercmemmmnemnnananmmmnaal AUMBER AND KIND Of EMPLOYEES SUPERSISED BY YOU REASON FOR LEAVING CESCRIPTION OF YOUR WORK LP 19—aroae-4 Pulle-tires | eivilian pesition.
SALARY OR LARMISSS: eh CALETA de. ymonti. pear, tar, Be CLR UGi mo ey | STARTING §° Faow. To: FMA § FLACE OF EMPLOYMENT (erty end State) * = RAME AND TITLE Of 1eMED 4 SUPERVISOR | _MANWE AMD ACOAESS OF EWALOYER (Arm, orfanitation, or person:. af Federal | Kino OF BUSHES OR ORGANILETION (@. g. wholesale ath, insurance agency, name department, bureau oc establishment, and division) Mmanutacture of locks, ste.) , . ReneS OOF LOE raaEO TOU, | HUMBER AND FOND OF EMPLOYEES SUPERVISED BY YOU - a REASON FOR LEANTNG DESCRIPTION OF YOUR BORK nee, pa ceamination t vf Lrenuing teceeved, auch aa hours per week, Det i informatiog regard: ing acy tpeal service acheols you attended ig especially unportant, (Hatre _ PaKee a y de uest te give fy criptions.} is the apsce below, describe any training & {mot Already heted uncer Eterm 16) thet scat. u most offer y. Indicate ectual PL wipraay Tear DESCRIPTION OF TRAINING LOCATION Lense; “eustons;-seciolosy;-hew-end-~ histery and economic: arceresstany. : Tamed S-|-Deosd5-- ann-APhor,s-idond eah--- nee [once [ALEEG, Wea. Michigch $h EDUCATION. (Circle highest Grade complated): BAME AND LOCATION OF ust HGH SMO ATTEALED | . ' 2 3 a 5 6 ? 8 3 ie W 4} Rich eh Sckcel ef oek +re:] ft 2K CX) THE APPROPRIATE BOX TO INDICATE SATISFACTORY COMPLETION OF: | (2) SVSJECTS STUGIED IM KISS) SCHOOL wHICH APPLY TO PUSITION DYSIRED . Cj ELEMENTARY SCHOOR, [7] ss0e HIGH sew. Gel S£200R HIGH SCHOOL | Bro l i gh Brer aie rt vetoes h4 stor maior | CATES ATTENDED YEARS COMPLETED DEGREES CONFESSED © [SEMESTER (23 NAME AND LOCATION OF COLLEGE CR UNIVERSITY : apn | a ae | ee OURS _. “|= Feow to cay | onisue une | DATE one tene Sir. Geo Villicas Collage... _.... 2rinity.. College, Gonn, U,..-pehisen,. dor (9) LUST YOUR CHIEF RGRADUATE COLLEGE SU DATES. ATTENDES YEARS COMPLETED FROM Ta day 1 siGHT ALITENSES OP CERTIFIED MEMBCR CF ANY TRADE OR PRO jan, radio operator, feaches, lawyer, CPA, ote." FESSION (such Oe prhst, ese: Tae, gous Fea fee. {coo Pam! Us few, — — aren aan mails ah} J ES, ll RO Gk RIND OF LICENSE AND STATE: Fest ue CENSE OR CERTUICATE OEAR) veel onan OD. iF YC RAVE TRAVELED OF RESIOLS IN ANY FOREIGN COLI, UP NAMES OF OGL BIR s SCOSATES ANS LENGTH QF TIME SPENT TREAE AND le. ¢., mlitsry service, business, educa~ TLSEWRESE IN YOUR APOALICATHON SUCH AS: On (do mot submit copies unless requested) w ewpenste aN PES ISINCRS AND FELLI@ 22. LIST ANY SPECIAL SAILLS Yau & CHINES AND RQ. IPMENT YOU Tek REveUNGn, TERRE PATHE colentiric oR oROEESSIONAL Detents Public reistions 2g interpreter STO £11 cine equipt;teletynes; stort- Censer and revieu-editor of nre gs, rave-receivers & transmitters, radio end roticn-cicture fields. — ” SeORTHAND woe APPRONIMATE VUMBER OF BONOS PER MINUTE IN TYPING |. 1o-Gadend
14-00000 SE RLEENINGES Liet there gernece batngin the Unita States or Veristories of the Usted States wine a> NOE golatedt to you and whe have Asharte knowledge of ‘ea sted unser Prem 16 (ZX VPRRIE NCES Four Qualh ates end Stuees for the soutien for which wee are applong. Doe nut pepe dt nemee of eal : renege PRUE NT BURNER Ca ee A, : ; . nh ak MESS GE OCCUPATIO! . . FuiL RANE AGiee complete current addrese, spelt. and nunvher) DURIMERS G8 COCUPATION 1 oe . (Veshineton 26 nC) Gal. “Apt =--Rassuseen.-- diplomtie. SAG See Gearh 5. GG cecsceerenns Presidie of Fonterey 7 ; 2 BS. EO BSE cece OTL ce jp LRSEIUCLOZ. 0s. Mil attacko.... gota t Yutak 4. unaka te. RUuichinley. dve Vonolult, Tee GIG. ccf EMDICATE “TES” QH TRO" AMS OR BY PACING “H" Is PROPTA COLuem | - | Ledatiehedl. 2... : WCICATE “PEE” OM “ND” ANSWEA BY PLACING “A” Im PROPEN COLUMN | TES aod, eee eer OS way aweceey BE MESO OF YOUR PRESENT EMPLOYER REGARONG YOUR (OBC TOU AN CT PICIAL OR EM PLOVEL OF SRY STATE, TARR EC HY, COUNTY, CHARACTER COHAN PTO De OR MENICLOARAT VE prac gtrseetet onan -  scaramcane Uf your answer ta Veo,” give details in Pte 39, JG DORR THE UNITED STATES COLE TNSE GT OPEL OY IM A CIVILIAN CAPACITY | ANY BrtaTiNE VEN US ALLS ON MAHIAGES WITH WHOM YOu tik OR HAVE LIVED Watts TAF Pa 7 x ff your annwee fa Yes” show an deem 39 for EACH aaah relatiwe CED tall mare, (1) present audrene: CF) relaginnatip, (8) Department or nt fy wr deeds employed, ened (53 bred | CALM A Abad Mea SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCE oS ASE you & OTIIEN OF oF PO ¥CcUu Gad, ALLEGIANCE TO The UNITED STartst . - | Xx 27. a@l YOU NOW OF WALT MO Pera REN, & wengee OF TRE cowMUNIST PAGTT US A ORANY COW UORISE OR ESTATIONT 0 | . f Se APE YOU NOW OR MAVE YOU EVER BEES, A MEMDER OF A FASCIST ONGAN. . tratiany an see ee m. YOUNIS OR HAVE WNC ESER ITA wiwethorauvauswararina i ne preference es @ PEACETIME VATAWAM who has ASSOUIATION WON EVENT, GSOUP OM COMUINATION OF PERSONS Wien apf - ° Oe ars Obit. a ase Disab nn VET. - OF A LESATLE U VETERAN, fe 99 the ATEZOW OF A WAR OR CAMPAIGN VE TEIAS, attach Veteran Freferemme Claim, VOC ATES TRE QVEETHRS WO OLR COS HONAL FORME OF GOVERNMENT, . OR CF AN ORG & STATION MOS EMEA GROUP GH COM OF FTKS or AOVOCATING oe THE CO WESSON DE acTse! £ FoR oe ae THEIR RIGHTS MMES ThE CONSTITUTION OF 7 ING TO ALTER Tht FORM OF GCUERNMEAT OF Trev ITED: SUTUTIONAL MEANS* ft your answer te quedtion 27, 2%, of 3% above ds “yee state in Efrem 39 the sanies of all ach onganisanons, asneratiuns, Movenrenta, groups, or coinbartatied of pertans and darter od membershin, Giese aunplete detatis of vour activeries therm and make any maplanagon you dvaire tegarding our menthershio ve activities Phare: fal CSC Form 14, tagett es with pref apeshed therein, Tf you wre g WAR-TIME VETERAN net cloiming 4 Siegbliity preference, we shonin! Nay sult your dicharce with this appiicatian, Peclerence will he tentatively ceedital ku you aml if apiennted, pene wll be eecpsiped te a brat fo the eppmnting Often garot fo entey on Coty, offic) evitence of separcas fine front active seewce in the armed forces of f Bie 27 (ab WERE YUNG EVES IN THE UNITED STATES MILITARY OF PAYAL Be AE i OURING TIME OF WAHT Jee. (DH IS THE WORD “HAONORARLE OF Lee ¥. IN YOUR Disc ager OR ARATION FAP DISCHARGE TIS EE YARATIUS: . - Cs Was WE PTREDR MED ONAN Ret ieE Ft JLL-THAE CA anarany FAY OND AL tC at cence ee see | DATE OF ENTRY ON ANTHY TaINTO EiNee | CSTE GF SEFAKA TION £2 Birk ealiOAS BD SINCE YOUR 1TH SIRTHOLY, Mayr YU EVER BLEN ARRESTED, INDICTED, OR SUMMONED INTO CONST ASA DFE NT ENR OCAIMINAL PROSTESING, ON COM ICTEO, FINED. ON PMES Ira OR BLACKS ON PRORATION CH MAVE . VR! EVER AELN ORCS RED TO CLOSE Balt OR COLLATERAL FOR THE VIOLAS NOLIKE REGULATION O® CROINANCE IERCLUDIES MINT GATIONS Ftc APINE C4 PomeE rune UF AS OR LESS WAS woh £20 LOL5 | __iPrege BRANCH VF vit (Army, Navy, | SLHIAL HO. GS none, five grade oF Marine Corps, Coust Guard, etc.) rating at tima of separation). 39. arr youre PUPING PEAcET: THOM AND RECS A Rar nen Wi le aanasssne sess weeeeetweee Uf your nnawer is You," fiat all each cases under from 39 below. Give sn each case CP) the date: (2) the nature of the offense of wdlainin, (it the name and focation of the court: {4} tho penalry imposed, if any, of other dispoetion of the ff appointed, your Angerginttea will be taker, tase, A A gn nnenp enn SE. HAVE YoU TNE R BEEN DISCHARGED O8 FORCE TO RE FOR MpaCON. DCT CH pNcerire weypony FROM ANY SOUTGGA? if your answer ia “Yes.” give in ftem 39 the na address of emplover, dare, atc toasen 6 ¢ach case. BADGE OR service RiDts (Bi ARE YOU & PARAGLED VETORANY Lo. Ff go, ame you Nave not listed pour feeen 33, asplacn in beers 88 below, (CO) ARE YOU A VETERAN'S WIDOW WHD KAS ROT REMARRIEOP (Dy ARE VOU PHP WIPE OF A VETERAN CRO HES & SPR OCE COURECTES i EASARILITY Wooton heh ALEPIES HIMEFOR CL OR Ior aye weeps THIS SPACE FOR USE OF APPOINTING OFFICER ONLY The information contained in the anavere ta Question 27 above has heen verl- 2 §9..-.. AY THE GS Cavite SERVICE Com MISSIOY FROM TAN CEPTING CLL SER ICE ASPOINT VENTS © Af your answer ja Ves," give cares of and fertonn for iS mm $9, auch debasrment in lite : i i i ME MaVE YOU EVER BER BR BANGICAR DIT. ¥3. HAVE You ANY Peysiciy WHITH SHOULD BE CONSE Us your amamer es" ae conipite detns in tam 3? a? Consideration can be Kon te pour Ahysicad Gtness for = xX aba sad. fed by cumparison with the discharge certificate Uf ..c.ccsecececoee HOO yOu Arcee AN tN OF COLL VERE GO. ERNVENT & CA ANY ALTIAE MEAT Ai 8 iT ARY a AW AR Sen cn STSER Cove. INST} Gf pour answee is Yes, fe tle gumbese tre wh. SETAE ARSal Uf mere epece te reguirad wee pa mi examination Ute. Attack to un: of thus arphioa tas. . "Before signing this arplication check back over it to make sure that you have answered ALL questions correctly. L CERTIFY chat the statements made by me in this application are true, complete, and correct ta the best of my knowledge and beiel, and are made in goed faith, False statement on this application . Room SIGNATURE OF APYLICANT . is punishat ible by tas w S. Code Siga ynur mame ia INK (oue > fame, initial or! is, aad surname). If fernai¢, Title 18, Section op rd : . f4ise of Bice. and tf nen _geh Nour own gioco mame as “Aira, Mary L, Dee’) : \ 3 an : te: - ee - , + BS COVERAMENT PRERTINS OFFICE «© 1G —~ARNEE-B re es
‘ . ae — a 7 V7SILIT.QY TRAINING Ceontinuea) - Rating received at end of thts treinine: ee 4 Second Sreeia’ Service Schoo! sttenced: Locetion: Fort Snelling, ll, incesota Dates Attended: Jan 1944 sats 1946 : Rating reteived ct end of th's trsininy:Second Tieutensnt 2 Soecis!? Service Scheolf Crier es battle, military What were you taught in Seeons terns of the Japanese sreed ferees, . Givil effsire, Militery sdrintstretion cf ocenpied sreas, propuranda writton. , Duty sestgnvent after this traini Student; translator: instructor : rerticles, onlinan- What did yeu do curing thie euty sssiengent? Tiunalsted news: Pou cas, SC.F dirnetives,-ete, | I mee instructor's suldes TE2aS.6 for civil affates cou
14-D0C00 “SECRET. ' dats: 13 October 1963 MEMOVANDUM FOR: Chief, Personnel Security ivtstoryOttice of Security SULT (P): Your Number: 37833 e 1. In coapllanco with paragraph four (hj of your latest memorcnadum, subject as abova, clearance, ta cover tha jollowing proposed change in Subjuot's status - j { ! i and/or uge la hereby raquested: | H , veges corm eter taanie Cage cn bar ne maenpim mummers ameenineince mam nee ache as ! Ops Officer | Position Title | Ops Officer | | GS-15 , Grade | GSa15 DDP/SR | Orgp Lez ignation DDP/WE Foreign Field i i Western european Area | TeExternal Ops Station | ' pen cpt antag ey at = oe 2. 3: bene eran a oe aed ee ar ee Ahn ec tt i | | daacyusrters i i { | | 1 | | renee ene emer en nfs Ane mene fsuremam-t crmtn min Changes cther than epecifiad above: Ths proposed effective date ot this change is: 13 October 1963, (f  AGSEPH 8. RAGAN Chiat, Contract Pergepgel Division Date 18 oct 1963 ip | 1 lyos been, granted for. Sect teak dt by this request vs seurily ivision OF Chief, Persc SECRET
14-00000 an gyn ™ - | - pr (When filled in) ve “ DATE: 31 July 1962 MEXORANDUN FOR: Chief, Contract Personnel Divisicn : . ATTENTION | 2° staff Agents Branch ” FROM : Ghiet, Personnel Security pivision L. Reference 1s made to your memorandum dated 2h July 1962 in which a covert security clearance was requested to permit Subject's use as & stare SR in the capacity of Operations Orficer at Agente Gs-14, by DDP/ 2, This is to advise that a covert security clearance is granted for the tise of the Subject, as described in your request as set forth in paragraph 1, above. 3. If your office should desire at a later date to change the status or use of this individual, a request to cover any proposed change shoulda be submitted to thie office. *. hy “This clearance becomes invalid in the event that Subject's services are not utiliced within six montha of ‘the date of this memo- “FOR THE DIRECTOR OF SECURTTY: We A. O860rne ~~ SECRET (When filled in)
to list the moverent, grou gation and det subversive, or commission of ants of force or violence to deny others their rignts undor the Constitution of the Unttcd States, or ag sceking to alter the forn of roverne ment of the United States by unconstltuttonal meang.- — PERSONAL HISTCRY 3TATELENT . (Appendix 1) , ee ate EAD ete? . ‘ e . . Listed be low are nanos of orrantzations identifted-py the Attorney General, under his responsibility pursuant te Executive Ordor “855, dated ?l- March 1947, ic names of vach foreign or domestic organization, associstion, P or combination of persons which he, after Appropriate investi. ernmination, dosignates ag Totalitarian, Fascist, Communist, or ag having adopted a polley of acvocsating or approving the. Sach appliennt must review tho follow ne liat of organizations -for certification ut : : Purposes, and sienature on the lust page, Abrahen Lincoln School, “hieags,- Illinots ; 4mericun Association Por Recanatruation ty, YWurostavia, Ine. American Committce for Protection of Poreien Born Amorican Committca for Yusosiuy Ralief, Inc. The Ameriesn Coznedi for u hemoeratts Craceo, formerly . ; known as tha Greek American Council; Greek Amurican Comittee for National Unity Amoricun Croatian Congress fmorican Loam Against dur and Faseiom American Learue for Pauea and Democracy, succossor to’ Ancrioan Loague Aguinet Yar and Feseism ane orodececsor of Anoriean Penee Nobi ligation ‘ ; : american Patriots, Inc, Arcrican Peace Mobilizetion.. : . . émerionn Polish Labor Council ; american Russian Institute #4 Sin Pranstoan ; , Amcrican Slay Congross émertoan Youth Sonpress american Youth for Democracy armonion Progressive League of Amerias Association of German Jationula (Rotensdcoutsche Vorcintzing) fuslondOrgani zation der J3DP, Qvergeca Pranoh of Nozi Party Black Drazon Sooies; , . ’ Californi, Labor School, Ine., 215 Market Street, a : San Franciseo, Culifornia — . Centra? Council of éneriean Yornon of Sroatian Deseent, also known us Central Council of smorteon Croatian omen, National Couneil of Croatian Women: “Sentral Japanese Association (Beikoku Chuo Hipponjin fet) Central Japanese Assoelation of Southern California The Sentral Organization of the Germaneimerican National Alliance (Douteche Aner ikanissne Einhelts front) The Citizens Protective League = Civil Rights Congress and its effiliated organizations and branches.« :
14-00000 4 & he a2 « The Colunbians Communist Party, U.S.A., formerly Communist Folitical | Assoctation, and its affiliates and committaes, ineluding: . ot Citizers Cormrittes of the Urper West Side thew York City) , Committec to Aid the Fiehting South. , emis Befense Conmittes Labor Researcn Aesociation, Ine. Southern Negro Youth Coupross United Hay Day Committed. imited Neere and Allicd Votorans of aneri¢s Congress of american Revolutionary writers Congress of omerican Women Conncaticut Stata Youth Conference Corwneil of afrionn affairs Ceuneil for Fanawnerican Denoerscy Dai Niepon Ruteka Kai (i litegyeriue- Society of Japen or iilitary Art Society of Japan) . Dante Jlighier’ Society Federation of Italian War Veterans in tho U.S.A., Tne. (Agssceinsions Nazionate Conhattanti Iteliast, Federazrione aceli Stati Uniti d? Amertea) Friends or the New Germany (Freunde des Neucn Deutsehinnds ) Friends of the Savict Unien and its successor mnerican Council on Sovict Relations, both predecoussors of the Nations Couneil of american Sovict Friendship George Washington Carver School, Nuw York City Gormeneanerionn Bund (amerikedeutscher Voi ysbund ) Tre Gorman-Amerionn acpublican Lenpgue ermmansdmericnn Vocations) League (Deutscho-an erikanisohe e Berar seotuinsehatt ) Hoimasks. Kai, nisa known as Nokubet Heicki Tirushs. Kel, *aibel Nikonjic, Yoiyakn Ginusha Kai, and gaibei Noirasha Ned ¢dapsnese Residing in anerian Military Conseripts Asseciation} Rinoda Fad (ine wrial Jacnese Poservists) Hinomari Nai (Sising Sun Flag Society - a group of Tapanese Pe Ser ¥eterans ) ; Zeige Shoke Dun (North ascrican Raserve Of Meers on is cb ee : rs Mobilization for Nufense can Council for Democracy sbor Defonss — Torkers Order, including People! 3 Radio 4 yer 3 ° 17 y an ee Hk - od 9 oy Ego} Oar @ “tion of dmerten Central Sectety (Kaigad Dabo Ciao Kai) a, 33 iy] Ba) os aQ or fe 2m “4 g « ia MG 4
cedommans ease as a Japanese. Overseas Tonventien, Tokyo, Japan, 1940° Japanese Protective Association (Recruiting Organization) Jefferson School of Social Science, New York City Jewish Peoples Committee Jikyokw lin Wai (Curront affairs Association) Joint Anti-Fascist Refugee Cornittee Xibol Seinen Kai (Association of U. S$. Citizens of © Japanese Ancestry who have returned to anerica after studying in Japan) . ; Yu Klux Klan | . Kyffhacuscr,aleo know as Ryffhacuser League (“vffnnouszr Bund), Kyffhecaser Fellowship - (“vf fhaowser Yoneradschaft) kyfPhacuser War Relief (Kyffhacascr Xrieeshilfswerk) Leaguc of Amerioon ‘riters | ‘Lietor Society (Italian Blacx Shirts} Macedontlan-#morican People's League Kerio Morpantini Cirele Efehi gan Civil Rights Federation Nenka Toikoku Gunyudan (Imperial rilitery Priends Group or Southern California “ar Veterans) Netional Committee for the Lefense of Political Prisoners | Nationul Comittee to Win the Foace National Council of smerieun-Sovict Friendship National Council of Americans ef Croatian Desecnt National Faduration for Constitutional Libertics National Nomne Congresa Nature Fricnds .of Amerien (sine: 1938) Negro lator Victory Sommnittco New Committce for Pablications Hichibed Kogyo Kaisha (Tho Grost Pujid Theetec) Northwest Japynese Association Ohio Sehéol of Socinl Sciences The Peaes Movement of Ethiopia ; Poaplos Educational Association (incorporated under nemo Los 4ngeles Educutional Association, Inc.}, slso known as Fooples Eduecntioral Center, Peopics University, Fcooplo's School Poople's Institute of Applica Religton Philadelphic. Sehool of Social Seicnec and art Photo Lonmie (ew York City) ‘ Prolotericon Party of Ameries . Protestant Wer Votcrans of the U.S., Tne. Rovolutionsry Yorkers Lecruc Salura Kat (Patriotic Society, or Cherry association - composed of veterans of Russe-Jarancse “ier ) , Semucl Adana School, Boston, Nessachuisctts | School of Jowisk Studies, Rew York City ’ Seattle Lebor School, Seattle, Mashington ‘Serbian Vidovdan Council Shinto Temples |
14-00000 Silver Shirt Legion of Amcrica " : . Slovcsiuceimeriesn hetionsl Council oo Coo Sociciist Workers Purty, including ancricen Committee fer Zurorean ‘lorkers' Relief . Sokoia ei (Patneriand Socicty)  . ; Po, “| Suike Ste (Reserve Officers Association Los Angeles) 7 . . : Tom Paice Sencol of Social Science, Philadelphia, — St ae School of Westchester, New York Comittee of South Slavic americans - United Zarlom Torants end Consumers Organizention a of the jbraham Lincoln Brigade Walt Tzitnen School of Social Scicnece, Newark, New Jersey “Nashinetor. Book Shop Assodintion Washin pion Comnittce for Democratic Action Wisconsin Conference om Social logisiation Yorkers Zlliance Workers Tarty, including Sootalist Youth Lengue esd ees Young “ommunist Lengue - ; _ fo certify thet 2 beve read the names of the sbeve-listed organizntions, and that Ian not, nor hare I been, e member of; that I have not contributed to, rescived liternturc from, or attended meetings of any organize tion listed, except as indicated and oxplsined below: . . See caer annem eed . “= . Orgonizition; (Dates of Womber ship) ‘rere cmt atte cm purer cree ef ethneesnnaeesene-mtentne ateendeeet+ mre rma EAD engage Sy etaetegnecanenlenneteeaneste—ieedte : Remarks: : se ee Ameren whet reper EE rrr LOE ELEN A Srna Pentfetnsrtnt Atte -Seeteyete<eeene here EN Acc SIGNED J. Ror: 00. . aug veag 20° TA 1 3
fe, ECRE A fe SECURITY APPROVAL T0 RR FeDeCOreeerc teres Deputy Personnel Officer pate: 10 June 1949. Fron =: Chief of Inspection and Security Number: 37833 - Subject: || || Hote "X" below: . i ry Security approval {a granted subject for acceas to clavaified x | information contingent upon the recelpt of dercgatory informa. tion at some Suture date. Provistonel clearance for full duty with CIA is granted under the provisions of paragrep: 4, Administrative Inatruction 10-2, which provides for a.temporsry appointment pending the com- pletion cf full security investigation. Unless the apzlicant entera upon duty within 60 daya from above | x | date thia aporoval becomes invalid. ce Your memorandum dated 14 arch 1949 stated Subjuct is an applicant for OPG. CREEL ~ Chief, Fergonnel Security Division fcau #0. <108 nar reap 28° FO