14-00000 4 a ; CLASSIFICATION GRADE wee FROM of cpeiseeececeeeceee: To. 207.3 CIF EN FEDERAL SERVICE) Tah EMPLOYING FIRM OR AGENCY .. ive choy. On. esc ie eee ceeaceeeteneenecees ees ADDRESS... SPECK: OR POET Oran 7 Sree Sly cess ceeeeeeeecees ‘ . (it. and Number? mosey, # ONG ri bounty. KIND OF BUSINESS |. VLA. ou _NAME OF SUPERVISOR 2000 LUM ccc ceneecee TITLE OF JOB... OT ACR ee nee SALARY 8.00000 URL PER oe eesceeceseeceteee YOUR DUTIES 2000 SR CE Occ cs tes cceecmeeeteeeseceeteeseesesseneaee REASONS FORK LEAVING .. “ cca tesl eet We CO cece cteeseecscteeeenenneens . Pies CLASSIFICATION GRADE me FROM BAP cece TO BPD cece UP IN FEDERAL SERVICE) 2A ee ‘ EMPLOYING FIRM OR AGENCY -... ¥oCounnk tah. VOLEEG... webu Ay. ul. More i . ea fe SV wer, ve : Fat 4 ADDRESS opens eenecseesvecsseneeseeeeneset 8D eee nO SOO) © Sa La bee cesetensnseceecesceceeeee (Se. and Number} culty) {tate tCuuntep) ete nee ene ‘ : KIND OF BUSINESS Votie...OuaLag .. NAME OF SUPERVISOR .«..Ce[__ id. a TITLE OF Jon LOC dntoubl. aK eeneee SALARY §.....2200...... PER cecens (gute dco) Kaye Don whe lbes! YOUR DUTIES ......na25.6.. mae t.. n S fuct ovios to epad uivdots CLASSIFICATION GRADE TA . (PF IN PEDERAL SERVICE) 020 RL cee - EMPLOYING FIRS OR AGENCY 0.0... 28.78. St GE SG) S| re t Ty . . “ Tse and Number} aCieya- ¢Since} iCoantey) r. KIND OF BUSINESS 0.00598. oo. ccccsse NAME OF SUPERVISOR 0000 oecc oc cececctee ee eeeececeeec eee TITLE OF JOB PODS tor SALARY $00 7Q000. PRR. GRRE So Gore c-vorwmuon) cpcter PeOlor tire Tattoo ; your putins 222" ok Oper. bion of bo bboy gud navir ide. Boomtoy vb abo do REASONS FOR LEAVING N.S e G2" ON fol eet
é oe 5 * * . “ ’ i 2 a | OEP i See. 16. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POST. TION? HAVE YOU LEPT A POSITION UNDER CERCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? GIVE DET AILS: ‘ vO] oo, eomwsemrner ot ate - _ wae Sev. 17. GENERAL QUALIFICATIONS | A. FOREIGN LANGUAGES (STATE DEGREE OR PROFICIENCY AS SLIGHT.” “FAIR,” OR “FLUENT*) . . LANGUAGE BORQ 0  SPRAK occ ce RBAD vcccccecmereecees WRITE coco coc cctee LANGUAGE .occanenceceee SPEAK Oocccceeeaeee READ ccc, WRITE 0, B.OLIST ALL SPORTS AND HOBBIES WHICH INTEREST you: INDICATE PEGEEE OF PROFL. CIENCY IN BACH: be ce Sozingscood profeg Daneballegood prata3 Go ndsecuod roles . . _Looboadlefudy uvoles Coblefadp proles oe C.HAVE YOU ANY QUALIFICATIONS, AS A RESULT OF TRAINING OR EXPERIENCE, WHICH MIGHT FIT YOU FOR A PARTICULAR POSITION? socined 23 ped £1, FOE, Oopecble of operating pongages yol.ted thovetas, aid teatnod f:1] wt Rdentl: ANG av.tiong ain | ] { . ' D. LIST ANY SPECIAL SKILLS YOU POSSESS AND MACHINES AND PQUIFMENT YoU CAN USE, SUCH AS OPERATION OF SHORT-WAVE RADIO, MULTILITH, COMPTUMETER, KEY PUNCH, TURRET LATHE, SCIENTIFIC OR PROFESSIONAL DEVICES: Qoev.to mortecnwae vedio [ par are. words pov Liloutee Crees ss sees ' - eeeas tenon ren a 5 i . pe : APPROXIMATE NUMBER OP WORDS PER MINUTE EIN TYPING la? adlORTHAND : . BD -paaen® E- 3) Rete LL o emstaerintn inate Ah Nee teee Aite eRDRE tate mo pL annette ne neh fener See see ee
(10) FARE YOU NOW OF HAVE YOU EVE AKEN A LICENSED O7 CERTIFIED MEMAER OF ANY TRADE OR PROFESSION, HUCH AS FILOT, ELECTHICIAN, RADIO OUERATOR, TEACHER, BAWYER, CPA, BTC le Udeoait 2a wove a i IF YUS, INDICATE KIND OF LICENSE ABD BTATE occ ec eek cence ccetseeee a snsnmneuees cectomees: i FIRST LIC. OB CERTIVICATE (VIR Lu. LATEST LIC. OR CERTIFICATE (YR) ccc coe F.GIVE ANY SPECIAL QUALIFICATIONS NOT COVEIED ELSEWHERE IN YOUR APPLICATION SUCH AS: ; (1) YOUR MCE IMPORTANT PUBLICATIONS (DO NOT SURMIT COPIES UNLESS REQUESTED) (2) YOUR PATENTS OR INVENTIONS - 4 ; (0) PUBLIC SPEAKING AND PUBLIC RELATIONS EXPRIVENCE (1) HONORS AND FELLOWSIIVS RECKIVIED t wre & ~ + Segcasncastae G.HAVE YOU A PHYSICAL HANDICAP, DIKEAHE, OF OTHER DISABILITY WHICH SHOULD BE 5 : CONSIDERED IN ASSIGNING YOU TU WORKT UF ANSWEHEIS YES, EXPLAIN: ILDO YOU BERCHIVE AN ANBLITY Fos THE UNITED STATES OR DISTRICT OF COLUMBIA GOVEENSMBS FUNDER ANY RETIREMENT ACT fi ANY PENSION OB OTHER COMPENSATION For MILITARY OR NAVAL SERVICE? PP ANSWEM IS “YES? GIVE, COMPLETE DETAILS, ee ie ch Ce ee a a ee ee err
ant OD | CRD Sere. 1S. GIVE FIVE CHARACTER REPERENCES.-IN THE UL. S—WHao KNOW YOU INTHE MATELY——(Give residence and business addresses where possible.) . Street nnd Nambee, . Cre Ntate L. Qe Goof avs. ADDL Cee, RES. ADD | Gale Loeaee rn a COME. Lipa a BUS. ADD, ce teeneae RES. ADD |, take sce Se Cod nes. app c/O_Veteruns pond Silico, adv. RES. ADDY. |. sects wanes “s vt RES. ADD... FO, vecnetene seetenenee carers % ft B Bee Ce Col nus. appc/2. RES. ADD. AK aoa eo IT 7 ee Tess se SERRE Re Tom te ten pt peet me ae DUK TY etre, - Meee Sz. 19. NAMES OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THE UNITED STATES—— NOT REFERENCES, RELATIVES, SUPERVISORS, OR EMPLOYERS— (Give residence and business adidresses where possible.) , Street and Number Cy State 3 . . _ nus, app bo ORR RES. ADD, ob ee ores . RUS. ADD. KES, ADD. 4 &. Bone Co wa. US. ADD. | cog age RES. ADB. al 8, che et RES. ADD. | Jotas IN THE U, 5S. Sec, 20, GIVE THREE NEIGHBORS AT YOUR i. AST NORMAL RESIDENCE (Give residence and business addresses where possible.) Street and Number . Cite State Tey rene “4, is) 2 Mosarden[ onus. ann, a "Yoe Le vot . RES, a Vb @ ha vide RES. ADDI — a SST EE elt a RE ET ee ee ERE Re SAT RET he Ba oh, Sec. 21. FINANCIAL BACKGROUND A ARE YOU ENTIRELY DEVENDENT ON YOUR SALARY? ...7 oF oT HENOINCOME ooo en ce cone cctee ten ereeen eee entecereneies secon ee rou yyy Ae CUENTS : 4 af
14-00000 442) COHAVE YOU EVER BERAEN, OR PETITIONS EY FOR, BANKECPTCY? P< peeneeees GIVE PARTICULARS, ISCLLG COURT Se eee ene we seme ae BG IVE TH i cr EbIt RE rEREne i IN THE fe . 1. NAME | LY. ADDRESS Poe mad Xaeatues | (Cie NAME | | OS. ADDIE: : . as Ants G kip! iabife Btate Nolet ut, | b aie Vitae? Gide "2. ee er al (estes a. NAME LOG ADURESS J. Galtboal, Col rears rer eCty F (Beate CO ea a Dae eect raenntennetatmeetnge oe Sec, 22, RE SIDENCES S FOR THE, PAST In ¥ EAR 5 , 3/5 rm Prazent Baws a4 oon nom 2/579... TOF tJ) cs ran wo F ; nanan TH. ghd wurntets rare TRtacey? Ce ne Tae Ae nom (A TO LS. LG rome ae ‘ FROM £9 . TO 1s. THETA A iia ky aw ol ~9f9- . Ae emact Sts : ttt ow . aft. of. : FROM vd TO ie) TRG, ark west tore 9 pigienrens FROM LOf 3... To Af... RETR IDS TOCLSOTT RES BROT , RE BIT BES FOI Fn te} Mdasuntry } 4 . f F i 7 “ Poy etre w % EROM ofa vee TO LOST oe. la ounbdra H Gag TE : CBS, weed preatilore } Ghar e. (State) (Coasntey) t 4 s “ re a ” tees TBA. ated exertion, 3 rity (state) “UChaantryy rif e ‘ ” Frost 22 fied vee. TO fe eeecene pe Cee Ee {2. wired facades bare » ifat p. iBtale} “EGmsntry) i at? ag + oo pe Be. pee : i FROM Ys TO ADS ee Be raeah sata LOE Me . ore ead a nist deg heed, e, . i os + t I, hag Oe TE ATE a ET Seen Re SIP SIE NOTE DIO 5 TALE PO 3 Bec, 25. RESIDENCE OR TRAVEL OUTSIDE OF THE U2 ‘ , of 9 : arr ft Lhi9... 10 PWG ce os . LY # fol BOW Lit sSs p . te, ty oe reve youn i FROM 00 ci TO cicccncaretnteere setenapenescsccenscsmmneeces eeeeamenmivcers vesnssnnesneeninenee qeacty oo saseas : att 7 eo fnotioes COuuntey) TPtur pms) fa Gt gf Oot Seo trie . Caunery) Tiree j FROM oo Loe ee TO tee pemtaneense sees an feecraeeceeseneneecucesserenwe cme mnemene aa cacennameseeaeane COU G ee aot} “haunted Serene Te tee at nae a AE er BS Let ae wt wie AROS 7 ae a PMLA OT LT eo To. “ oe Sec, “1. CLUBS, SOCIETIE s. AND OTHER ORGA NIZA TIONS LIST NAMES ANG ADDEESSEM OF ALL CLUES, BOCIFTIE.Z, PROFESSIONAL SOCIETIES, EM- PLOYER GROUPS, ORGANIZATIONS GF ANY Kinds ade (COLEURE SM BEKSHIP IN, OR SUPPORT OF, ANY ORGANIZATION HAVING HEADQUARTERS Oh WEASCH IN A FOREIGN COUNTRY) TO WHICH YOU BELONG OR HAVE EPELGNGHE Is: Ate Uoservo Aghosiation, Unive oF « {Hamme ard hapter). RL ated be asians Tiapeeny | ducting “omg, UA (States Centre DATES OF *Biates | iVnunteg} ~ (Naivw and Chapter) ‘ 12, edo Wucnbees ad shee DATES OF MEMBERSHIP; vere a epee eee perome cee temenn ete negees mine awteene pee cto ‘ : (Mame and Chaptee? : (#4, god Neemtart | vaaazs rr Crs) Meneategy DATES OF MEMBERSHIP: 00 ee Am Roam ft
SEC, tNaeme ant Chapter) . 6K, wend Mumbee) té"tey Minted qeantrg? DATES OF MEMBBKSIEP: . . a Lo. eee ce ee eee ce eeeneee pc wees aNeme aml Chapter! IRE aod Rumer t ilies i Aiate} ivoumiog? DATES OF MEMBERSHIPS 0000 0. ce eee eee eee sete cerns ~ eHt, pind Stearate + id‘ips Bloated qCountey? . UNaree amt Chapter? tated ean os iName amt CRarter} 498. sed Nusersteor t eta DATES | Or ME MRERSHIP: LENS POSES SOE EET ES ES STESEET OSES we ee ete re ch cme - MISCE LLANEOUS A. DO You ADVOCATE OR HAVE YOU RVER A EVER BEEN A MEMBER OF OR HAVE YOu SU ¥} ZATION WHICH ADVOCATES THE OVEICTHRON BRNMENT IN THE UNITED STATES? 319 ADVOCATER; OFF ARE YOU NOW OR HAVE YOU {yhTE BB ARY POLITICAL PARTY OB ORGANT. OF OUI COMBTITUTIGONAL FORM OF GOY- BDO YOU USE, OR JER UBS LY SHGRREREB on Laid eae .. IF SO, TO WHAT ate oe EXTENT? , cates coteeesecaea wet tues passed esouencaansssteeaseneeenes C.HAVE youl FEVER REEN ARRESTED, INDICTED OR CONVIC TED FOR ANY VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION? [TF 80, ETATE NAME OF COURT, CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE: od D. HAVE S you EVER BEEN COURT. “MARTIAL ED WHILE A MEMBER OF TIE ARMED FORC ES? 64s “IF ANSWER IS "YES," GIVE DETAILS RELQW: “List RELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OF FICES ° TO WHICH YOU HAVE APPLIBREOR HALOS GEST SINGH Fee gg ton av Bere eee e ree cares ee ener ne entwe ewes mee nee ° ° we. wee reese ° - ie eene ~ Tenet eee ene ee oe eaeee wee aa ee - aren fee Beer nes ee rat re Temenos taer ae, naeee oan tees 19 GBARH+