= SECRET : ~— . (thes Friled Pn} SECTiO# ¥ CORTERUES FROM PAGE 2 4. WAVE VOU EVER SEEM 1, OR PELITIONGS Fom, Bana RURTCY? ] [es qx] hd : armen erste 3. AF YOUR AMSUER 16 "VES" TO THE AGOVE QUESTION. GIVE PARTECUL ARS, ENCLULING COURT AND DVATEEB} BA 4+ 00 YOU RECEIVE aN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMEAT act, PENBEON, OR COWFENG ATION FOR WIL ETARY O8 AVAL SERVICE? C]ve [x] *° Po 8 vour ANSBER §S “yes” TG TRE AGOVE QUESTION, Give COMPLETE OETAWSE &- OO VOU HAVE ANY FINANCIAL INTEREST IN, OF OFFICHAL CONNECTION WET, NON’U.S. COMPORATIONS OR BUSINESSES OR Iu OR PITH U.S. CORPORATIONS OR BUSINESSES HAVING SUBSTANTIAL FOREIGN INTERESTS? Cc tF YOu Have ves, Ege answengy “VES", Give COMPLETE OETAILS OW A SEPARATE SHEET anO ATTACH 1% A BEALEO ENVELOPE. . SECTION Vi ° _ Crt zeusnie A . ®. CHTEReNgeth ACQUIRED BY + CHECK (x) Ones Cece [] wanes eas (eres (Specs ty ys &- PRESENT CLRizENSHie (Couatey} U.S.A. 3 WAVE YOU TAREN STEPS TO CHANGE voua present citizenswip?  f~ ]vea gia ] xo Give PARTICULARS WA S: FF YOU NAVE APPLIED FOR U.S. CITIZENSHIP, INDICATE PRESENT STATUS OF YOUR APPLICAT {On (Picet papers, “ - HA 6 SECTION Vil “EbucaTion _ ” 1. CMECA EK} MIGHEST LEVEL OF EDUCATION ATTAINED ete.) Lise (HAR MEBR SERoOR GeaguaTE 1 pest rao Vaase oF COLLEGE HOON BCHOOE awanuatE MH Lercwsroaes errr THOSE, BUSEMT SHE, CHR CHOMME RCE a GCKHOOL BeaovatE SVAHUATE GTUGY Le aDewsa fo Mmicunre beget Feo Years COtinse oe Lras WATER'S LE SATE | | BOCKOR*S Ot aare 2. COLLEGE OR UNIVERSETY Shuor : OATE j STM OTR. HOURS ee aec’o | SPRCISY HAME AND LOCATION OF COLLEGE OR UNTVERSETY Penn. State University 3. Te ape ee Tofsae MAME OF SCHOOL i STUDY OR SPECIALIZATION MONTHS ame san etnnatetret enc ifm Em, etn eee ~ St eeaeeeceneneeeanemenee cee i ! i we er ne a ne egalised schoais suck a9 Ordnance, Intelligence, Communications, e2¢. } 1 ATEES ~~ F VATED ATIESGED ewe enmane nee inrnee mmaneteenan mee negate ten arcretneterterene eh Full cme ETARY FRAGSER tenemos te j TOTAL NAME GF Sceden StubY OR SPETrALITAT? ane ; . j STAR IEATION vaou to | movin a ae ROM Sehool Chicago, 11 ‘| Radio Cper. & Mechanics AAF Comm. Cadet (¥sic) Communications Sage ing SAF Sch ., Chanute Fiald i Cryptography H- OTRER ESUCATIONAL TRAINING MOT JROECATIN ABOVE SECRET
& SECRe f ee TYPIRG AND STEHOGRAPHIC SKILLS SECTIGH a TreikG (WP. } Tos SHOR THANDE WPM. D BHORTRAND SYSTEM USER +» CHECA a APPROPRIATE TEM z | “om “Tearcel “Varreonms rine ~"[stenotver OTHE TRATRENG (Cores melee, Himeas INOICATE GIMER GISTHEGS MACHIHES @1TH RHICH YOU MAVE HAO GRERATING EXPERTENCE OR BrSph, Card Punch, ete.) 4. SECTION Kt PECIAL QUALIFICATIONS B--LIST ALL MGBBIES ANG SPGRTS ffi WHICH YOU ARE ACTIVE ON HAVE ACTIVILY PARTICIPATED, tN is TACdPishing, golf, bowling - fair & good. Reading, church and comamity ectivities. 2. SNOICATE ayy SPEC TAL OL AL SFICATIONS, RESULTING FROM EAPEGIENCE GA FRAEN ING, PusiTion oa wre ur ake Pieatronic Engineer - with 6 years experience essisting in adeiniatration and @irecticu of research and development work oe List any EPPCIAL SKILLS VOU POSSESS RELATING TO & Boba eP ME OF May MULTILETH. TURRUT LATHE, SCHEMTERIC AND PROFESSIOeAL tevicOs, ETC. um PROP TCTENCY Were wEGeT FET yOu FOR A PARTECUL AR 3. EACLUDInG CQOULSwENT HOPED fr SECTION x, CHINES SUCH AS OPERAVICN OF SHORTWAVE RADIC, Hand tools, machine toola of various Kinds, profeasionel electronic dostruments. Electiicsan, Radio Operator, Teacher, ISSUING SYATE, AND 4. 9F 76 ADE & LICENSED Of CERTIFIED MEMBER OF ANY TRADE GR PROFESSION (Piles, Lawyat, CPA, Hedical Technician, otc. ), tNOICATE THE KIND OF LECKuSe GR CEATIFICATE, NAME OF REGISTAY “UMBER, IF ENGen. Served ag radio operator in Service, teacher at Penn. State College, experienced electronics engineer - but no licenses FIRST LICENSE O98 CERTIFicate (Year of issue} Larest LICENSE GR CERTIFICATE (rear of isaue) NA NA and : SECRET _- & a . (Phen Filled Fn) ? : - Si] section vise FOQLIGH LANGUAGE ABILITIES BeAr FO peacoat AoE fare CoMPa TENCE >» bR OMOER Lasten Moe AC Qereed £ AN GUase — ners aim _ Foviwabent meee AOEQUATC | ape auate Limereo Arb é. 7 . . me (Lest beiaw each fangusges in Foe FoR . COMET AC : ne ehiCh you porsese any degrve NATEVE | O8¥ 1ousLY RESEARCH TAAVEL AwOMLE DS ma PROLONGE: dwt fre ut? 4 of coopetoncea, Indecate your FLUENCY | FORETGY RESTOENCH] PAHENTS CAL’ profaciency to read, write or oF COUNTRY cred LEVELS} Ghetelelele Te] Tate] epeed by plocing # chech (23 “cl Ma the appropriate boxe . N Bs French : Ht ites a a. F vOU waved CeecKeo “ACADEMIC STUDY" Ll “now acourmee”. LLL LENGTH as a OF BTuaY High School French B- BESCAIBE YOUR ABILITY TO OO SPECIALIZED LANGUAGE WORK INVOLVING VOCABULARIES AND TERMENOL OGY Om THE SCIENTIFIC, ENGINEERING, TELECOMMYUMICATIONS, MILITARY OR ANY GIMER SPECIALIZED FIELD Insufficient ability to do specialized language work @ESECTIOM IX GEOGRAPHIC AREA KNOWLEDGE ; . ® a. LEST GELOW Amy FOREIGy REGIONS OR COUNTHEES OF WHICH YOU HAVE KNOWLEDGE GAINED AS A RESULT OF RESIDENCE, TRaver, STUDY OR WORK ASSIGNMENT, UNOER COLUMN "TYPE Of SPECIALIZIO BNOWLFEOGE”. EROICATE TYPE OF KNOWLEDGE SUCH AS PT f g £8 Boe yt AAILROAGS, INDUSTRILE df reaver . DATES oF RHOALEDGL ACQUIRED oY MAME OF REGICH OR LOUNTAY TYPE OF GPECAALIZEO ANOWLEOGE RESIDENCE. TRAVEL, ETC. TRAVEL sfyoy Hawait General Phillipine Isles. General Japan General x 2. I8GICATE THE FuURPOSE OF VISIT, RESIDENCE OR TRAVEL FOR EACH GF THE AEGIGNS GA COUNTREES LIGIER ABOVE Juae 'hS - fpr. 'h6 » Residence, result of military assignment Apr. '§6 = May ‘S56 ~ was Agency duty assignment [)
14-00000 a+ ins ~ SECRET _ . . . (then Fattod in) ~ SECTION Ai CONTINUED FROM PAGE & \ . . ; 7. LAST ANY SIGMIFICANT PUBLISNED MATERIALS OF @mtim You ART THE autwoa (bo nal Owbeit copies unless sequested). PHOECATE TITLE, PUBLECATION DATE, AUD Tere OF BAITING (MOM fectaonm, acdontatse artictee, general interest aube Jeeta, novela, short stories, etc.) Prepared maintenance, overhaul & ingtruction manuals on rodar equip. for Navy. Variety of significant reports and publications prepared in ' normal course of job performance. : : @ INPICATE ANY DEVICES HICH YOU WAVE INVENTED AMD STATE rE tHth OF HOT twtv Bat PATENTED No patents, contributed original technical ideas on devices in normal course of ob performance. : . 9. thar ANY PUSLIC SPEANING ANG PUBLIC @fFLAVIONS EXPERIENCE Military dervice instructor, college inatructor, many talks, lectures, briefings during past 13 years in aormal job per formance « ee net etcovemnamresonmen neet nnn : cose 10. LEST AmY PROFESSIONAL, ACADEMIC OR HONORAMY ASBOCEATIONS OR BOCTATIES FR eH ICH, YOU ARE NOG OR BERE PORUEMLY A : MEMBER, LEBT ACADTMIC HONGRS YOU HAVe AECES YEO, Phalanx fraternity, Eta K f Ru, A-I.E.E. @ SECTION KO ORGANIZATION WORK EXPERIERCE ~« SINCE Last COMPLETION OF A PERSONNEL QUALIFICATIONS QUEST IOANAIRE @ i. ONCLUSIVE DATES (Frome and Fac) 2 GRADE] 3. OFF ECK/OIVES SONS BR ANE OF ASSIGNMENT . . 1952 - Present G8-14 | TSS/APPLIED PHYSICS DIVISION 4 NO. OF EMPLOYEES UNDER YOUR GERECT | B- OFFICEAL POSETION TETLE . , SuPEAVESI ON BO ' . . od, 0 CL Deputy chief, TSS/aPD ‘ S- oescaipyion oF outiesAggiat & act for the chief in general administrative jor ace ~ : personnel, budget, security, contractual arrangements, etc.; assist and/or accomplish organizing. procedures & administrative machaniama for accomplishing technical projects. - 7 - Examine operational problems, suggesting devices & techniques for Implement the operations; recommend & organize technical projects & programs; supervige work & progress of project engineers; conduct liaison; provide consultation... ‘ - $. INCLUSIVE BATES (Frome and To- ) j2- GRADE 13, OFFICEADEVESION/ OH ANCH OF ASSIGHMINT © OFF ICTAL PASRTION TITRE 40 NO, GF EMPLOYEES UNDER YOUR DIRECT SUPERVISION ' 6. DEACRIPTION OF DUTIES 1. ENCLUSEVE DATES (From and Fos } ae conn OFF ICT/DIVESTON/ QHaHtH OF ANSI GHMENT ee ener tarectmeareunre-srsetnannen werantannienicteanntsett EMPLOYERS UNGER YOUR OF So OFFICE AL POSTION TITLE ay fe on eens cnn mmenvnen nearer be peter are mn ni remem ng tet cnt ta neem em mee seen Ss DESCRIP LEON OF DUTECS t. ENCLUBIWE DATES (From- and Tne J a & noes. OQFFEEL/OIVISION/ORANCH GF ASSEGHMERT t # is Sac e [ene ponte neernen neenenmane ee ce een . 4. NO. OF EMPLOYERS UMOER TOUR OLeECT $. GFEICIAL POSLTIOM TITRE . } SuPFRVESEON - 4; ws a ee eS a me eee pera eo eae G- GESCRIPTION OF DUTIES 1. INCLUSIVE DATES (From- and To-) 2. GRAGE | 3. OFFICE/DIVISION/OPAKCH OF AGSEGNMERT $. OFFICIAL POSITION TITLE 4. 40, GF EMPLOYEES UNDER YOUR BIRECT SUPERVESION 6. DESCRIPTION OF BUTIES (Use addittonal pages If caquired) SECRET . 5
OT . Lo, of CHET . ; ‘ : . fr Phen Fified Im) OFT in. ; : CHILORER And OmtA DEPERDERTS + wUMBEa OF CHIL ORE Cimeluding otopchildren B. nuwnee oF rs: ] DER TMOENT Ladi og apouse, fad | odop. ed ehéideon) eno an rake AR . paerints, stepparents, efader, ete : Srane oF nee “aud ane nor gear: wu UEP ERD O%8 YOU FOR At irastd . . SUPPORTS . . 5 Tue) H SUPPORT, Of, CHttDREN MV | Ros jt OF AGL SHG ABE NOT BELT: SUREOM + FROVIOR THE FOLAOBlaG INFORMATION FOR ALL CHILORE® AND ae RELATIONSHIP YEAR OF aie Oe she SIGNATURE OF EMPLOY DATE Hat. AG S987 Pi re & 3 SECRET oo 787 a) ~ we 6 sree
14-00000 Wiehe dR OUP. Me Mee emt hab eens sr obey te paints They Lane Meartenine sees wrtte anee tevebnee ubube este yet suet wT seer net eater eae gy By . PERSONAL HISTORY STATEMENT Instructions: 1, Answer all questions completely. if question does not apply write “not ap - able.” Write “unknown” only if you do not know the answer and cannot bain the answer trom: personal records, Use the blunk pages at the end of this.form for extra details on any, question or questions for which you do not: jave .sulti- cient room. 2. Ty e, print or write carefully; legible or incomplete forins will not receive cof - sideration oS MANES vou READ AND DO YOU UNDERSTAND THE INSTRUCTIONS? Yes - a & Ko, - ay ee tate —"Cobay . ISIN ARE «Aone WIIAT OTHER NAMES HAVE YOU USED? Mane ___. UNDER WHAT CIRCUMSTANCES HAVE YOU EVER USED THESE _ NAMES? yal Ayplasb HOW LONG? IF A LEGAL OHANGE, GIVE PARTICULARS Mat _____ , 7 | Where? Hy Whet Authority —_ : é ©. DATE oF BiInTH 4/29, ‘22, PLACE OF BIRTH Lea gna pitty [hay aL county D. PRESENT cirizetisitte pide 5, BY BIRTH? yes BY MARRIAGE? Country . . | BY NATURALIZATION CERTIFICATE # 1 lol Hh prbasich le a a BY < & : chy . rate Canntry HAVE vou HAD_A PREVIOUS NATIONALITY? Soe En CONNELL SNOT TE A - , . ad . Yea or No County . HELD BETWEEN WHAT DATES? TO eee ANY OTHER NATIONALITY? ae ae 4 . . tee & GIVE PARTICULARS * e ; HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP? __...-... GIVE PARTICULARS: eee eee ee a. i FoRM HO. ace tean *8t
14-00000 a ae Te ame get + St panera rent Bee maenen = rt ION DRAR TID tT ACT RRCIMMIET r STII ete ee tae LG eee Reetan so ae a mane my kee i aoe ce dl . Lk - . 7 E. LF BORN OUTSIDE.U.8. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY? ————_— BE PORT OF ENTRY? ON PASSPORT OF WHAT COUNTRY? cece cen LAST US. VISA Sree “Hie T Pate of Tanne um Sete of Baus . / SEC. 2. PHYSICAL DESCRIPTION 7 .. Do - pas 2 ex Plate wnane _6'o y WEIGHT ne Lee Oo ave fe ; ves Gray sam Brawn. courrssion Fale scans nn Bas tf t Birearm. dy ne aa fe fe antle, BUILD p Lhe dis.ea- OTHER DISTINGUISHING FEATURES A. swNoLE STATE. bate, PLACE, “AND: REASON FOR ALL SEPARATIONS, DIVORCES OR ANNUTAENTS oa i oe 2 -F YOU HAVE BEEN MARRIED MORE THAN ONCE—INCLUDE ANNUL< pete “fh B. WIFE OR HUSBAND MENTS—USE A SEPARATE SHEET FOR FORMER WIFE-OR, HUSBAND |~ _ . GIVING DATA REQUIRED BELOW FOR ALL PREVIOUS, MARRIAGES.) - NAME OF ‘sPOUsE —hhteza Lar areé Zimmerman Christ . Firat “Shittuile * Maiden | Last PLACE AND DATE OF MARRIAGE Hag. 19, Lott, Mout dhaven, Coan. a . 4 of, Lads ON (oe HIG-(OR HER) ADDRESS BRFORE MARRIAGE maa USDily Lets. ld Sif ie LIVING OR DECEASED meer DATE OF DRCEASE . CAUSE LTD. = oO . PRESENT, OR LAST, ADDRESS : a Top, fu, bese Se an - DATE OF BIRTH ILAL24, evaee or pert LAU SAY, ist a oe srt Dunit ry “wns fw, +s IE BORN OUTSIDE U.S, INDICATE DATE AND PLACE OF ENTRY Wat Leepiisrble 4 CITIZENSHIP .... mene WHEN ACQUIRED? ne WELD emer geenenercoteesnesuee eee oy Mate Country “  GCCUPATION 7 fous es iFe pase entvoyer (ve Iesteuren t £ ; PER , 2 : Cole 2 <j / EMPLOYER'S OR BUSINESS ADDRESS _(C lege iy whale es “st 7. Sr 8 Ra State ton -' "MILITARY SERVICE FROM wae Lt Lip évake bez .. BRANCH OF SERVICE —_______., COUNTRY peer re nereenewee DETAILS OF GTHER GOV'T. SERVICE, U.S. OR FOREIGN
' 4 Ppa + if ' Aether Pane . , , 4 anette AAMT Biimaye sale ere alietE) ESOT . : t . d ‘ i amherst ria" nea beh Mentone ase Pde vseve 8. SEC. 4. CLUILDREN OB DEPENDENTS (Include parttal dependents) . i, NAME LLG. aa med ~- RELATIONSHIP ne -S 7 aon —i— comune 4-5-2. ADDRESS watath : County 2, NAME ce arg RELATIONSHTP isp sce i crnizssnie _-5-/7_ appness 0, 82. Zip, fan, MeSH ok : «i = - * Rete Countey- - 4 3. NAME AGE , AP ay tna aN tnt St tebe ey IF BORN ourive US, INDICATE PATE AND PLACE OF ENTRY Ee ayuat crrizensim _.______ WHEN ACQUIRED? WHERE? —_ _ entry oocupamon Liceliee Lonel rinse EMPLOYER = tik tadingaan EMPLOYERS oz ovis susivess appaess A /# Colle Mine Law 248, fi Ant ftieg L.$, 7. CONF von QntbeED OES APN tb RSENS Canta herent ena > _ MILITARY seRTicE FROM 4 Wot Mp bea ibl: . BRANCH OF SERVICE feof . “$+ COUNTRY DETAILS OF OTHER GOVT SERVICE, Cs. On FOREIGN. ; o i SEC. 6. ‘ MOTHER ‘(Gis ye tée same Information for stepmother on a separate sheet) , ees. FULL Name £@1 dr a Aienore Wahl Chres Chrisef ; bre OH fact , LIVING OR BECELED Asng DATE OF DECEASE .WW_ CAUSE . : f "4 PRESENT, OR L4ST, ADDRESS =0:20-Sfelting an Sy. a246 fa UIS fe 7s fe, £2 Ho, cus Bfite ‘Country ¥ ' _ ‘DATE OF BIRTH 3 2UE LPB PLACE OF BIRTH Taningua, Fay tbs O. ‘ CITIZENSHIP WW . WHEN ACQUIRED? WW WHERE? OU : ry Cuy State . Country i 7 og ~ ; LF BORN OUTSIVE US. INDICATE DATE. AND PLACE or ENTRY (Vos /7 22 g 3 i j H 4 { + ' if
14-00000 RO TENS RAE Seo Ne oN SB Aree poet im te - we Carell - so Nee anette tenn . o +t tee ‘ - - - ° - 6 é OCCUPATION lou tut E vase waptoven Mane Not fy Nica ble EMPLOYER'S OR OWN BUSINESS ADDRESS - 88. & Ko. tty Bintw Country. MILITARY SERVICE FROM Lt Byes bivale BRANCH OF SERVICE - : COUNTRY . . DETAILS or orn: Gove SERVICE, US. OR PORZION. * SEC, a “FATHER: N-LAW a . “pute Nass er be ch fabert -f Zemer rman Fist. "Middle Laat CAUBE LIVING OR DECEASED i v U Vn pair OF DECEABE PRESENT, OR LAST, ADDRESS | ftute § 2 ptausau , ohs., US. A . City Btate : Country &. & Ne (0. DAFB.OF BIRTH: i ‘94 PLACE OF BIRTH Thun of Easfon, bis IP BORN OUTSIDE US. INDICATE DATE AND PLACE OF ENTRY MTGE ‘ CITIZENSHIP WU. WHEN ACQUIRED? 8) 92) |) id 2 : * City Rate Countsy ‘ ‘ occupaTion areiec. Last empLover D/A t @2e | @&e “anne e
Pay 1 es cigs | seta ont tet acme tenes ain Aenean canter beats ents. iantsininsbin HO! Dn oh oe. aa ‘BEC. 9. MOTHER-IN-LAW FULL NAME aa Zer/ Ha etheher mmzeman Fay Pues - Middle LIVING OR DECEASED Live DATE OF DECEASE _____. CAUSE “ ef 2 oc ae by St. & Ra city Btete _ oreatey pate or BintH 4/4//2 L528. PLACE OF BIRTH é IF BORN OUTSIDE US. LIDICATE DATE AND PLACE OF ENTRY a CITIZENSHIP | | wHEM ACQUIRED? OCCUPATION 0 dase LAST EMPLOYER De PRESENT, OR LAST, ADDREGS- tt ‘e° SEC. 10. RELATIVES BY BLOOD, MARRIAGE OR DR ADOPTION, 9 WHO EITHER LIVE ABROAD OR WHO ARE NOT CITIZENS OF THE UNITED 8TA . No ne a wanes RELATIONSHIP AGE - CITIZENSHIP ge ADDRESS . a at 4 _ al. eet . . : 88. as-Bie, - city . “. State Couniey oe & NAMBL caenwe RELATIONSHIP AGE CITIZENSHIP - ADDRESS . : . &t. ds Be. City - State Countsy 3. NAME RELATIONSHIP = AGE CITIZENSHIP .___._____ ADDRESS - SEC. 1, RELATIVES BY BLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE OF THE U.S. OROF A FOREIGN GOVERNMENT. p/oyz - AGE 2. NAME eens Ee RELATIONSHIP + ADDRESS ee Bt. ds Be. city Baw ' CITIZENSHIP « “TYPE AND LOCATION OF SERVICE (IF KNOWN) WU Be NAME ere tee RELATIONSHIP ee AGE CITIZENSHIP nner eee ADDRESS : Bt, & Bin. City Beare ra TYPE AND LOCATION OF BZRVICE (IF KNOWN) 9. NAME ee RELATIONSHIP A CITIZENSHIP WDD RESS ns Se a wo. city Brate TYPE AND LOCATION OP GEEVICE (IF KNOWN) _._ 2. 5 tian a cee eee ee Fo na AraroermatueneejatA mt a tte oh stn et ree tk aePOREDM EERE Eememnttenn toh avernicaarenmye fea Bethe emma
SBC. 12. wR EIS or wr ae weet 8 mews pee eee gtee to ewetl ree EDUCATION ELEMENTARY SCHOOD cece ee ADDRESS Bitar, Pd: 0 Lbs Chey Sate yes DATES ATTENDED awn con GRADUATE? HIGH SCHOOL a Te ADDRESS gpa ie SEC. re MILITARY, NAVAL OR OTHER Gov'T SERVICE — US. OR FOREIGN . oy ¢ ch 62 bi ay Fo couauy Dates of Service . . | lat sp nan pin BI20E_ sepa ation From Station Type &f Discharge 2 Free ~é ty Officer. pewarxs: ommunicatsns officer, C ohiye SELECTIVE SERVICE BOARD NUMBER Uf ADDRESS 2 IF DEFERRED GivE REASON — AGO/. J pelica bl: INDICATE MEMBERSHIP In” MILITARY RESERVE ORGAN ZATIONS DF. SEC. 14 CHRONOLCGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT FOR ALL PERIODS. INCLUDE CASUAL EMPLOYMENT. INCLUDE ALSO PERIODS OF UNEMPLOYMENT. GIVE ADDRESSES AND STATE WHAT YOU DID DURING PERIODS OF UNEMPLOYMENT. LIST LAST POSITION FIRST. rrom £26 1/959 ro Present ; a. ee 3S KIND OF BUSINESS Lick. Ards tr ~”_. NAME OF SUPERVISOR fic. Ge: roe Br: ork SITLE OF JOB Dis fret afar .. SALARY 3 ¥ é Agr PER Llane th your puTies _Z List rete ori pnts binds Frias Sleetri ck 4y Efoedrén es REASONS FOR LEAVING 2. EMPLOYING FIRM OR AGENCY ao Seen? —— ~—
” wena & rer hy ete etéhremienatienneton tht ay eee Pe eee ry ST Bath wis, can Se nbd hee ot mw é . EMPLOYING FIRM OR AGENCY ., KIND oF Business £4 5. FROM ea TO er + 6 8t. d& Ko 4 KIND OF BUSINESS offege. : & - qmzorson__S/udeat ss satany rer ADDREES : 8 & Neo, EMPLOYING FIRM OR AGENCY L4.S, Z Ea ‘aporess hc Boys Tapan (fe Ceres KIND OF BUSINESS _Comi: nuanistie, NAME OF SUPERVISOR Caplin hed TITLE OF JOB Lthk SALARY s LZ per Hien lG < your puTtes Ci riya f nunicatroas CLs ieee, O Crypt oho ruphie Sic. O. REASOUS FOR LEAVING a Biparal boo Krom Service _ - / EMPLOYING FTRM OR AGENCY ___/#7/a : ADDRESS CL ds 4 Le i: S77. a TEES - Oe" Be A NO kis Gy ta L. - Le dS. Couey KIND OF BUSINESS DtI SIMS NAME OF SUPERVISOR kita ck. pioyre TITLE GF IGB _L4 Las des a Lbs bee: *... SALARY rs do PER Ag. your putzes ._ Galen 2B b. Gant y. Eelahin Loot Lick ” ‘REASONS YOR LEAVING flee ayy bs  aeanewenesenennen Woke: . Lon tinged ow? Wa gs M3, 0 NAME OF SUPERVISOR Ld Math Ir. i i t i
14-00000 # t Fy ME He mes mtg rt f | t SEC. 15. HAVE YOU EVE2 BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY FOSITION? . HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO_, EXPLAIN? GIVE DETAILS: Not Applica ble . 6 ! SEC. 16. GIVE FIVE CHARACTER REFERENCES —IN THE U.S, — WHO KNOW YOU INTI- MATELY.— (GIVE RESIDENCE AND BUSINESS ADDRESSES WHERE POSSIBLE.) Street ead Sumber . caer State SEC. 17. NAMES OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THE UNITED STATES — NOT REFERENCES, SUPERVISORS OR EMPLOYERS — (Give residence and business ad-' dresses where possible.) Htrest and Number City Rtate " foul Go Aitkmee pus, avo. . RES, ADD, Ded ine. Fe AAV TT mT AY ara ire pp a Le ' 4 Wf BUS. ADD. RES. ADD. “Teiiay ma pth Dds A. ) iy ies 3 (Mss [earl B Yeaay Bus. app. Li, of. pak Ei He pli Se dei dcaicilaite g A ; RES. ADD. LL Le She Eduun Qlisy ou. Bus. ADO. v ————~ bla bch be) je RES. ADD. —.--. 5. L£Orak &: ed fy / BUS. ADD. 2/4 tu yh ‘ RES, ADD, 2 Lt oy
i | } ! \ SEC. 19, FINANCIAL BACKGROUND { 5, ¢ Q F i rrom JUN? tng £7b'49 & fgets lon of (aerapucy 3 } £ 4 SEC, 18. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE U.S. -- (Give : residence and business addresses where possible.) . Street and Number city State . 1, ne BUS, ADD. | RES. ADD. Mild an a A, ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY? —W2S_._. IF NOT, STAT SOURCES OF OTHER INCOME B. NAMES AND ADDRESSES OF BANKS WITH WHICH YOU HAVE ACCOUNTS dane. aL. - AVE You EVER BEEN IN, OR PETITIONED FOR; BANKRUPTCY? 2 GIVE PARTICULARS, INCLUDING COURT: é BE. , Ra. 9. NAME C2. ADDRESS uf = 2 "a & No. 3. NAME suka: Sal Of Sone pencil tae, tae BEC. 20, RESIDENCES FOR THE PAST 15 YEARS os um £2 b 40 ro £ jegeoh &-0. fo {4.33 ‘ . SA , : . Bt. No, city” Country . Hh! Sho $22 whidouvst, stake Colbye _ FROM ou E88 to £2h'50 Fgh eld wey bya babs belt wan aL), Piyp Leda fhe Terie Country Btave Coubuy rrom 1239 to J2#2%_ 202 eel thigh 3 fy fans pu Ae 2p fb US A : prom £2.26 5 70 1929 LOF A 2hry yh ay Fistapay 2 bebe BRO neers TD rerneerncn es ner nomen er rT Ht meee pees earn nen a stent te Ciy Sista Quustry 7 rrom Jct ¥2 po slur 4 Litibacy overt olla? addyss, Sime ds above . ciey St. No. & FROM nL, <n slr ae TR ES BEC. ‘21. RESIDENCE OR TRAVEL OUTSIDE OF HE UNITED STATES.- - A. FROM Jeine ‘to, TO Atay ps _Uuby. _Sitatoaitan _tilands Philitary Service City oF weet og country FYurpoce ef FROM Guy "> no whch es Ge odtiad Pua LD et Purposes 44 City ar Bection ¥ From Jc!'2) to fipe ot Massy ryan a City of Section Country ST 9 D: se Judet-endae mone ; - - ve 1, appress J sda pend Hib,
ind ease PUTT tm sete enna nrermur ween tah mere n Ng mE HES SEC. 22, CLUBS, SOCIETIES AND OTHER ORGANIZATIONS . LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCIETIES, PROFESSIONAL SOCIETIES, EMPLOYEE GROUPS, ORGANIZATIONS OF ANY KIND (INCLUDE MEMBERSHIP IN,-OR SUP PORT OF, ANY ORGANIZATION HAVING | HEADQUARTERS OR BRANCHT IN A FOREIGN COUN: ~ TRY) TO WHICH YOU BELONG OR HAVE BELONGED: . Leal, alow Crrteraty , Zan tigeteing By hielo __ Name ond Chapter city Country DATES OF MEMBERSHIP: TTP awe oe ws . 10 FROM TO eeecncrerercinen _eoremnenestete semana ithesnanrsetntnninnvenne th et RSE ts City or Gectican Country Purpose FROM i | ¢ pean Caty oF Section Cauntry Purpose FROM 5 Se : - __ - city oF Gection Country Purpose B, LAST US. PASSPORT — NUMBER, DATE, AND PLACE OF ISSUE: Mat Ayplecable GIVE APPROXIMATE How MANY OTHER U.S. PASSPORTS HAVE YOU HAD? PASSPORTA OF OTHER NATIONS: be ye Spal. & @ . ay Ef Ki. fa MK or? Lay . . 2. roar ro ae 7 Lp oe Ko. 4 City . Beate Country DATES oF MemorRsinp: _.A 4! (99 Aces r) ra ge pe AS ie “s¢_/ 3. Lh bs bb 83 Bh SA ey or Kd Vibe AS. Name and Chapter Bt. & No. Cry, ork id! 4 en DATES OF MEMBERSHIP: ihedenk memhee Lrom Oot apt Ce : Nome and Chapter St, & Noy chy State Country ~ DATES OF MEMBERSHIP: .. _ . neers men sone ene ery easeee canine epee vere eunusemenenenenerenrereeenrrcereemne * Meme and Chanter . 8. & Ra, cig State - Country DATES OF MEMBERSHIP: 6. er eenaryoy Sates a-cntaenementi-e mqnenasariaber re foagneane era streamate tert niASr AACS EET rRNA Name and Chapter 5 & No City Brate Country DATES OF MEMBERSHIPS — ee i Aan —— ce ere weer tocar ee rere ~ Name and Chapter at & Ro. City State Sausvtry, DATES OF MEMBERSHIP: aeenrenrerene
14-00000 * day SEC. 23. GENERAL QUALIFICATIONS . ; A. FOREIGN LANQUAGES (STATE DEGREE OR PROFICIENCY AS “SLIGHT “FAIR® “FLUENT") LANOUAGE Lunch speak Mane READ whgil. WRITE my /E TY 5 OR LANGUAGE SPEAK READ ceemmnneeme WRITE emmmenencnremmene _ _ LANGUAGE SPEAK READ WRITE _ -  B, LAST ALL SPORTS AND HOBBIES WHICH INTEREST YOU: INDICATE DEGREE OF PROFI- a : 0) GARNGY IN EACH: HAVE YOU ANY QUALIFICATIONS, 48 A RESULT OF TRAINING OR EXPERIENCE, WHICH MIGHT FIT YOu For A PARTICULAR POSITION? © LI8f BELOW THE NAMES oF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO 5 ; . WHICH YOU HAVE APPLIED FOR EMPLOYMENT SINGE 1939: . - { - . ‘ i _Wone 7 . ~ meth + . na . on andneneneygmeases panpant sap areneenanN . ; ] . a — ~ ‘ A i ower ear traemanarervene nemo ’ } . r ; peer errr anenap nenpei pte a an : : Ir, TO YOUR KNOWLEDGE, ANY or THE ABOVE HAS CONDUCTED AN INVES STIGATION OF Eg. YOU, INDICATE BELOW THE NAME OF THAT AGENCY AND THE APPROXIMATE DATE OF FHE INVESTIGATION: OE ee eee hing api Sestct bie | Merry. Lae bare y Lelie 23 23 fL3 Palo d _ and Lee | bl yA gue ue ahowt Pilar tty bDES a nn So merge: i on pa enn is a3
sean sce pmo Sh emits + SEC. 24. MISCELLAN EOUS Aa. BO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED: OK ANE YOU NOW OF HAVE YOU EVEMt BEEN A MEMBEH OR, OK HAVE YOU SUPPORTED ANY POLITICAL PARTY OR ORGANI- ZATION WHICH ADVOCATES THE OVERTHROW OF ‘OUR CONSTITUTIONAL FORM OF GOV- ERNMENT IN THE UNITED STATES? No if “YEs", EXPLAIN: ‘ B. DO YOU USE, OR HAVE YOU USED, INTOXICANTS? Sa a if 60, TO WHAT ' EXTENT? ers a c LAW: OTHER THAN’ A MINOR TRAFFIC VIOLATION? IF 80, STATE NAME OF ‘COURT, . CITY, STATE, COUNTRY, - NATURE OF OFFENSE AND DISPOSITION OF CASE: Pith ll ppehic a be a HAVE ‘YOU EVER BEEN COURT-MARTIALED WHILE A MEMBER OF THE ARMED FORCES? If ANSWER I8 “YES,” GIVE DETAILS BELOW: SEC. 25. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: NAME Mes thts the chragh RELATIONSHIP Mike. é wn fides Fe ,, ADDRESS Ake 22 ey Paha Lif Pap ipl sng Soar z SRF SIS SES See a Pines rae ny a et ea SEC, 26. YOU ARE INFORMED TIIAT THE CORRECTNESS OF ALL STATEMENTS MADE HERE- IN WILL BE INVESTIGATED, ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE NOT MENTIONED ABOVE WIC MAY BE DISCOVERED IN SUQSEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EXPLANSTION? IF SO, DESCRIBE, IF NOT, AW- SWER “NO.” Me EA sat ee a = & HAVE YOU EVER BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF ; ce ge
ayes te eee tthe te a Pf ee, fmm meant, ein + een nett ene oe . a a QO  @e SEC.-27. I CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BSLIBF, AND I AGREE THAT ANY MISSTATEMENT | OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE GROUNDS FOR IM- NEDIATE DISMISSAL OR REJECTION OF MY APPLICATION. Tu by 24, 1950 ; Senger . e f SIGNED AT lountain Fee, Po, DATE > Chay eat : 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 . MATRRIAL. If ADDITIONAL SPACE 1§ REQUIRED’ USE EXTRA PAGES THE SAME SIZE AS. THESE AND SIGN EACH SUCH PAGE. yee. contad,) — . . . =e eho te ~ During this period of time 4 €as employed by Mhson's Esso Service famagua, (%.) aperatin a gas stafion for Or. Biliden 6. Meson. Lf lett thes positian™” fo ob/ain better paying. em fe ment wa fitlas Pavder Company, Taw Reynolds, 4 £ also worked @s Q Small Machine iclder fer Tamagac Pianukac having Company ) Tanmag ac, fe, MwAing and posing gry Cust ivan molds My wages merc 4 2138" poor Hone, L kK wher the company went? guk oF bustl os, L wes also conmplryed by th: PEP 7 re. Cay Mater, fa, For a %hert prrrted oo ap time, £ selh phys catapa aly fer better conphyorat 8 A aSetom tere ne weearee on
TOT tente mevante mtn Secon tat tom sr eeemnen eto enn eu me og Poesy steatenned smormene ents 2 Seen Li peste amin conten eeetet Lente ate oon wet mee } Nene semrcreommcion _._ APS2ICA>-3N FOR FEDERAL EMPLOYME-@ #4 wee ci SERVICE COME IGS IOP Type cetinn, answer every question on thie form e¢leartg ast «complet write we print im be Rete UF EeARIMATION OR RIND US PLAT Ym BSPLTU FUR VY orien” Gi mentioned in saaminetion annoencement) we: David  Lariar TT SREY ans wabeR OR Wo wai APPLICATION MA E17 Mountarn Top z, . a UM ves imd RESUENCE ater) Pannsylvanta “PBaTe ow bunts Cenonthy day, peat Jan 2°,1918 WT. ince wr BRT W (odty and State, @ bown ovtesde Jamagua, fa. TS Gl HEIGHT WITHOUT SeraS ren TES ane OO rewne _ GR AF SO, GIVE LAST GRADE AND DATE OF LAST CHARGE mH HAO 7 | = 64-19 1, ay Woah 19 THE LOWEST ENTRANCE SALARY You wit AtctoTS 8° F SOAR PER YEAR You will not 50 conadered for any pdaattion with @ lower entrance aalary. 5 : (8) CECH IF YOU WHA ACCEPT SHORT TERM APPOINT UEHY IF OFFERED, FOR, LTO 3 MONTHS 3 TO 6 MONTHS CJ e192 wonres NOTE. Acceptance us refusal of a temporary shart-ferrn appointment will not adect pour oppurtuasty to obtain a prabationss appuintment. (0) 98 YOU ARE WiHLLIAG TO TRAVEL, SPECIFY CHO ASLONAR LY sae | FREQUENTLY 46. EXPERIENCE Te be tmgewtent for you to furnith aff totvenariun sequested below im sulliclent detail t9 eneble the Civil Gerews Cranpasa end the spronting oMcere Gf ageneics to give you full credit 3 Setessnining your qualifications, Ube a esparcste block fer cach paren. Sut with your preaead portion anf work Lack, expisining ghenrly the grumepel taeke which ou petlanied in each pation, accuurtting for all parece -f unen ployment, Eipenence auned mode tise 15 peers ago which te are peyternt ro the warle for whsch you ave apptzing say be summolred in ose oc ade of the ble ke, if your duties shanged mmetenally white working for the geune employer, uae @ seperate block to dewrthe each postion, You my weriede any pertinent BAILS GF ENPLOTMINT (rondh. yaar) a wy ACE CF tMmeES testy and Szate) aitkes: Barre, Fa. 7G RRESENT THatl "Rae rement, bureau of vetablishment, ard dieses} SLO 6¥ YOU RUMBER AND KIND OF Boras hs SUPER YE te ne INSTRUCTIONS fn opder to prevent delay in e-wsexte~ ote oh your appli. ¥ dn sppiveng for a enerche ected Deatee Cink Gervice gtamention, reed the esamination annnruncerene emeet chy pr fellow all divectuone 1 vine 6ee applyiig for @ WRITTEN ese cvation, follow the Apphiation For Electrontes post lon T RAT BF EGR OvuENT. APrLiED Fon (City ond State Wf: Tad RPPLICATION | ee ial ae Pred 1) WEIGHT, 42S rns $4. Ga) WAVE VOU EVER exc EMPLOVED Oy THE peoERat covtsawers [7] veg [Shes ED cocsrarer DAREN ©. DE EMFLOTER Chem, organtaation, rf perae, if Padaral, 5 gohan ie, fa.Sstafe College EL afensan TS E. ¢aion St Soh IkKes ~GBerre, fe. - “instructive cn the aviresuern 69d lad ald Grepeeton ef this epplicatiog, tf yor are epglying foe on LICR PIT TER evocunetvm, mat thie application ta the aFire named we the wreeravement Be suse ts mail to the same office srpad wz the ebiweeetiant, Pieeity the allice with which ef trees + tetas rh per OhArene any vi hee foe org © ergs ay file thie sve atten O90 HOT WRITE 1M T4:3 BLOCK For te of Gril Servke Commission Oaly D REGISTER af fF Cherish 4.0. #2, Plountain FepP, Fa. — sonsensaneee nenmmeae|sceneaser|ranecrsnss ||] POTS |. osee 2299 (Wuangela oan ANNO sssccecensrecenaces+| ononeenne pore [ennneee [7] smave scdecnonwrctes us sovee| anncenene one seanse - - stecsnscraaconeroesen|sevcosene| -neseneeee|{ | OFBAly | onsen. ceccescrccassccsnocce| seersnore|arsssscces ||} INVES bscores | ccscorerarresaragarelersgrgomel penererane lene seeowess (Db CHECK WF YOU WILL ACLEFT soo ,NIU LET, IF CHTLSLD, me pa, (Sin waswnstone.c = Ev amcanava os reg uteri erates (7 oursoe rue uneven erares (IF YOU WILL ACCEPT APFEAMTIRLIT {8 CERTAIN LOCATIONS ONLY, GIVE ACCEPTAQLE LOCATIURS, IITISLS Att 7 al tehgious, clyie, wafers, ad cf cececetemal activdy whi h you have performed, eithes with os without eccagertetea, thiywimg tht avinber of hours pee weelt anil weeks per gitar in wh. te you were engeye3S te euh activity, Militery eaperience aauld be dew nieAaG Unt epeine Laven 1m ie proper sequence, (a) Hoyo were aves gingleye4 in eng contin opter a neing diffecene from that ahown fs Item 4 of thee egeiuetion, gya ander “Description of your wars” for cah position, tha tas. used. {b) Uf you have never bere esopiyet ee ssa sxew enemployed, indicate that fact ua the space presitet tale Le “Prgeent Fiwtve,”” : ; PRESENT POSITION ; Tat TORE A 7GUN PRESENT Fat TiO Cease ec one Eee [SEE Ce CARNES: an Padesad Berea)  bseseriess ¢ 990.00 pea Me. Tastractey fad: Electric MOM ARAM SB AOD MR Da | WAME ANG TITLE UF Tascea Ts. o. Fis e fOr. Georg? Brarty Ll Kind GF RUCAELS Gn LFA 2 vA ls @, whulecels eit, snaucanua agency, eanufeoture of lacks, ets } Fechnical tnspitufe REASC" PUR ONSINIAG TG Led ok LORD TELRT 20-23 shidents per 2lass, Ve.cmback or, a oar _Engingert Sdustrta. Janne brn cek yb bidders «lindas frtat... ahbischirgareS hy aead.. bah BOLI IPA MIA IFES. p- OL... céabntial.vrtilate i level. ABS MEL rv LOLA CAL. LGM ES 23... fad pat ll... FO. MC.... Bhd. Bac adilege a LEM Mssrovvee ee so neneecesnceseestn ee OPO 16-—-83000-8 {CONTINUED ON NEXT PAGE) wer of Electrica Ue
NP mamas mppey peemite eee et SE nek gee ‘ ae of moe rade areca ttans...9: Feet mianth.'y year) Tract Nils of WAS ROSIN | CLassiHdatiae Gale Biteey ox qaAaNGs be PER . a P? oe, (fon Federal saree) sraenies a fe 2, ae ftw a RE Pe : BY qeey and is \ MAME AND PYLE rr ISSCaTe Sc RRA Viay Colson ieyn ofe's, Ma. NAME AS ans as SE EMACER, (him, Grganivation, we perma, ef Federal, | KINO UF BCSIAESS OF ORS ‘te @. wrolveele ada. inet anee agerray, ete } wey, femeree, Suey op oy and dev enamel manufacture of fouda, abe as saw er Co er ary £4 / . yplosives Royrotds, fe. fr P huMBER fo ae oF (is7 SUPERVISED | BY TOU EASON FOR Liang ae “pariabl lelséce belsaw) “aiend Pa. Stat) Collage. PSRTTN ERS [0000 Sidra. $6. £0... Soph tha, 2 atorked. ball-fime, seed land 4 28 C Air}... latin... far. SHaipenenh. ia. tbe....calarser. eh p. Fuartee prt eTen... Sram. Se Lota ta. feb GR, ko acerked. fog —f fait, iad Lyd. fiull-tirnre_durshg... vacations, white,.attendag. th. state Calisa 2. Made cg caduatc.Conta.sy. Labbe VOM 8g Ly At? A aL tine. Elect a... Enqinecin a Ca ccign. lawn...020... Feb) 92. antl. Feb. a2. _ 2. attended Fhe _m2a4 [ca.on. fries Bb th Bonn CALL je ak.ttake. College, "Pha DATES OF EX AUST WENT (month, year) TrbeT TITLE ry, “a fa GastincaTion Gaare a SALARY OF TARNINGS eee ia Le Cones tf it Federal serv ee! Stans § 37. oo. ren 17 6; [FROM Jet ‘#2 wm May FG ‘st 4& P : 847990 Ama. PLACE GF EMMOYWEST Coaty and State) Mansy, Tapan= APOI2D . rex, ‘ordanisatian. of pert. Ferean, of Federal, KAME ARG Wa OF UM MEDRATE ee, od Cat. James fur fame ARO, + AORTSS ca ae fir RIND OF BUSINESS OR ORGAMIZATION fo. @. whohesale wth. iteufance agency, mame deparrenent: Burney or watabhahment, aod drew manufectires af locks, etc.) OEE See. 323" PACS Sguadran . Airway Communica trans FUMBER AND RED OF EMPLOTERS SUPERVISED BY ey jog 7 REASON FOR LEAVING Se- FO Vey a de shah’ 3 Fettian | Spare fron Front Service CBECHPTION SYS REE YS, ey abd, fmany . Paty knae wi ORELL R22. O26 IK, LA tendee.... a. Mads eatit ach. Sahaat 4 pent. Sp. erwed.. as. aden. Debs Laste: wclor, Masa. attend dé friatia Lad dats (lamnra acoltensd, 2. sore 21g. Ink sseped bee t® £ betams..o. Cammunications. fLicer aatl. Cryptegraphts.... epariky oD btece rn. Abit. Ade te bby bBBEh. LRES. Ss nip he, bit BE. MA GO> A $40 4 ty. naumca es ": CLASSIFICAT Ow GRADS Gé in Facer al service, SALAW’ G8 EABAINGS staaness OO. GS” sere Bose, FIMaL § @: 8 Fal PER fay? e 4 . DALES CE Ew CP aENT (anth, year} o/ er 2 rou (73 fF - Oot A 'g2 | Ps SNEWS VILE GF THMERTE © Re SA of PLACE OF EMMOVMENT hstey and Stara) re wal eynetor sy! fa. a - 4 ftobert Serna _ ors iter, OF ganization, oF prean. i Foderad. | GND CF SUSALSS O2 ORGANICATION (a ga WADasaS SIR, ineutance agency, fT OE Woe es and diviemrd manufactice of locks, ote.} ae ot aa aa y ‘Explosives ERENT FOR LEAVING } ° ! Enter rmsd 24 Preped Ab Boot, 14. fee ce /.. fe Maes a wo RS) pedi, aiached sassy Tank. Fer. pn BEI LIA, BRIG (ied aT Pee ‘eat day Ate RTE men wa seneeete teeen inane ene omnes satueateenee { hd. aay jhdlgs fein d 2c. OKs a! £94 ‘La. ies hin... £¢ sr shipeis ae farentan Of. Bar pack Cle be
14-00000 DATES OF LuPLOYWENT (eponth, roar) ag? THLE OF TOUR POSITION CLASSIFICA, GRADE, SALARY 08 EARNINGS eo 2) . Ut in in FoR or 9 ane PER cou Of 9 G50 to {937 - Fifa, Pun PACE OF EMPLOYMENT (osey f hotty and Stated | SAME AMD YITLE OF SBMEDIATE MEDIATE SUPERVISOR ° RAME AND ADDRESS OF EMPLOYER (Arm. organisation, or person: Hf Federal, | KIND OF BUSINESS OR ORGANIZATION te, &. wholesale alk, insurance agency, name department, bureau of sttablishmaat, and diviarom) manufacture of facks, ofe.} RUMBER AND KIND OF EMPLOYEES SUPERVISED BY YOU _ -[ REASOR FOR Laaving CESCMPTION CF YOUR WORK emtieemnnnnen 271777 j-7Bis-p eiadab._tn2,._.%.was..zrplyed b Wile ($3.0. G2rvK?.,famagida. poy. dp 20M as..abattet.for, 4 bear. Co Alpsar LLL. asitlon. te te thtanl be ek Lecpaifing ABD rapa 9 $0 yoiznt wutth. fellas. faa ber $a als wai: ds... Khia fl... Pr dep Idér for. ert ji. UEFG Cbg a p. cre bis: LLM. Kre2 9.2.10. iin ULIAG.......AAS ny S08 gia Sa. / acd a bin Deb iE waht ...Afye2 cathy ; A inuti citd OL... NELLA Sed. pace as fe fs0......21. raf La yes. by ye Le 2 Aale TP. GAY y BS. 5 Bon OBE Mn LA A... SAR. Ch parton: ‘fF. (rte faces leaving. fhe, rer’ oy olay. fax., . OLLI n-p saved em: ole wi ef. wtith. phe. Tamb sar do! 110 aw the. Cates fe ane, ae equired, usr @ costinuation shect (Standard Poerh 0%, 68) of @ sheke of paper = eame wise ag this page. oe D adds ene, “hove ‘a phot ead ¢remunation Hie. Attach te nade of thin opidusuon, > “TF, MILITARY TRAINING In the space belw, deecnibe any taining secowed id of traimag received, suchas hours ‘per week, Detailed informevon rr: the Armed ‘Services (not slresdy tieved uoder Item 16) thet wonid eeest jag any special service schools’ you attended le especially important. ata _ appating © officers ia placing you cet effectively, Ef Hes secteial war emer sat pages may be weed to give TudB descriptions’) ; LOCATION ‘pescripnon OF TRAINING fa: la.Op. ald tc Asante Bal BOMS. CFO. st prrrseemernenrsesrninece ae Aaation. Cadet... fre-THh. nese eS, BOWES. : _ Cennmngniadt ans. QAv e867 DOG BOWS, iccgeorecnesees TJan’43.. fla 23 1Chiage. FU... fart Wah 't4| San. dafbains Tea.. ialyaa.. Ode 94- salad, We itn omy meee ne were ne cenamennewnsen st rer lewersernee renee Men ete nae er cnmmeamann rere” . EQUCATION Guale highest Grade completed): t we GIVE MAME ATID LOCATION OF LAST HIGH SCHOOL ATTENDED t 2@ 8 4 &$ 6 7 8 8 f ft Gi Tama que AS. . Tamagee WARM (x) THE APPACPRIATE BOA TO IRDICATE SATISFACTORY COMPLETION CF H (5) SUBSETS 3 UES Fe MESH i he APPLY POSITION fs CF] ecemcrmany scnooe, (C) simor mcs scs008 [ec tewon wan scorn | | _ flothemattés SIO S ” ~ . MASOA OATES ASTENCED . {C) RAMA AND LOCATION CF COLLEGE 02 UNIVERSITY AND SEES TEEN GIRDER PEA : LSPECIALTYf nom TO - L allege. £5. ign lees Baty ap SLA |Aek. Bo. Li anal, Cadle9 2.5. Fe Elect rant bt cecsntctaan|evoneereone|accecneenere [ecoeseerscenene| preaeerea: ORPOwAE. CALISE SVONECTS CE fee 4; we wy — flag Seen Les ange eeeeeeene T22[ ag esd Elecdcanigs. Lo dA A lec tiga lsc, -gegites Aas Efectutval Courses| Sh. wee. 1b. Eng, %IAME TAC Angas ah ¢ ~_ meer ee fink NY8tiy Palse Te: s DATES ATTENDED | veass Compierto fad | wseT QE) OTHEA THAIUNG $a0H AZ YOCATItR, Bt $, STUDY COURSES CHES ” s cers ernest 7 THROUGH THE AUNLD FORCES INSTITUTE (show naine and focation a 3 ” rosa To ef shoo!) Of “-EEAVICE TAAHRING” 19 PUBLIC OR PRIVATE FMPLOT MES 4 LLL aw FROM of TO sa enn ew off OR MALE COT EVEN BEE A LICENSED OR CERTIFIED MEMGER OF AS THAD OR PRD. CARING i UNDERST 2% 22 ARE Yo, NG He READING ae 19. IADICATE YouR KNOWLEOGE oF F.$5108 leucn a2 plot, electrician. radio operator, teanher, law yer, CPA, ote FOR GN LAR “ a eae wera} - ie an - - i cs 4 20 1F COU HAVE TRAVELSO O2 PETILED IM ANY FORLIGN { to atest LICENSE Of CEUririce Te (VEAP) th NAMES OF COUNTRIES “ CATES ASD LEMSTH OF TIME SPE HERE, BD meen entnrntenemme ermine HEALON OF PURPOSE Oa. §, mulitary ewrvice, buerncos, educa’, 22 Giek ANY GPLOAL COSLIFICATIONS MOT COVESED ELSEWHERE IN Yu A APPLICATIV MUCHAS 60M, gecreatien) i (6) (9.4 MORE IMPORTANT PUBLICATIONS (xfo mot subatt copios unless soqusoted) ’ fusspiae Estland; (2) (Sol PATENTS OF MCENTIONS Maula, Phy a ¢; saps! Su 5, OF I. ELATIGNS EYPEEICNCE Jini ‘gs 4s Aoki ‘2S niulte oy ‘seh Ate j 10) MEMBERSHIP 1M PUDF! NAL OF SCIENTIFIC SOCIETIES, ETC. AGRE AND FELLOW ou! H R 24. LIST ANY SPECIAL SRILLS TOL. POSSESG AND UACHINES ABO TQINEMTTY TOE 1 A ECLVED. . CAN USE SUCH A3 OPERATION OF Die387 WAYFRAINO MELTILITH. COUPTOM. ¢ Studtnt BlM ber Odeo ETER. NEV PUNCH, TURRET LATHE, SCIENTINIC OR PROFESSIONAL GEVICES | : Frat- Efe Kaepa As. | Watenal Henorary Frate- APPROAIMATE RUMBER OF WORT PER MINUTE LE TYPLAG SHORTHAND ._...
ta REF COTM Bree ghone —we-gows Weing i beth. of Teateee 2 yur qualfvatume aad Stress for the postin ba wtoeh you ore épplrng, PULA MAME MH Cachee ‘(r. Charies 4 « scseneneneucensonsrmensnne catsserersencnemenccananeseracsnoncsns[oncsnndith Lath Idi ROLE. : 5 eeres Ba ymtecrins spt pire eee eran tnnmnmnnnnaanemnasntens pn i i Sa 7 dade ors Zadaste cur, Fe tS: oF FOG Hall, Te ‘Pluss Peart 4 oan 7 PSS cote TES | Tapieata rs vy “ao” TNiete GY PLaciNg “E~ im PROPER ColuM PY war (NAB WANT OF HOUR PRESENT, EMPLOVER RTGARDING YOUR uv | CUMMACTEM QL ALIFICATRINS ETOP oo ww eee eee fe eerste re pan, 2A ARE VOU 4 CTEER OF O8 50 YOU | owe MLEGIARCE TO fe UTES ee BIAIE SE -: oe ee we Pree ee eee ee 27 ant YOu NOW Of MALT YOU EVER BEEY, A MYM BER OF THE communist PRATY USAR. OR ANY COMMUSIST ORGANTEATION? settee tection bey A@E YOu BOW, O8 AVE YOu EVER OFER. R.A MEVOENOF AFANCIET ORGAN. FF AT otr0e3 5 ~ wee age rs . aes 28 Ant yOu NOW OR wAYE VOW EVER BETH, A MEMDTROE ANY ORGAN TION, BTM 1A TIO WOVE MENT GROUP OR COM 1088 OF PERCHED wide a WRC ATES Tock OVERTRROW OF OUR COMSTITOTONAL oO OF GOVIAMMENT, ORTD AN CRGAMIZATKIM ASSOCIATION “MOU EE AT GROUP, OA COMBINATIGH OF PERGONS WeiCet HAS ADOPTED & POLICY oF ADVOCATING OF BFFROVING Peek COMMISSION OF ACTS CF FORCE OR VIOLENCE TO OF RY OF MER PERSONS FOE UR RIGHTS UNO A Tet CONSTITUTION OF THE URITED STATES.ON OF STE K- it; PO ALTER TRE FORM OF GOD ERNMENT OF THE oniTeo STATES BY UNCON - SPUTUTIOMAL MEARSE 2. iu your answer to question 2P; 28, oF a hove be ’pas,” fa ftom 39 the names of ail such organise Movamiante, groupe, Gr combifiation of persone and dates ul sbemiber ship. 5 complete detats of yuur activitias sherein and miake any e:planateon you dealte sederding yi snombers Rep of tivities therein * state OR CONVICTID FINES, OR UP: vou gver BEER ORDE WED TO. THOM. OF ANY LAW POLICE REGULATION OF OF NCEUERCLUDING winoR” THAPPIC VIOLATIONS FOR WHICH AMINE OR FORFEITURE OF #29 OF LESS WAT PM PSE DN bz Oy f in each case w eh ‘date, 2} ¢he netuce of the offense o7 wiolatian; (3) the name and bwetion of the court, (4) fhe ponairy sinpossd, Uf any, or ather diapoaition of the S8ad. Pappointede pode Angerprinta will be taken Mo HAVE yOu EVER OER DISCHANGED OA FORCED TO RESIGN, Fou} Moca DUCT GF UNSATISTACTORY SERVICE FHUM ANY POSITION? ff your anewer 1a Fea, gite in fram 39 the ‘namo “end, addrows of employer, date, and reason it each care. W wave vou CviAt BEEN aaaaro ‘DY Tee Y 9. CtVEL SEAVICE COMMISSION FROM TAKING E AMINA TIO’ >as On ACCEPTING CIAL, SRAVICE APROHINT MENTS if your anawor 19" Yos.”’ giee dates of aad seasons for auch debarsmunt itt, ftaen SS. BI. HAYE you AnY PRYSICAL HANDICAP? DISEASE. OF OTHER DISABILITY AMICH SHOULD BE CONSIDERED IN ASSIGNING VOU TO WORET. 0.0... --- i your answer ia" ¥'03," give compilais detacis in Stam 39 20 thal consideration can be give to your physivad Aliness tor the job. S46 6) FOU RECENE AN ARMGHTY FROM THE UnITEO STATES ON CHT RICT OF COLUMEIA GCONTRNMENT UNDER ANT RETIREMENE ACT OR ARY PEON OR OTHER COMPENGATON FOR MILITARY OM NAVAL SERVICLD . ve ff yausr answer 12 Fea," sive somplete. details in Hism 39° ae eves veeseene sevsoneteeeeeeee weer epace “ “required, use “paper the game ere ue thie page. of thre appli ation Hefore mgnin FEE SENT By SIME TSC NS ALES (Give corn piers cur PA aes eee 6u 753 R-6 rae on ag ‘ re] "TION AND RECEIVE A CAMPAIGN BADGE Of SEAVICE MOBONE, errteme es of tue United Riatee ake ace NUT releted ta you and whe heave dednite bnowledge of bho net repeat Names oF Popee res heted ander tem t6 (RATER RIENCR) . reiting atroed and mumbary | __ Business 08 COTA’ ave lap mst VI Ata vf, fitess Pued Ce, ‘ nel S28 Conve Mr ea Ree saaneananenscesse|-enee (tines dn edbnge., atthe Guys fh.) Prof, F heb Pras | ayes I4ioe 7 nee. eons inpicata “HES” OO Wl ANSWER BF PLATING “EZ” PROPER cole i Es | wo 33 ARE YOU AN OFFICIAL OR EMPLOYER oF Any STATE. TERRITORY, COUNTY a OR MUMICIPALITY? ff your eniwer ia 3 Dora tre MITES STATTS COVERMMEAT EMPLOY INA Civiktan CaPaciTy ANY RELATIVE Ge YOK RS 3) BLOOD OF, MARMIAGE)- WITH WHOM TOU Live OR HAVE LINED WITHIN TNE PAST 24 MONTHS? oo. rr i if your answer is “tee ehew in iiem 99 for BACH suck . relate (2) full name: GC) peosent address, (4 felationehip,; #4) Department os Agency by which employed, and (9) din of a ePeg eva rte SPECIAL INSTRUCTIONS FoR CLAIMING VETERAN PREFERENCE A. Uf you are siaming piefevence ao a PRACK TIME VETERAN who hae been avrendead @ pagh badge of gervice mbhon, of sy & DIGANT KO VET. BRAN, o¢ as the wi re OK A ISABLELD VET ERAN, of ag.the WIDOW OF A WAR OR CAMPAIGN VETERAN, attach Veteran Prefereace Cletma, nt dco JP CSC Form 14, tegeiber with proof epecibed therein, B.-lf you ate-a WAR-TIME VETERAN not claiming disabiilty eee should NOT eutmue your dischafge with thle application. Prefere: sah tentativety creditad to vos and if sppointed, you will be Cewnteed ty te aubrnit to the appeanting offer peice “te entry on duty, official evidence of expara- tien from active service io the ermed forces of the Unites Aitates tm time of wer, * - rad, NO 37 Ay HERE You EVER Pe TRE UNITED STATES MIUITARY OR NAVAL SERVICE —, QURING TIME OF WARD... cconsonacerorocesecboscnstststsetestearzaeesvaees {0} 1 TNE WORD “RONORABLE” OR THE. WORD “RATISFACTORY’ USED’ : i YOUR MISCHARGE OR St RTO SHOW Tee TYPE oF your ae GISCHAAGE GR SEPARATION «Ch WAS SERVICE PE@OAMED ON AM ACTIVE FULL THE Asis. WITH FULL MILITARY PAY AND ALLOWANCES? |. wee wae 10) | DATE OF ENTRY OR NIRS INTO Seaviee Date oF SLPARATION OA SUPARATIONS Jef 29,19¢2 flay 29,/9FG PARA OF RT Che NG | HR a ahi Gis Bae Marine Corps, Coaat Guard, te.) “pating af tiene oe eapsration). 6 y ree -£ 3 F- : ry: 38 tA) IF YOU SERVED IN THE | NITED STATES MILITARY OR NAVAL SERVICE DURING PEACFTIME OLY 0.0 YOU PARTICIPATE IM A CAMPAIGN OF EXPE | 9. et ed iB) ARE YOU A DISARL ED VETEAAND OL, Ferrey Hf aa, and eis have pot fated your disablicty ‘Gn answer to from 33, oxplaim yeu deen: 3° below, tC) ARE rou A VETERAN'S WIDOW WHO HAS NOT REMARRIED... -.22maes (9) ARE YOu FHE WIFE OF & VETERAN WHO HAT A SERVICE CONNFCTED ti Maka WACO MS OCALIENNS HIM POR CIVIL SERVICE APEOUST MENTE ., "THES S6ACE FOR USE OF APPONITING OFFICER ONLY The information contained wa the anawess to Question 37 shove hae been verl- fed by compannm with the diecharge certificate am ....... neaeweneee vonnee Woo ane Whe on cach aheet your name, address, date of birth, and examination title, Altach to amante & this appheation check back over it to make sure that you have answered ALL questions correctly. {CERTIFY that the atatements made by me in this application are truce, vemplete, and cerrect to, tes best of my knowledge and behef, and are made in good faith, ‘Palse atatement on this prgneation wo pumahble by Law (U. & Code, Title 16. Section 8d). , a) UW A COVENANT Finding CPE IMe-O 90207 "ey SIGNATURE OF APPLICANT eee (Sign your name in INK (ane mene, of ini ievtials, arat nani eh. fernale, ee on nume as “Afra, Mary L. toe’ § peeie Miss oe Mea, and sf marr at OSidur o AG~ Sdvt-)
6 an 4 \ 4 og an , ss eae PE ERY ie ots TO - Office Memorandum - ¢ UNITED STAIES GOVERNMENT t ' Chief, inployees Division, Special Support Staff DATB: 9 November 1960 FROM 1: Chief, Inspection and Security Steff \ 4 SUBJECT: CHRIST, David Lemr = 43872 .. Reference is mate to your cemorondum dated 28 Alpust 1960, which requested that Subject be granted provisiousl clearance to permit his immediate entry on duty. Subjeot ia an applicant for & position as Electronics Engineer, G$-10, in OPC. This is te advise that this office interposes no ob jection from a security standpoint to a temporary appointmont of Subject to work on unclassified duties for the training staff, upon the ‘ gondition that Subject (1) not have access to classified material, (2) not have access to CIA secure aroas, (3) not be issuod a CJA badge or credential, and (4) that he not roprosont himeslf in any official capacity as.a CIA enployeo. The Subject may not be ase signed to duty in any CIA staff. or office without further m thority fron the Thief, Inspection and Security Staff. : FOR THE CHIE?, INSPECTION AND SECURITY STAFF: CY C. Ve. BROADLEY % Chicf, ~“Ssourity Diviaign f SR
14-00000 - } 3 ORGANIZATION | 4, id - hwor MOVaS psyoee Laaise DAVID LK” | a2 346 v rr NtW SALARY BATE ie. rvPe action’ OLD SALASY BATE . ’ tout ff. Dew | Geado | Sieg | Selory tree ve DAT? asl banca 11/19/67. CERTIFICATION AND AUTHENTICATION é a CERTIFY THAT THE WORK OF THE ABOVE NAMED EMPLOVEE 15 or ACCEPTABLE LEVEL OF COMPETENCE. ad wignatune Oe Ay) OO Bate RS [7 yo excess whe & ve PAY STATUS AT END OF WAITING PERIOD i ([7] \wor status at eno oF waitna Prenton 7 4 CERES INITIALS : : * 3 PM sooe Mygrin <7 ‘ Behera stited hasds, sageh Ge LPR aN soon wien tre ese aa ante bi Aneel wae Metharanipirnerc, Sie whe Boe ton beotetey hk . : y i : . . . . . 0 MPAY ADJUSTNENT IN ACCORDANCE WITH SALARY SCHEDULES OF PL 91-231 A EXECUTIVE ORDER 11526 PURSUANT TN AUTHORITY OF OCI a&S PROVIDED Ih THE CIA ACT OF 19499 AS AMENDED, AND A OCI DIRECTIVE DATED 8 OCTOBER 1962" EFFECTIVE DATE OF PAY ADJUSTMENT? 26 DECEMBER 1969 , : , . NEBW NAME SERTAL ORGN, FUNOS GRaSTEP SALARY / CHRIST DAVID & 059090 82340 V GS le? - $342837 ee wpm i we TE or cea SS Veer es a a ae ad ia rk OLE Se ae al aT i i sah Bt ep ap BO EY ET SEE oe ; : i 2 RAY AGUS TRENT TA SCCUEDANCE WITH SECTION 212 CF PL 99-206 AND exECU ” ; Off Llats FORSUSNT TO CUTHOREITY GP och AS FRAYVICEG TM THE CEA ACT : AS AS EN pos LOC? OERECTive CATED & Clot otk peeer ERSECTS+2 GATE GF Pay spgusTeht: 12 ILLY L949 ! ile a NAME SEN TAL ORGS. TiNDS GreSTte SALARY : mEGCGs BF Rub vo GS io 7 $30,054 CRRIS® Cavidon
14-00000 ND gone pe 90r200 APT. net . aANO 21 ; “THe 6 TIONS 212 pacv IED IN ccoRDANCE WITH see ORITY cr OCT AS PR eae mpay ADVUSTMERT IN COME Uaguant TC AUTH aren a OCTOBER ® executive oxcee bebe php aged pIRECTIVE © 69» BS AMENDED? _— a guey 1968 of ee te uF PAY ADUUSTMENTE Be EFFECTIVE 00 ove reay xy Saba! SALARY . eTBL  DRGNs FUNDS GaoSTEP 27) 40% vane genial | gs eT ggaeite 827 62 340 oe ., 959096 eHarst oavid & Pm action]. Pr | aor ° Tas ie wey [tes bow | ome] re 08 16 | 6 [82heh?7 §, Semaris and Auibentration yg (ef RB WATTEE Ms Yo 88 8 ok 8 OS 8 Sn 29 FSURUARY 1968 _ 4 PAY CHANGE NOTIFICATION 741 $69 Mty 4 ea 7 Mag ATE eg aT cae? Ron PORE gen EIT RE (on ee ane opt ata oatmaygh reat gee ee ; ae . . : sc 25 OF PL yitle@n6 HAY ADJUSTMENT TN ACCORDANCE WITH Sayaay SCHEDULES OF PURSUANT TG AUTHORETY oF DCT AS PROVENEN TN THE CTA act OF 1949 AS AVENGED, ANE AeDCE CYRECTivE Gare&d 8 OCTOBER 1992, e EFFECTIVE WATE OF PAY ADJUSTMENT? 8 OCTOHER 1967 OLD . NEN ; NAME Oo SERTAL ORGN, FuNAS GR-STEP Salary salahy cnatst DAVID L 999990 62 349 V GS 16 5 $220755 $232778
u ; ; CONFIDENTIAL \ ia) . SECURITY APPROVAL 3 ’ : Chief, Employess Division, Special Support Staff : To $ BararnnoR eLearn Date: 2, November 1950 Fron ¢ Chief of Inspection and Security Staff Number: 1.3872 Subject: cyarst, David be i. Note "X" belows Seourlty approval is granted subject for access to classified information contingent-upon the receipt of derogatory informa- tion at some future date. Provisional clearance for full duty with CIA fe granted under the provisions of paragraph 4, Administrative Inatruotion 10-2, — which provides for a temporary appointment pending the conu- pletion of full security investigation. tl Unlesa tho applicant enters upon duty within 60 days from above date this approval becomes invalid. ro Bubjoot is ourreatly on duty ‘with this Agency. Chier, Pergonnol Sacurity Worthen Branoh FORM HO, MAY 1966 38-198