i+ 7 & OF abe erttnee wet ies es SEC, Prom 4/71. SECRET Security Information il, 2. experience, To t/u Tot.mo's / Class] {fication Grade(if in Federal Service) 3 3. Salary 2: 226 “eon Number and Class of Employees Supervised: none Employer Da artneat of Interlor Kind of Business or organization... ‘(i.e., paper products mfr, public uthlit CPO ale To 4/7 Tot.mo’ Sil Classes rr on Werrerst in Fedéral Service) Salary (1.70 />r, Number and Class of Employees 2 4 atepiey Supervised: 2. Employer. lee hewe Kind of Basineae or Organization (i.e., paper products mfr, public ts) oss, “Eek Sheone From 3/59 _Tor/s Tot.mo's 4. Classification Grade(if in Federal Service) Salary 7250 / mo. Number and Class of Employees Pee rv ed_ Employer | bd ue, aunt Kind of gon Sinens GF Organization (i.e., paper products mfr, public utility) trata as taoelakion a ere ener: Marae pee as From _ SLL? BLhG Tot. mo's.4 Classification Grade(if-in Federal Service) Salary Number and Class of Employees Supervised: _ Employer paged. Kind of Buvinest ae organization (i.e., paper products mfr, public utility} . From To Tot, mo's Cla 1s sification Grade(il in Federal Setvice)” Salary ea Ger te Number and Class of Employees Supervised; Employer Kind of Business or organization f., paper products mfr, public {fice ) utility) once | Description of Duties: Security Information WORK EXPERIENCE (CONT'D, ) \ Other than CIA: (Describe work experience for the last 15 years in sufficient detail to perinit specific coding of your qualifications, List last position first.) Include military work Exact Tithe of your position Ghatiatienl rifteman Description of Duties: T did statistical draftine, cartepranhy Parking of Sieerttites | 64h py Fe Ca rn rr st ton, Duty Station if overseas: Exact Title of your position atnistant to the Description of Duties: An a- ap yircnasing stock axscntives Twas reepo cibhts ' for the pifft shopne ad L-stheint!: reanhouse annlavashn [ had © Tl-ragnonatihl tity te Daolva ail oaths lo para penorts on the is salos ctars Sor thea shopne vy clarke and of bigtrans ad ante Duty Station if oversens: 8% Exact Tithe of your position Assistant Rookkweper Description of Duties: Tomade ronth'y financial reports, had the _ . } afd t-ning and rasporsthillty af tha hoaks obacr posers! e oe Wor: OUL Lice Duty Station if overseas: Exact Title of your position Description of Duties: In Bhe offtne of tha Chem in tha factory, oo “One! ove month wi eheratory and tug montin 1s: . — Duty Station if overseas: Exact Title of your position E908 corporate entries re EERE en erroreremterano tune Artin Ione rp AS Series oem ESS eLearn Duty Station if overseas: SECRET & 3
14-00000 — SECRET f Security Information @ SEC. Il. WORK EXPERIENCE (CONT'D) 3. Special Work Experience: Check any of the following organizations by which you may have been employed. 61 U.S, Seeret Service :. 24__—sAir Force A-é 02 Civil Police 25 Forcign Economic Admin. 03. Military Police | 26 Counter Intelligence Corps 04” US. Border Patrol 27 Immigration & Naturalization 05 U.S. Narcotics Squad 28 Strategic Services Unit ; . -06 FBI 29 Forcign Service, State Dept. ’ y 07 Criminal Investigation Div. 30 Central Intelligence Group te 4 21” Office of Naval Intelligence 31” Armed Forces Security Agency 1 3 _. 22” Office of War Information 32” Coordinator of Information ¥ i 23" Army G-2 33 Office of Facts & Figures é ; 20 _Office of Strategic Services 34 ___ Board of Economic Warfare : i % Federal Communications Comm. ; Hl : SEC. IN. FOREIGN LANGUAGES _— i List below the foreign languages in which you have some competence. Be sure to include uncommon modern languages, Check ( X) your competence and how acquired. i COMPETENCE HOW ACQUIRED g) VN arattie 8 see emt es a pane Nae Gd oamees wens lent to Native Fluency * LAHGUAGE Fluent but obviously Equiva. Porlufissa and written forrn (e¢.g., Arabic), explain your competence herein | BeSpecialized Language Competence: Describe ability to do specialized language work ‘invelving vocabularies and terminology in the scientific, engineering, telecommuni-— eations, and military fields. List the lancquage with the type of speciality. SECRET . ' Security Information
1 tee enett tenant weve bans SECRET \ Security Information \ SEC. IV. AREA KNOWLEDGE. I. | List below any foreign countries or regions of which you have knowledge gained as a result of residence, travel or study. Study can mean either — academic study, or study of a foreign country resulting from an intelligence, military, commercial or professional work assignment. . Dates of - Manner in Which Knowledge Residence, Study Was Aquired (check (X) one) Etc. Travel es es _ Ld é. Specialized Knowledge of Area. List specalized knowledge of foreign country such as knowledge of terrain, ‘coasts and harbors, utilities, railroads, industries, political parties, etc., gained as a result of study or work assignment. Include name of employer Country or Region or organization. How and When Gained SEC. V. TYPING AND STENOGRAPHIC SKILLS (PRESENT UTILIZATION) Per Cent of WPM (Approximate |‘ Prefer Assignment Skill Time Used {Not Used Proficiency) Using Skill Oftener fyping j2. fe) 1. Yes Z.y Nes | Shorthand 2. FW lL. Yes 2.% bio Shorthand System: 1, % Manual 2, Machine 3. Speedwriting, SEC, VI. LICENSES, HOBBIES, SPECIAL QUALIFICATIONS i. Ticenses: List any licenses or certi-~ ~~ [.2. Hobbies; List any hobbies such fication such as teachers, pilot, marine, as sailing, skiing, writing, or other special qualifications. etc. ptinthine, skiing SEC. VII. PROFESSIONAL AND ACADEMIC HONORS List any profesSional or acadernic associations or honorary societies in which you hold membership. & SECRET Security Information 8 peed attempt ERR React otaaemreneenere
14-00000 | (i) 2 year Tour (2) 4 year “four _ (33 interested SECRET & Security Information & SEC. VII. PUBLICATIONS List below the type of writing (non-fiction: professional or scientific articles, general interest subjects, current events, etc; fiction: novels, short stories,etc.) of any published materials of which you were author or co-author, SEC. IX. INVENTIONS Describe any devices you have invented as to type of work for which intended and whether patented. . SEC, X. CIA TESTS Describe below the type of tests which you have taken in CIA: SEC, XI, PHYSICAL HANDICAPS List any physical handicaps you may have. SEC, XII, OVERSEAS ASSIGNMENT Are you willing to accept periodic tour of ows overseas? SEC. XHI, WORK ASSIGNMENT In view of your total experience and education, for what assignment in CIA do you think you are best qualified? : Peal Tuan? auallfied for a geporta or rteaire ceaition. SECRET Security Information ie : Diet Gov anise on
A TER Dee o TR et oe et yl eke ceatRa we eee song wien earn Chien treet OT RMN 8 4! SEC, XIV, MILITARY STATUS i. Z, SEC, XV. CIA TRAINING SECRET Security Informoat on Present Draft Status Have you registered under the Sclective Service Act of 1948? If yes, indicate your present draft classification Yes Present Reserve or National Guard Status Do you now have Reserve or National Guard Status Yes ___No- If yes, complete the- following, ~— 1. __ National Guard zZ. ~_Air National Guard 3.” Active Reserve Status (member of organized unit) 4 ~__Inactive Reserve Status Service Grade Location Reserve Unit with which currently aftillated Service Mobilization Assignment, Af any Location of Service Records, if known List the training courses or subjects you have taken while in the CIA, Course or Subject SEC, XVI. REMARKS Use this space to indicate any other qualifications you may have which you do not describe above, vance nce ene Ten ea eave yee enenerec tears nunanenenancr nen DATE 13 Septenter 1912 SIGNATURE. 7/2, varie SECRET Ce) Security Infornration A Me
won eee ae BAN TEF Lao ANT Gamay oo “ROE TR a Pea dante “SEICATION FOR FEOERA. .NPLOYT US CIV SERVICE COMMISSION coer ant age an nnn tga ann INSEPRUCTIONS Ie anfee te prevent detay ab comouteratonn of yous apyt. Iretyrctieete ee the almieme cent eogacing diaretion of the eppicetion cetwus prawn evere qreetwer on thee foens viearty Gent arsagletely — Type. Pyen are aaa Ge an UN WEETTAN esaminaton, cead thie apaicationy write of pootis INR. tea apadeing foe oe ape, United Beotes Civil Beewis & te the ofter nammd in the anemisement, Re sure te eral te the pave office BAS Sele: ioe eee Pepi est be the apavencement, Nook Ube otoe ath which CRASH, remd Che ewmeer a Reread Core folty aid fedtow Alp dvestume It you are apgiuing fer a WRITTRN reuminetan, fellow the you te tha appeceten wl ane shaogo tm wus aehirmes RaMe ow BRAMIMATACA CA RIND OF PAISETION APA TG FUR . DO NOT WRITE tH Tors 6.0K art, Fer Use ef Cirl Servke Gomedssiza Only genes ages tsiadiengngastanin seein me | ne nn eterna tee nn tt Aaa THAD UF mentioned im slammaian announcement) n “VRE OF ESA ON UERT ROLES FON [Eaty and State) | BATE OF Pd APRA g ‘ E Washington, D. ¢. PS qeates name. qb Maden, uf any qhaag mss Charlotte L. Zahrung TAD Si REET AS eae On Bae CARES | PRERTR. U0l = 16th n Stes N Mes, € Unelading posts ce); rs GRADE | garing | et wn City Ca RST OF Washington, D, C bh oak OME Te mie L qstate He’ Ud26" U8) ROME Pit Onioe “PS DATE oF Bint Cenanth, day. roar) TR, 3M 51,50. | 198l2=29 o Kl mae WRC SF Maln Gigy and State. if Born auteide T'S S name elty and countiy) 5 eseeeny Organ. po Partone Ohio em eee . fens ig tC} MaLt TD ay Midget WHT MOGE S088 ‘Bp WEIGHE cecesesoncoustancessfaveecuece joo OL SES, _ kl me 14. (AD HAVE YOU EVER BLLN FEPLOVED BY THE FEDERAL QOVERNMENTE oO) ves Gl no InITiac ano GBP IF SO, GIVE LAST GRADE ANS CATE OF LAST CHANGE IN GRADE ? DATE 18, (Ap WHAT 15 TRE LOWEST ENTRANCE SALARY YOU Wikd ACCEPT? 8 0.00. cise sear eece (0) CHECK UF VOR WRAL ACCEPT APRONNIT MEANY fF OFFERED PLIE YEAR . eee & You will not ba eonantarcd for ary poaiiwen with a lower entrance QO Ae RASANG TON, DC, q ANYANERE 14 YHA UNITED STATES salazv. . ve us {Op CHACK IF YOU WALL AOUEPT SHORT-TERM APPOINTMENT UF OFFERCB, FOR: QO Out TRE UNITED STATES ETO $ MONTHS STOE MONTHS | 0 $10 12 MONTH 8 tecationse ACULPT APPOINTMENT: IN CERFAIY LOCATIONS ONLY, GIVE ACCTPTADLE NOTH. Acvoptance or refusal of a tamporary shut fern apgontenedl % wall not affect sour opgvirency ta catadt a prokatmaal appointment (Cp YOu ASL ILLIND TS THR NIL SETH ASADNA eee ae Th Pepeditete Bt ay Gupeeret feo you te darniens ait isfurmation sequcated Feligioie tian, aethsee ap ergintatytt act whih wae Rewe performed, fetow or Bastia tot fetes te enable the Qava degvice Cammiemen aad the other with ce witleut comprasation, axewtig the aurskes of hears pes veete Bppanabog chev « eee te sted aea folk crete pe determing yee UEP weeks per yea ty alah ys wee Srgaged fa puch soto. Mevcary fy duane Aart n ste Rh Os cach prsatiur  Srort witle Fove  eapenence shad Se deanoed mn she graces Lela ia ta pres pate eearsk position ened week ON 8, @aguede ng the principst Yoaky whlch ‘ we : sist oye 3 soe te a toe. Wren performed sn each poscteedy, os DUAL S| ala uf wimcmnps sinemt CAE oe eg rg ae give Gade "Deng ca a! pose PN gears age whee préetinnat fo the workt worl Pee @acd Pout, the Gtme gael” * x Lapecleace gamed mone th for whit you are apphoag mar Pe sitter ee ae if your duties changed neatvesally white working ie: asepurete Link ta descnts tak gemitiig, law ins a ne ae mr seaman PRESENT POSITION _ QXact FILA OF YOUN Parle NE UTCS em mute at the blake, Re sane empdeyer, uae ah bade wey berunent WRF now UsEicral, indkare Presrad Parmtaca” 1o} Hf yon Rave neve Bera cots thot fase ta the ane stoveded bell or fg . [es se TAR Ns, sranmias 2050  aa¥Pe PRESEN, § FRO es woe ack OF beet we Te ead Se etay OO RAMG AH TIER oe DWE CIATE e Penis ‘Washington, BD, C, Meg, Mildred Voorman eee Ee pay An 5D roomseernive | abe atdel tical al Draftsman! _ Tul edural, | RAR GF Bla Se Oe ORATION GS g Te Solanate arta aatulactuca wh dwas, afc y > asd fame department, dutta oF ¢ Board bop’ graphical Naneg srbaoae oa rare? oy Aertel a tenn” a “RLAESA Ta vehanng TS catenins ener mememnaaemee aN 2 bepagears Sey Nie ott neg tte Septet eet ERC eR :kaN se hee mere tens =m gre " MOne 2... “PELI MPTION UF rot ante vecscnenaace atatistte AL. CREEL es censcensecessense snsosane cence sentnns asca suustanassanesstesvenvinvanavun asanavavante marking Atacritics . (CONTINUED GN REAT PAGE) emt er
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Pete ene meen eens etpeetnen nme meee tet eee rece BE BETES) Leet three geeracese Feng ta the United States of Pave ane aa ef tie Verio States whe Bre Prk related tor vena aad who have deSece breehed ge of fav ore cere at crameg ad super wierd bacdd under Liem §@ (ROPER AON RS WEBI ch aaseie ations end fitress for the positicts foe which you are sept rm g ? @ re at @ NE CR HOME @ 9 PEGS y =: vu mae "(Gere tom pTode syreent addr! acluding street and if number) | BVHMFSS CR OCCUPATICN i, Mr, John Lewis Oakwezt High Scheol, Dayton 9, 0. Principal Ae MO ROA wes ABEDOET EAA O HE NOOD Aen ba MONOD EDELALEROROR DODD DEED PO Wt m 1S ER OSE LET RIPON IL AD tD ONO LH COCRORROR DEER DEST DEDE DEL Ones des naneeooeeeslemerrorscans due: aceerens 8 : Mise Teadosia Horan - - (5 Cazanovie oH, D, 2, N.Y, Teacher Op noes enaraanedeatreneedsmemensssdseeeneeesesunasnninmmmnnnn enone | acnnaseee: antersusssseacamannenncnsenangneassregeansnaonatnser j+ne snes cmnenecce: aeaee Ur. Harry Schwartz Univ, of 3yr acus@, Syracuse, LP Te Professor “TeDIeaTE ree” oa re AMSBTR BY FLACIRG “HR” (ed PROTA aren i yep eB + MOICATE “TER OR HD” ANEWER ET PLACED “R” be PROPER COL UATE | vis | a6 ten . FS WAY IDE OE MADE OF YOUR PHLENT @MPLOYER REGARDING YOUR Fy ART YOU AN OFFICIAL OR EMPLO FEL OF ANY STATE, TERMTORY, COUNTY CHEPAOTER Gea reie sTejes RPO SD wy. 178 WUMICIPALOT YE ooo ea cccen tees cerecsass § ceseae amteeesenerans > woe : itm OF OF 60 Fou Gwe ALLEGIANCE TO THE UNTED eS < : a foes $f your anewar de ‘Yee, give detaite in from 39 FoOCRE A CITIZEN OF OF TOU OWE ALLL GIANCE Yu ver is srareay, , m nr a a a z ba tS THE UNITED STATES 00.74 OREO RT § MOLT IM A COLIAN CAPSCITY Abe RELATIVE OF TOURS (AY PL00 OF MARMAGE WITH WHOM YOU ue x u AMA VELIVEO WHTHON PME DATE 2a MONT : 2? are yOu sere OF HAVE You.F Ea Orem A pepe OF THE COM MUST a 4 J? your anawee te onan ** phere ta Fee c PASTY tf A OF AMY COMM MIST OBGANEPATIOME - | ~ solative (2) full name; ¢ 2 pe aont adfidrese; (3) relatronship,; fs ‘9 Veparement oe eine iy whiek employed, and (3) dind ¢ bo DE TE TIGL #8 AST YOU HOW, O8 MAVE YOU f(vte BIL A MEMBER UF APASCIST ORGA®. : rg trayiney x SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCE PP ARE VOU RET GOR AYO ETE Ot 000 aE MEA OF AMY ORGANIZATION i en ies are flatning iootovenre ae @ PEACE TIME YE TERAN Bho hes SIRT A LEME MT GOK, e FM CUM RIRATICN OF PEASONS WHILM AD Oe oe a ISAM RED VETERAN on ANLED VET. " i EMAN, of aa the WIFE OF A DISANLED VETERAN, of sa the WIDOW OF WEA RPS POUR Cred OT ROM CF Ct 1B COM TIT TP IUMAL PORM OF GOVERNMENT, A WAR OR CAMUAIGN VAT RMAM, attach Vet Pref GR OF ARUP RIETANOS, ASSOCIATE MAT MLMT, GROUP OR COMOENA TION x CSC Piam U4, together with gered ope ified therein. eran mence Claim, GV PERS A MEH HR ADOPT T & PORE OF ADYUCATING OR APPROVING Ho oaf aa . " o, you ate a WAR-TIMK VETRIEAM not claiming diashility preference Ww; TOALTE® foe Ponte OF trek BME BT OF ent UNFILD STATES Bvt mom | tantetively cledited te year ord vf eginanted, you wall be requicad te ube anirutieat vittesd ° , i * te the appenting officer pea tu entey on duty, oficial evidence Gf eepara- errr yore eterno REED? Pen ee fran active seevicg ih the semed feces of the Uncted States ln tine of wae, neentontoten tn eer ern ea feet in Ham 3 tha nainas of oll such wiganientiog ape aa | | atts nO mevemante, groupe, o¢ corhinatians of parsungand dator of 4 BF ht wene YOu (vER in THE USTED BPATES MILITARY Of MAVAL SEALICR x Paerparenie Gare caniilnia jatalte of eee eerie f SAUNG TIME OF WARD oo. senrcee wetweweewmn een en es ehe et aioe! BPE Fes. make ANP erplanatian yow Geaire regardin. i 18) 1G THE WORD ‘ HONCRABIE” OF EME WORT “SATIGFACTORY * - y * a: yo usED nus membership or aetivitiee thercin oe. $8 YOUR CISCHARGK Of SI PARATION PAPLAS 10 SHOW THE Tyre ‘OF Yous DBM VO1 8 Ueto MIR THOAY, fa JE fers PVE BEL M ARRESTED, INECTEO 2 AAMARGL OR SLPARATIOND oreo escncreriese terserece seatercen ar a Or PAARL OTS TET COMAT AS ALAPE RUST IN A CHIMINAL PROC Mt ie 4 C) WAS TERVICE PERFORMED OM AN ACTIVE rik: TIME BASIS, winn ake OR CMGI TED, FIED GR UMPRIT ED OR OLACED ON PHOBATION OR Hag f MIULSTAR YT PAY BRD ALEDWANT EST (OUR AR BOER GREENE TO TASUE BAH, OF COLLATLHAL FOR THE VIG A. i 1D [ Dat@ oF Latay & StRNCET DATE OF BEPARATION Tait ed Rhy Lede FOUEE BE ALLARION OM ORDINANCE IPRCLUDIMY MIaOR 2 | DaSEor thtny OR iNPRies ITO LERTICE TATE GF SEPARATION OA SUPARATIONS THAFEIC RA TOES FOR HOMIE A PING GH FORPEIFURE OF 925 CR LEST WAS WAHL Teron eene eee I your anawar le Yoo,” fie euch cases under beam 30 q GESNCH OF TIRE CArny, Naeys UMW UF none, give grade oF 2 iy, Mavy, | SEWAL WO Cf none, give grade or batew, Gree trieanh case Ub} ihe date, (2) tha satuce of the 5 “ary ‘ a j attensa wr vielatinn, (3) the ferme and fooation of the oouel, q Marine Carps, Const Guard, ote.) ratiodg at tiene cf separation). {$) the rally pa ool, af any, oF other Hispoaiten of tne | s . cate bs agyouiiiied, your Pngeacstente wilt be taken enon rans COREL ~" a we rn Se TA Ae vou =F EO Te TMP CONTIN) STATES MILITAR YS Oa naeat apace | ns ny i CME OME Gta, Aer meee AER RING gare | at LB PORT TRIS POH Teen BHD RECEIVE A CAMPAILN BALA GU SEP VILE RIBQGH? Oo ee fed Li PRE AM PUNETION) th sthel tte, Cod BL Ee SUE CR GMGATEERE aE 8 yuur cusmer fa Vane,’ gave fee deen 39 tha nar Bddrace oF employer, fate, afd paaecn in Bagh core ad i ! & fae. | | eB) ARE YOU A DISARI TO VETTOARP LL. . i Seeeeeeenc ee OE en | ee | UF aah CCU he OTA Mawes Re FEL SF Chek LACE Conmetion | . Maa, abd you hove nat Hated your dlaabthty in anewer to i i FATA PER IMATS OY ALO ERE SG CTL SLICE arnt Bae) t iz Hew 33, eapiain an diem 39 below a 243 Yea give fates of and ¢ 7 ‘ .: i PA aA ‘at beenne 9 are 6 OF and reawwug for | ‘ SO) ABE YOU A VETERO IOS WiUtiy aie) WAT NGT BreApaIOD ener aan THE WIFE Gh A VET LICAN Wied HAD A Se LE CONNECTED | [ ‘ a) ARE Ge HET THIS SPACE FOR UIE OF APPOINTING OFFICER ONLY The information wontained i the answers to Questia 27 aipeve Sas been vert. severne 19, ements rr ntact ere eee TaN 22 HAVE fOn2 ANE PHY CAL HABLICAP CISTASL. OR OTUER OISABITY | Weill GetG84 DBE COMMES NEY Se AL GSGNIBG VOU Te ROME. : Ef gene anawasr ie Vas.” gion complete cdotaitein from $3 as) 3 thal comideratod can be giran ta your physical fitnera far : them Job. Fete TTT E dete STUNT PSQUAL IETS BEE hed Ly comparison with the dlaciarge certiicste un... lees ee VW rer vor Peer ee ae pues are Furyas CMF pei VP aTET On BARC RETIGR MENT ACT it anv Fi CF LA MEA O60 UIE AE OR GOR COUPER SAT apt soa Mngt aie OF KAYAL SERGE . Fi . . af your anawer ig Vas, give cosiniern sietatia vn tom w Agony: Tete, “Fe HALE SOR (Aten eh ab ES tu Cited But tiahe Wh Unatieate ior? Ruvtdars (whieh ahawels apply) ee ET eee Te Bei seen mene aaa oe cen te ee chen ee ere ern amar pene oe } nena ewe fern e ee eens ean Benne ban ee ea eT PRE OE TROT OES OT Ona ree Nee va es era re wernt tarens veetreetpere pene ten eeu ny ede a ers rene ROEM EMEP ANE TO ED ED EE MORNE OEM EBA aEEe ET on i res Deere ene) sewecees |eonemensteneneensnrcumec tens coewew ce ceee sees cereeerereatee vane a“ t t) seen . - ” é sta seue eines tenteteres per paatee ta veowmes Ae me Om ome Re eee met mene fee ne eee ae re i eee ee en RRR RPT OR eRe RES USAR ON Ee nT ROR mn ne ne TEE Ne Re rape see |: { Jr ore cnet senators cone rew ane ve renv acter career eteartcee oti pint dame, Tatler bate at tina eril eaaiuoalaa Bthe Ailey to inate wa tequitel, une pages “the gaan n38 on thie, wer Were a6 werd, ef “hse apttee eee Before sgning this apgheation cheek back over WP oter wise core Lat you have anawered ALL Guratians correctly, TCKRIIFY that the aratementa made by ae in thea APR aes tom prt True, complete, ene correct to th oe beat of my knowledsr and bebef, and arc made in govai Gath. . Fates 2 . False statems nt on he appleatrars . SIGRATUSE GF £PFtCAN is puataahaple by Law CU, a Corte, ss SIGNATHSE & ART vee ee a Tytte fa, Seae Rad) vite SES BAT tiNK tase gs, we, era ttad wenats, and egret tf formate, Title $4, Section A Brees Fhe ot Ref AD aes Foust sow G ren names oo heen Afecg bh baw) & rareinawenRRRraRtee Greene Hen naesapenrarserans nanan - “ aS WR ONTR eK Ee PE eRe te O Ors! Ye ewes t
GEN Ie 9 ot eo ante mnt an gence ORR Bad ge i ae hase : OPS SF TE IM CPE BO BI Kari sscem op site, MERE EE Wt ob 5 Tye Wyss, Scbjulf Wethingoy Adldrecg ¢g ‘ JE? Davis place Wl [Phere ~ ORedivay 16/F
14-00000 GE ae ek” RRA EEE See Torre mites ser anes Grass Nandan git aeteatnnmtihattadh hic Asbintntauities tiie st hblinetna sine. RY me adar tape § te Me etiem bL oe ey ey PERSONAL HISTORY STATEMENT Instructions: 1. Answer all questiona completely. If question is not applicable write “NA.”. Write “onkesren” only if you do not know the anawer and cannot obtain the answer from peracnal 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 sufficient room. 2. Type, print, or write carefully ; illegible or incomplete forma will not receive conside HAVE YOU BREAD AND DO YOU UNDERSTAND THE INSTRUCTIONS? __... fee tai (Yea or wanpreennpsee st eget cei eC PEPE Sec. 1. PERSONAL BACKGROUND , : Telephone: . Wiss , Office... RE..182Q. A. PULL HAME x4. Cha rlotte. Louisa «.. be oeeee Zehrung; caseaeeneeneees Eat. ...... 4691...... ass} BRK (Hess a Home «:-.:80:.5450 Jastints j PRESENT ALURESS - vee AAD Le 16th. Sts. die. Ml. Washtagton, DW, 16S 14t. and Number > PERMANZ ST ADUSESS _ San. Rag. Gardena , Dayton. Bp: ,,Onio- “BRL Us aaeea (St. and Number} B. NICKNAME BLS 2PA WHAT OTHER NAMES HAVE YOU USED? .... nong@---—- | een lnccearecnearmnnecumnereeenee UNDER WHAT CIRCUMSTANCES HAVE YOU EVER USED THESE : «gh o . “ fe WARES? WU BEE ES SE 60 Use LS 8S BORON cece ccececcccesencety vensueeeene HOW LOSG? 8 UPS te A LEGAL CHANG BE, GIVI PARTICULARS Voce cece ener crete se uy” what nathority) a CG. DATE G¥ RIBTII. oT ie/e9 veseee PLACE OF BIRTH Dayton beset Onto... vee ISA... pone tceuntry T. PRESTR F CODY, (SA, .... HY RIRTH? ere FOB BY MARREAGET 2 Ql iGountey BY NATURALIZATION CERTIFICATE NO. ..49... ISSUED oo eee BY cece ete ee teeteeee iDuted qCunet) ase (Staste} HAVES YOU HAD A PREVIOUS NATIONALITYT _..... ROE oo ec fYeaar Na iaustigs PLD BETYSLEN WHAT DATES? oo. TO ee ANY GTHER NATIONALITY? “Woantey 7 GIVE PARTICULARS 2a neces cece n cree wens ene oe tenes amen ene cenee Je teer eeeaeeednenaner ens tne ne enensnes ean interese ane peeaeaeeace a ieeenatel aanen teaietaetienadehaentanns deeainemerieentomectaatnieetemedetaatetet aici cement rae re eee HAVE YOU YAALN STEPS TG CHANGE PRESENT CITIZENSHIP? DO | _ GIVE PARTICULARS: ein ee rete a AON NTN NOP UY ey EET Oe ng ete ye ESE Ee «8)
eneetthehieeciniansentc cad tink aE oe STEHT I Pr EL Sen stents Mee nee epee hs San aman tnan lat nats sh aod, seeas tar cent eee aa a! ST Ae Neate et okt MINE LOR ai Sl OF ea Ae meBeearey Geena bee ee fet ve Sec. 3. MARITAL STATUS B. WIFE OR HUSBAND (IF YOU WAVE BEEN } a . C ELIF RORN OUTSIDE U. 8. WHEN DID YU FIRST ARRIVE IN THIS COUNTRY? — nant nennenenen aces Ladetnece PORT OF ENTRY? .....---.. ON PASSPORT OF WHAT COUNTRY? _.. eee ; LAST Us S. VISA eens sce ene nneee tee tesco ggeeee fe cnaneececeeecensacgeraecesesescescsmeevatismciuteangscensangepenesenewene * (Number) aTypre? iFlace of fasue) tDate of Issue} ‘ . a ss cement Sec. 2. PHYSICAL DESCRIPTION ace 2? sex rout 5! 8" weicur 228 blk ‘ : ue HAIR ___brown complexion 290 scars .DOn@. . slender BUILD onc ceccsneccewerrnene OTHER DISTINGUISHING FEATURES oe eneeconn snes sense nnee cee SS SIS t A. SINGLE _...... a eeeee .- MARRIED —.WW... DIVORCED o.oo eccrencccees WIDOWED o.oo ce ereceee State Darr, Place, AND REASON FUR ALL Seraxarions, Divorces of AX SULMENTS MARRIED MOLE THAN ONCE—INCLUDING ANNUL- MENTS-—USE A BEPARATE SHEET FOR FORMER WIFE OR HUSBAND GIVING DATA REQUIRED BELOW FOR ALL PREVIOUS MARRL. AGES) . . NAME OF SPOUSE occcccccccecsccsssecesceveeceseeee ete ecuee eevee evenseessevececssiectsee ston tanenevanmeeneeissravctcveseessenesnenee (First) iMbddie) (Maiten) (Last? PLACE AND DATE OF MARRIAGE oc cece cee cee ence neces tenn entncec cee enae nn anvanaeee tenaneaenaes HAS (On HH? AVTRESS BEFORE MARREAGK oo... 0 le (St un] Musber?} LIVING OR DECLASED |. woe DATE OF DECKASE occ CAUSE oc cee tee ise yew! ‘Namter) {iiss ‘(tate “Yeeuntry) (City } {State} (Cauntry} _TF BORN GUTSIRE U.S INDICATE DATE AND PLACE OF ENTRY ou eee eters eee ee CITIAENS HIP oe eee eee WHEN ACQUIRED? arn weseremeenee WHE ORE? VGN sees aay OCCUPATION ooo cece ence see eee LAST EMPLOYER o.oo cece ccceececce ce med ene en eee sa nenenertnene ae EMPLOYER'S OR BUSINESS ADDRESS | enman ent ctarnnaner mannan eunmes sianaen tenn scauemieee evceeeese froin eed Humterd (City) {inetd {Country} MILITARY SERVICE FROM W.2..... ——. TO... . BRANCH GF SERVICE _ vetetetieceeersnseeddte aPate} i iPat a COUNTRY one een eee. DETAILS OF OTHER GOVT. SERVICE, U. S:-OR FOREIGN PO ADRES &
tena eacen sevttnnns . . * we ne te mee ee eee mere mee Seema nine oe © Toate on oo tee | @ Q , . Sec, 4. CHILDREN OR DEPENDENTS (Include partial dependents): none wate land CITIZENSHIP oo. aneneneenncermaceces ADDRESS ooo. cc. ceccsse sce ccemeeeesnectoneepees ssmeptesascatsuseonacsen recess once : (8%. and Number} icity} (State) icant 2. NAME uu. nccccmccornncnse cnmeen mienansnt antane nner estas saversnseeenme RELATIONSHIP ...-crcmccerecsweenmnece AGE woscmscciee CITIZENSHIP -ccweccnecnneersrnnecceees ADDRESS wong senor esssepua samensnguesesaseenaneess 2 eeeed Number} {City (State) " iGountey) B. NAME oon ctecccscecsnrercsne somesnmnscmensencneeremensnemeans RELATIONSHIP op eecsmeenseemeene AGE woueeee CITIZENSHIP .,...n-.--ceoweccennnenescnnee ADDRESS oo... cscs speneeanmenenternesnesons |e suous assess monneneeateecevesteassauuone (City) (State} (Country) : {St ond Number , DEE IS SS RTS a ST EP ee a siieiaiiiinaad Ric eee oe fee aa SSE Sec. 6. FATHER (Give the same information for stepfather and/or guardian on a separate shect) FULL NAME ........c8DUelh Penford ss Sohrung . {Fiept) (Biddle) (Laat) LIVING OR DECEASED .....2AVENE DATE OF DECEASE oc eoccceoneeneee CAUSE oo. cnsonncsannsveeee PRESENT, OR LAST, ADDRESS _San Ree Gardens, Dayton 9, Ohio USA ‘ (St. and Nualee) (civ) Geigy (Country) ” pare or ninety 2/23/2892 piace or pintu Roseville, Ohio = USA iCity) “(Bestey (Country) i “nate pam tnetnem nena ay Gales eee shanti denier nites ont SAM Ee oss Me ENS Sue’ 2 TK HORN OC PSI To SOINTICATE DATE AND PLACK OF ENTRY 20.0.0 0 eee eee eee i H USA . i CITIZENSHIP 0 oP wien acqumen?.... CAPER wannn eo cesneee eee teases : . State} Country} > - yard os q Pe ™ ” 38am a o % ? a oo. ocourartonea® iz sears _Arohitegt LAST EMPLOYER . own OF sployes 7 over FO yea. i . - a 4 EMPLOYER'S Ok OWN BUSINESS AppRESS S92 Ree G9 ardena, 2 Da yton = Ohio USA i . (Be, asd Nuubesy qCity} “(tated iCounley} { MILITARY SERVICE FROM _..2 TT. TOT ITT. BRANCH ors SERVICE, 00 ecenneee eee eeeees } Rates (Dats) . ! COUNTRY * 0.00 ie eee ens .. DETAILS OF OTHER GOVT. SERVICE, U. S. OR FOREIGN : : $ i : Sec. 6. MOTHER (Give the same information for stepmother on a separate sheet) i a FULLNAME.._.H4261 Charlot (¥iratp (Emeny ; LIVING on pecrasep Liv www DATE OF DECEASE ween CAUSE coc cece cenene ‘ . , PRESENT, OR LAST, ADDRESS _. “n i H 3 T, OR Sant Rae, iaay dans: ; proreee tong. ial .Ghio- won USA. pate or pintHt9/27/1896 piace oF uinra MOntasue, Michigan USA. . crpizensurp USAC owuen acqguiren? birth oo wrene? co ceeese ce vee vesuaees : “ECity) “ yBaater pantry? IF BORN OUTSIDE U. 3. INDICATE DATE AND PLACE OF ENTRY 00 oon ee ce went (3) 9 --emae-t 1, NAME w...2sccecenmaccrenoomene: tnt sunnsensrerscvtenvurresensesssue RELATIONSHIP ....ussroccnscsnensen: coos AGE wascnconane ‘ Bee att at ao Ret eee wat mest betnemenete cimeanste Ie
14-00000 Tei ctl oo aS ar me pn eae mene Renae wena ats ober 4 esahtn UAE ab RETESET pl Mb BAN ER Sec. a mae . () housewife Last emprover Dotroit Boasrd of Educ ak 4 3h OCCUPATION OA EMPLOYER'S OR OWN BUSINESS ADDRESS ooo... ce. cco cece ceeecessecnenenatensentesermeneanes (Bt, and Nurvlerp (City) (State? “(aramtry F TO eee HRANCH OF SERVICE ......... sracesevaatenetane MILITARY SERVICE FROM ....° COUNTRY ...W... Area neeanemeesteree ee - eeseee DETAILS OF OTHER GOVT. SERVICE, U. 8. GR FOREIGN 7 BROTHERS AND SISTERS (Including half-, step-, and adupted brothers and sisters): AGE Bhi... cone L. FULL NAME werent Nancy... ‘Verity Hall, Liadletown Hospital, iddletown, | mine USA nd Nu SER “ fon (Stay z Zehr (Gountry) , (Grttzershiv nm &% FULL NAME ..W.w...0.0- . ect and eaaenes venmenvensoe one ‘iii . San Rae Gardens, Dayton 9, Ohio Neer een (inst * (80 and Numer} {City) tHtates” iGountes) . (CI itiseaship) 9% FULL NAME MOP PbaZzabeth Zenrang... AGE IB . CUAldaie) | (Laat) : Firat) San Rae Gardens, Dayton 9, Ohio USA. “(Ht and Number)” (GY) “Gates “Yeounteyy PRESENT ADDREss .. “ig PRESENT ADDRESS . PRESENT ADDR ESS .. (Middle) (Last) “(Fint) * (Wathenehipp sats ‘ (3t. and Number) (City) (Stale) {Country} BK FULL NAME 0 cece caceatens une (Bisaty (sidatey PRESENT ADDRESS 2 ou. ce eecencenteeneen eg conte nonenmere te scereeareccoenme cod certee ees terenenme * iMtated eCibrenebip) tH, nod Murgherd hy) (Covatew) VAST SEER Sec 2 SET AT a WR eer RS Oe ERED ST cet gt Re a Te Te PREP STER F eaReE SS era SEc. 8 FATHER-ID N-LAW {First} > PREM I faep ° Ubaaly LIVING OR DECEASED 2. ww. ou. . DATE OF DENCH CAUSE CSAS) PRESENT, OR LAST, ADDRESS oo oe cece cece ce cece coer es cecernan ceweenerenets citys s (3s. end Number} (State) DATE OF BIRTH oo ee eee PLACE OP RIRTH woes ceeeceee pe reenanene pen Cn etereceres sents wenn If BORN OUTSIDE U.S INDICATE DATR AND PLACE OF ENTRY peetheesereunntessttuee cee come get aweneaes CITIZENSHIP - WHEN ACQUIRED? ~ w WHERET wo. ne. eee eCity} | (Mtate; *Mouatey > OCCUPATION | oo ee ce eee LAST EMPLOYER o.oo cece ee
% pone SBE Aten BE Pe TA et ae eee Re keer te dent ett onbeneny tee Nedesa voile miei mpd nth tae on Wak an i ee i ed @ al Sec. 9. MOTHER-IN-LAW SSE ce tie saree So Sec. 10. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION, WHO EITHER LIVE ‘ABROAD (Firat) iMbhfie} LIVING OR DECEASED Q.c.cccmessmesn DATE OF DECKASE occ cece CAUSE ccccccesnesneee aneenee PRESENT, OR LAST, ADDRESS sesemessqcasetnneesnnesenuenece asee san eecneemnne a eenenscammteienseass: sassscssasseapesesecs eoenen (S. and Nomber) «City qState) eOountry} DATE OF BIRTH w.consecsseveeccceeee PLACE OF BERTH ~...ccccnccemecens wwvnecmntemessmoustissenananessitnansias anne IF BORN OUTSIDE U. 8. INDICATE DATE AND PLACE OF ENTRY cescscantevigsnunsssnee auescunenaasaueeee CITIZENSHIP .....ccsneanceonere WHEN ACQUIRED? 2. ccne cmocr cece WHERE? 0.0 ee see cscs esmtneeseegene seen (City) Ghtate) (Country) OCCUPATION erste csecc mene sneviesevsvene= LAST EMPLOYER . PERRIS ERENT OS EN Ye OR WHO ARE NOT CITIZENS OF THE UNITED STATES; AGE ..28... USA ADDRESS I USA YE, APO. 6353 SPost | sagber CITIZENSHIP nis uceereesrecmmmnnennee {oh end Namboe) yeny) ‘Weis iCountey) $ 2, NAME cistant relatives in SHEA TRECATIONSHIP ... seceeweeeweaee tee Ys Grandparents on other's side cama from Sweden CITIZENSHIP occ see ceeee wee ADDRESS Lue es (St. and Nazahez) eCatyd * (tet, (Countey) ~ B. NAMB oo. cccee ce eerste rece suctes eore remeaatterenessencaemmens RELATIONSITP 2. eee AGE ene CUTTARNSHEP 0 0 eee pe eer ADDRESS Joo. 1. NAME 2 ceecerse deere nests renee ee een . NAME... 3. NAME oe clam eeer rere tenance tL. RELATIVES PY RLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE OF THE US. OR OF APOREIGN COVERN MENT: a] ‘4, Sol, Paul 4ehrung a eeLavionsap _SS88ir gee 38 crrmunsuip USA... ADDREss EL USA BE, APQ 683 HPoat Nanter, $Y¥PE AND LOCATION OF SERVICE (IF KNown) Director of Nainte corsin acre Sh aw RELATIONSHEP Wo , + re a creaensatp USA 0 appress Washington, D. ©, USA (Su asd Nutnber} qOicy? (State) eCounery} Ba jor Seek iacklin TYPE AND LOCATION OF SERVICE (IF KNOWN) 2a BDEAROI, east: Mra. Elsie Dic tee nt ee RELATIONSIp fine AG PO CITIZENSHIP USA appress 514.8 29th St. Sillings a “(su and Number} “ede asuntes TYPE AND LOCATION OF SERVICH GF ENuwny SOCisl work = Dent. (3) ~-loecated in EKortanu fa ant (St and Naber} iia itatey tt yer # av, poe, . x enange. IT USA FE + once oo erin ematenanmmarteceemaltarnicanid Binnetteenn ss $f sucmnibentineestnncemt ak CTA wer ate es OA URS ne UTR URE Pee nt vated A eatin o 6 peaseans webs manse
tern he a ere nee Spe mee reer % Seusssepenmmuprecneiems atin names tan pease ERAS ARMS AENRNLNRIIS Ea omer! My | 2 Serra, crseeriee tne rate minstrtnenttren ore tare ea = ett emerncaene woth Se Senet etiSeratireteese * Rdeaies 1A cect I SEER BIT 6 BE REO RIET, SEC, SEC. 12. POSITION DATA (8) at . s A. KIND OF POSITION APPLIED For . Agdodnistrative pogitien.with Latin... AmeriCa, Economist, Statiaticlan, or temporarily as a enn ALLO Le SPADRAP eres, seseecaneeceenmmumiecesesseecsecnotinnensaesteteesrseeesevavaneeseununtnnenecrssesctesncasanennasente B. WHAT IS THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL ACCEPT? $28 1100... (¥ou Will Not Bo Considered For Any Position With A Lower Entrance Salary.) - c IF YOU ARE WILLING TO TRAVEL, SPECIFY: OCCASIONALLY ..... Bannerman entre 1g CONSTANTLY 2. .cenccecnecnsermecmnscen cnce sommes cornea seen ems FREQUENTLY aeovanaeoute semeeneteranteinttommmanenannnssen ee D. CHECK If YOU WILL ACCEPT aspoweMewn IF OFFERED: IN WASHINGTON, D. C, wos Bvenenoe ANYWHERE IN THE UNITED STATES ............... QUTSIDE THE UNITED STATES a E.TF YOU WILL ACCEPT APPOINTMENT IN CERTAIN LOCATIONS ONLY, SPECIFY LOCATIONS: So rac Tatas Paciett IO ik EW at CBRE CIE ee aera wiki BZ Dene REA ON eee tbc hen a eS SEE EEO NERS 13. EDUCATION - ELEMENTARY SCHOOL 11836, Garrod ipihesslent.. Garrollton, 04 USA. (Country) (Finte) 1953 = 1944 GHADUATH? F88 eceeceueneee ign scnoon C@k#00d High Schoolypyrrss . Pad! ton 9, Ohio "USA 7” “tei ity (State) ¢Ceasntey} coureces Syracuse Univorslity  sppensg Syracuse, New fore USA. ~~ hy) (State) ifeasntey) Mason asp sproraLry Beonoudes & Spanish, ARS COMPLETED . a BA : DATES ATTENUED .. 1946 | . = 1950 Hire DEGRER Wt Universidad de San Cyadea, Guatemala Clty, Guetemsla CA, COLLEGE JST e! vaeren ae se (city) {State} (lantey Spanish oo. YEARS CoMPLETED 5 credits MAJOR AND SPECIALTY... RATES ATTENDED ....... 90M8e 1848 oo ecuer.. none given Qn 4 2 CHIEF UNDERGRADUATE COLLEGE sunsecTs ...... economies ~ statisties Pps RLad. gamma Rm om vdagoreas GAA DRQR. cence cneteeeecceenceeeecevanessecnenen © feet eee ee Heer eee CHIEF GRADUATE COLLEGE SUNIFCTS _ oc cceees cece eee cent ween 2S aeeices @ &
+ eet ® » so eee emma memes on oceme eee Sec. if. ACTIVE U.S. OR FOREIGN MILITARY SERVICE none omen a weneninten abe ts ee ee Ot nnn ae een. Tere reery it cr ec (Rank) ” “(Dates of Service} BRO e ed oer Dae Oe re ED Nees Dando a tnee REDS CESS OSE AIRE LEMIRE OWE OTE FOE Do Lee eee ee eee enenemmanemmtinnn rh nS HELA ENDS ETRMARN OEE Teed tenes wen en een eee, a8 dLast Station) A (Herial Namber} {Type of Discharge} REMARESS on .scssceseeesnncnsamnsssemnsennmer pesascsendegmevonseamanns veneessenemececea snthensascerssscinnsnenenneeacsenerseseseaacoasnan « SELECTIVE SERVICE BOARD NUMBER .... necomeee ADDRESS 20. cscussstesssssevsesssenccnrennsessamecssnecnsersoess IF DEFERRED GIVE REASON .....-ccooreo-seoee senroorsnantenensens wtenesenvenesanantnonsuanssustesensensnanessaneasansnaseanaseee INDICATE MEMBERSHIP IN MILITARY RESERVE ORGANIZATIONS uo... ssecsmeseneesereerosorsnveteenecers 15. CHRONOLOGICAL HISTORY OF ‘EMPLOYMENT FOR PAST 15 YE ARS, “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. (List all civilian em- ployment by a foreign government, regardless of dates.) 4/61, CLASSIFICATION GRADE 3 FROM 0.0.20 22 ceccccsccoenes TO oocecenuceecns coccereneccenene Gi IN FEDERAL SERVICE) —...... srameenevnowen tonne oo: EMPLOYING FIRM OR AGENCY __Board.of Goourapite amos Interior Blay. ; ADDRESS —...0.& 18th Stas, t.M, Washington, De G. USA (St. and Numer} (Citys iState) (Country? Uva. Elldred 3.00 rman KIND OF BUSINESS ces eceeccenereremn ss NAME OF SUPERVISOR | seesasreenene peek Us a Phss arse Fa) te + eee OS SALARY § 20 C59 oo pee Sh St bees ak TILE OF FOB... suena nes araw dis ae ‘ Ira PE a H REASONS Fors Raving bobber poaition more in my interests: 5 Je, CLASSIFICATION CTADE vrom 5/69 to. AfS posers (EE PN PEDERAL SERVICE) ooccc cessceneeoneeere - avton G ADDRESS , “Box 2 #0 Tay mye On 2a se Br as Se. and "Number) Tena (Stated - ‘simte KIND OF BUSINESS UIP S Ory _ NAME GF SUPERVISOR Re a elise cies smenene conesase we . : ® TITLE GF JOB eherke oe we SALARY 3 sain weer PER A. et vase weesseie vg Pa: nancial BP pengen é ; we as Fa bg ‘ea 4 ” your DuTies ....bookkecanirg prop vta, ovéerirg weolenselo, REASONS FOR LEAVING ....29 taks a job sore in line with my trainin {7} : 39 + 42%65-8 TONS 2, Peels kOe tia dete ntinen mented AON pone Batre rn
14-00000 er + (8) CLASSIFICATION GRADE CIF IN FEDERAL BERVICE) ose WOE Mdtentnt eos Ceeamee FROM W.. EMPLOYING FINM OR AGENCY Jabtional Peanut Coures 1) oe cece ene i111 Dipont Clrele Euilding, Washtir. £, G, USA EG OTs we We pate” we ecsnccnceneuneaee cade rasan sone . {Coneetiory ) Villies ¥, Seals TITLE OF Jon 1 Aaate. Eookkccpor saary 200 a ADDRESS . . det oes (Bt and Heimer “Wigs _ bookkeeping, L1ling, goneral offices YOUR DUTIES .. reports Wass eacces csney necca sneres msn onnnsesanaseded . WEED TASS D1 OEE EI PEE OSES ONDE D CLO 2ECERSELEOEEEDS 24 COU LEL LODE CDEPEE LE PAOLA LEOEE ALOE DE ORE ED Fat eee ssetaoe ' Romeepeetar cates c00e SAO NE mie LOO NE a LEE LS RLES OLED SIAL WE EAA EDEL SEP ODOSDD DEVERELGLEL TOOL EE NL ELLE LIS Le SOOE LO LIDLTLE AIOE EE DELI OS ODED EELS OBOE ‘ ER AT OIE TT TREES SET NECN PN centre ye natty ny tens 7 AE nee raeae rae ati im / . REASONS FOR LEAVING... Poturn. .blone.ta hbelp.my —fether.in. bla. tuainess 8/47 _ CLASSIFICATION GRADE FROM ... T0 42 Ts esterreemusssme (UF IN-PEDERAL SERVICED come cceeecueeoeseeecnee EMPLOYING FIRM O AGENCY ..P’rigidaiva, Qenersl Dotora YR? Leyton 9, Ohio USA feansetey) Eerpert Haldernan 6/47 Je eeversecseseses nee ADDRESS voce MB ont ” coe eT BOM Sy VOLO tat and Pharatery (tity) (Ststes KIND OF BUSINESS ...... 980 L oo NAME oF SUPERVIEOR Los 90 ove. TITLE OF SOB wa ceccsssscccssocnepessiesatieese we BALARY Bivcccncecemcenneesceeees offices ork in the chemical lebor YOUR DUTIES wore dn i WA fuctory proper ; Masa nee want ae BAA re eee CLASSIFICATION GRADE PEN WEDERAL BECVICE) oe eee FROM ooccescot ese seee 4 4 Fad EMPLOYING FIRe on AGENeY,....orants 5/10 St Oe eemeonpsnennsnemenes vartassanecs veces vests yee PRB GUS Ss. tentya (alata) ADDRESS once nee nee nmee ees {BQ ord Haze leary ara r ny b peg enereneyewce ob KIND OF BUSINESS SAME OF’ SuLE 1 216) eee cles 2 2 aes Lars ent. f REASONS FUR LEAVING? A, ed ad
14-00000 @ . So 16, HAVE YOU EVER BEEN DISCIIARGED OR ASKED TO RESIGN FROM ANY POSI- TION? HAVE YOU LEFT? A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? GIVE DETAILS: Sec, : Won yee newts OMe e mad REA ee moves a trmrtewarad sr Ode: ROADS SENSE HEOOE LALA a OES SPEDE REDE OE NS OOS REEESS POTEET URES E ESET EROS eRsOG SO senes es Tes5H67 HUNEEERS Rha we Resewees cones atsesanesceet Daseareiverepansceceetenea: Spasgabs coseneesee aeccesenccn: somasarsnacara: Berenson pa ttescseges pesebronuerenunes. dersepuereoces seams eens bemeavesectanasanssenestae se PRREY se: Sec. 17. GENERAL QUALIFICATIONS - A. FOREIGN LANGUAGES (STATE DEGREE OR PROFICIENCY A8& “FLUENT") *SLICHT,” “FAIR,” OR Spanish speak fluent oo prap fluent wring fluent | LANGUAGE .Praneh... .... SPEAK Slightuowu.w reap AAR. write... folr WRITE occas tteectineee LANGUAGE LANGUAGE .ooicecccecceeencee WL BPRAK cole wae READ Woocccccecceeeee ° LIST ALL SPORTS AND HORBINS WHICH INTEREST YOU; INDICATE DEGKER OF PROFIL CIENCY IN EACH: _Art-dpawing, printing, crafts, Studied at achool ~ good Stinn Lng » goods Reading; Knibhing, 000s ‘Basketball, fair; AUER eb ate tag sunes teomeme Phe the oOo, Role camer «oe Bae ee ee eee eben eater ener ebeeee meee tennta, foie C.HAVE YOU ANY QUALIPICATIONS, AS A RESULT OF TRAINING Ok EXPERIENCH, WHICH MIGUT FLD YOU FOR A VARVICULAR POMITIGN? Pr in Gustemals, Adving with wo Gu. ‘onalan rere ew eee sprete ceterenneede : Tohave : spent | Bau igerning Ghe Life and | ways of F a “Spanish Ponty end erty. i family, Tohave cuite a complete nos, thode re oF the Plomist mnsizeaa tron sheer Af period or Beous 3 (NOOTS 6 } : ” D LIST ANY SPECLAL SKILLS YOU POSSESS AND MACHINES AND EQUIPMENT YOU CAN USh, : SUCH AS OPERATION OF SHORTWAVE RADIO, MULTILITH, COMPTOMETER, KEY PUNCH, : TURRET LATHE, SCIENTIFIC OR PROFESSIONAL DEVICES: - calculator 60. sHuorruann. 79... Sm eras APPROXIMATE NUMBER OF WORDS PER MINUTE IN TYPING _. cD)
14-00000 + ween om ents aster detent Utne mek ‘eA om way amin © MR settee ee ek sate oa (195 OU NOW OR HAVE YOU EVEN BEEN A LICENSED OR CERTIFIED MEMBER OF AN E. AE ¥ RADIO GPERATOR, TEACHER, TRADE OR PROFESSION, BUCH AM VILOT, ELECTHICIAN, LAWYER, CPA, ETC, __ ony KO NDICATE KIND OF LICENSE AND STATE ....0.-02- ccc LATEST LIC. OR CERTIFICATE (YR)... if YES, 1 FIRST LIC. OR CERTIFICATE (YR) ooo arene ¥.GIVE ANY SPECIAL QUALIFICATIONS NOT COVERED ELSEWHERE IN YOUR APPLICATION BUCH AS: (4) YOUR MORE IMPORTANT PUBLICATIONS (bo NOT ZUBMIT COPIES UNLESS REQUESTED) . (2) YOUR PATENTS OR INVENTIONS (3) PURLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCE. (4) HONORS AND FELLUWSHIPS KECKIVED | _ Sef did a: lot of extent. and declemation. vork itn.public. apeaking secenseoeene contests in high | Bohogls. 2, 21 8 member of toe... ‘ OL ce 4eI recelyed 4a partial scholaranin from Cuapel of Syraguse UII N OPIN Occ cneseneeectcsersserceneececeestenectsinaes G.HAVE YOU A PHYSICAL HANDICAP, DIBEARE, OR OTHER DISARILITY WHICH SHOULD BRE CONSIDERED IN ASSIGNING YOU TO WORK? IF ANBWER IS "YES," EXPLAIN: penrceretetbl Daveresesneeueconrcourrce + Lictee ceeraerseeesctetsneesicteageceeensescn/mnssortive convisequsteceeene ane HO YOU HECKIVE AN ANNUIT’ FROM THE UNITED STATES OR DISTHICT OF COLOMBIA GOVERNMENT UNDK: ANY BETIBEUILNY ACE OM ANY PENSION OR OTHER COMPENSATION Tf ANSWEE IS “YES,” GIVE COMPLETE DETALLS: FOR MILITARY GR NAVAL SERVICE? ’ 9 6l848S-4 National Forensic i ‘ 1
14-00000 * TSE EREERERRIRRRNEC RPS meemnmEnE a Sosa, eileen inant eaaeeenatneniaiaaiitiiasaeetemeteiaiins meets ialebieantintiaemmindisiniai aint £ ERD @ Sec. 18. GIVE FIVE CHARACTER REFERENCES—IN THE U. S—WHG KNOW YOU INTL MATELY— tive residence and business wvigoweces where possible.) - Stevet and Number City State 1 bin, gonn Lewis 00 nus. ann _OSkwood Eigh School, Dayton,Ohnie res. apn. NAL. we aeaveuecineasseseeeeren weceeeseeeeseeee pus. apn SPic Acatres Plant. ae ton 9, 0nle RES, ADD. 5... MATOANG UB g Mee, Hasbert Holdernan Kr. George Pohlnever BUS. ADR... 5, an . g. _.siss Kath nerine Saith aus apn NA _— 5 RES, ADD. - 59. Wiltshire. Dayton. 95 Ohho.. a Sec. 19. NAMES OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THE UNITED STATES— NOT REFERENCES, RELATIVES, SUPERVISORS, OR EMPLOYERS—(Give residence “ ....._ and business addresses where possible.) Street and Number Citi State nt iiss Peadesta Loren. BUS.. ADD. ~g ik ceecvewetsnecenateevens wacewenvunses 2,... ers, 3d Bastin = pus ann San Ree Gardens Layton 9, Ohio RES, ADR _Peaas..Ave > West. Gazrollton,..chio fn ateeee pede ‘ a... Kiss. Setty.Hollis..... BUS. ADD. Arlington..Adbx,.Arlington,Va. : : RES. AND, 1401lelé6th St. 1, _ li, ties shington ™W. wu .t re rye 4 syyay rad . BUS, Ane. wes ai of Syracuse, Syracuse, N.Y. ye wet v Rake : e 5. me beaker bonm opus arn. binber's National bani, Deayt: ™ 2 ereonmont hyd. bby toh, RWS. ADR, See. 20. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RE SIDENCE 1 IN THE U, S.-- z (Give resilience and busines addresses where possible.) a . ~ . Steve? and Numther City State ‘ . uily, Bar 3. MeKecnnie oo yus app. San, Rag Gardens, “Payton. 8,. Obia : RES. ADD... RO. 11 Scheel ( _Hhas Shella Teweyv gus apn. RES. ae Boe nidigkhors : - . “18 le ww Md82 Rarllyn Marris. BUS APR HA-. RES. ADD... Sli. ‘Abbatt fone Ta I Sd UE, cee en eee, Src. 21. FINANCIAL BACKGROUND A. ARE vou ens DEPENDENT ON YOUR SALARY?... ¥@4._ TP NOT, STATE SOURCES B NAMPS axa ALDRESSE s OF RANKS W i WHICH YOU HAY E ACCOUNTS ... HES Usrroi tion cancelest Urrrollten, Gnio- RS ; 1 to . H eo ‘2 @ ly ie Vas. argton Loan end PAys So., Washington, D, ¢, G RES. ann. 96 Winding ‘Way, Dayton, Ohio. i
14-00000 ' (2) i C. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY? 22... TI... neers GIVE PARTICULARS, INCLUDING COURT! 02.1 cess eee ceee tonnmammenenac scenes D. GIVE THRER CREDIT REFERENCES—IN TRE U. 8. Name ....veredian Hill liotel apnness 2601-l6th.St.Uw Washingkon De 2. NAME Kra, Blick sesmutscutsssstssssssucese Appansg 14021 1aT6tn. St» oa. Washington De tStatel ad 3. NAME Delta Gamma Sorority ADDRESS. SOEN Walnut Ay Oe os. Syracuse NY. and, Number) {ony (Stated a er: ee ee ee REET De Set tawes eR Melee yo Sec. 22. RESIDENCES FOR THE PAST 15 YEARS From 421-51 7o Present 1401-16th Shes. dls alla. Maapineton. PCy DSR commana comemenemnne RN  mmnmncnaacracaneranene (Be. and wumbery Mate} prom 5-50. 0... 425)... Sen. 1 ipa Gardena, Payton 2,..0nto.._.USA Bed mus FROM ..2250_ ro... 5250 2601-16t7 St, MT. Washington, | Pre. USA i ° Ct. and number) (City) iBtate) ! rrom 2748 ro 2250 9 Ol Walnut Aye., Syracuse, U. Ye a v Sa . {8t. and number) (City) (Btate} (Qountry) . } iz - = ar : rrom 2746 go... 2948 HO cottages of Syracuse Univ, Syracuse (AL and nannber} techy? (Minter) (Country f From 7748 go E788 CPs # GO Gustemula City, Susterala | ' (80. and mupthars p City} (Rinte} (Carantry > ; time before thia San ee Gardens » Dayton 9, Ohio USA . : PROM occ lccccacene PO snessrscersn snares sone FROM oo. ceeea cece “cee cee ew eee Sec. 23. RESIDENCE OR TRAVEL OUTSIDE OF THE UNITED STATES Mexico City Mexteo tourist Arrom ..... 7746.0 co wor. Kexico City Moxd —— a Cy ore ett § . (arontrs F Purpose} From... 7848 ry 8048. Guutemala City. Guvtemeala. .. .. Bidet seceee : “a Py ee new oD Cl uatey? “pee (Culp ar gentieray (Courier) tParpe.e) Cary? ana qtew) auntie ) FROM... SEC, OCINTIES, AND OTE R ORGANIZATIONS : LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCIETIES, PROVESSIONAL SOCIEYVIES, EM- . PLOYEER GROUPS, ORCANIZATIONS OF ANY Hina (INCLUDE MEMBERSHIP IN, OR SUPPORT OF, ANY ORGANIZATION HAVING PPA TC AETERS GH ERANCH IN A PORFIGN COUNTRY) TO WHIECTE YOU BELONG OR HAVE BILONGLD Delta Gamma ~ Pho 90] Walnut Avo., Syracuse, i, ¥, USA {diame aed Chaptar)” “Someones "ENE ‘and Number) . qCurz) cStatey “ “oes en sy) _ 2947-50 active - 1950 to presant inactive _ be 24. CL e Le DATES OF MEMBERSHIP: . _Spanish Club Syracuse Univ., Syracuse, N. ¥. USA (Name ‘and Chapter) ere “EBL and Hieriters 9 ins? ees “Thats “eee “Wwuanaey) 497 » A= 4 DATES OF WR MBERSHIP: bo a : 8 vote tee ne em ae meee ne ieee Syracuan Univ., Svrecuse, MN. YX, USA 1st Number? Ee te) “(Btate) Conant gy? O68 . Go BO DATES OF MEMBERSHIP: 1948 - Oo © | cee cee ce cote pene gues ete eigegs soe @ Viestuinsterr brasbytcphan Clarch - Darton 9, Chios SA iy wrest 7. Brownias - Grace Seloal = Wesb Curroilton, U-lo USA
Pa aceeeeinmeeieeemneenen aad fe, Girl Sconts = cigh Sc ool - Sesh “sro: lien, Orlo USA ft. Howmador EA, ~ Westuinuatee Pres ortork Gourch = Dayton 9,u, - 1943-4 Ula f€. Alumni Association of Syracuse Univ, Syracuse, He Y. USA 195D- & ~-ginternational ‘Relationa. Clubs Sysacuae. Univ, Syracuse 3% rs (Name and Chapter} (Bt. dnd Number} Cag tBtate? (Countey) i DATES OF MEMBERSHIP: 2996709 cececeste in eceneceshansnssenseeneneestenanae g 2nd & Ist Cadinot - Chapel - Syracuse Univ., Syracuse, Ke. Usa (Name and Chapter) — “Tse. and Number) ag oo" "Giate) "" Goaatey} DATES OF MEMBERSHIP: .....294 809 occurs tese ees sbessessscsasesensesieassesceseasee soeseneee a . & National Yorensic League = “Oakwood high School, Dayton 9, 0. VEA ~— ‘Nae and Chane) et and Number} ee ae Gmeatey eee . DATES OF MEMBERSHIP: .... 1949996. BOGD VO oc ceesesssssesseeseestereesentenceessotansesen : Sigma Theta Phi - Dayton 9, Ohio USA high achool sorority wheat “seen Sane ond Chapter) SASL and Number) ; serereneeen en tates ees DATES OF MEMBERSHIP: ... 294596 on. ea Se na eee a ER EA SRS TE Daan hmrergrs-ce sensor aaa nt Sexo. 3. MISCELLANEOUS 4:PO YOU ADVOCATE OR HAVE YOU EVER ADVOCATER; OR ARE YOU NOW OR HAVE You EVER BREEN A MEMBER OF, OR HAVE YOU SUPPORTED, ANY POLITICAL PARTY OR ORGANEL ZATION WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOV- ERNMENT IN THE UNITED STATES! no. TP TYES,” EXBPLAINE cccccccccccecccsccecsese saseecsesenenenee sce seesevaee soe aascosoaseesoesesessseesssatectsseeauescuesssonesees BBO YOU USE, OR HAVE YOU USED, INTOXICANTS? ....X5S.... te seavseseuses IF SO, TO WHAT an occasional drink at dinners “und parties EXTENT SY occccsscsesc cece svecna sane anseenecuenseceme cocesmenerssenus eseneeseesausstees sisccepearensanasesensareeessuetssaveseccaseesmeciee COHAVE YOU EVER REDPN ARRFSTED, INDICTED OR CONVICTED ham ANY VIOLATION OF LAW ULHER THAN A MUENOR TICAPPIC VIGLATION? TE SO, SCATHE NAME OF COURT, CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE: ps HAVE YOU EVER REFN COURT-MARTIALED WHILE A MEMBER OF THE ARMED FORCES? : IF ANSWER IS "YES," GIVE DETAILS RELOW: : S.LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FORK EMPLOYMENT SINCE tou: DPA gs TrAs orn nergy..Gs fimapndt atid Qhlae. ba Lad abe. Bnerg, o 89 hors WOURGLE. OF. nee --~-Beononia Advisors; vosrd OF. GassvaQile VEMGS... cece ceeee ST nn eee nae eeeteneieiemmneenetesammabiaiiiniad | j
14-00000 i (14) F.I¥, TO YOUR KNOWLEDGE, ANY OF THE AROVE TAS CONDUCTED AN INVESTIGATION OF YOU, INDICATE BELOW TUE NAME OF THAT AGENCY AND TUE APPROXIMATE DATE OF THE INVESTIGATION: see ecinnnersenmnnnOaPA Of Coograprie Names hat fen : fhe ae a Os ane am ewe Hae srtes oroD ne Ae ee ee PP Ce So ee Re DELS Li es ee ‘. erent eeenpeey: * saosin tote on P32 See I I I CE A CE EL a EET t Sec. 26. PERSON TO BE NOTIFIED IN CASE OF EMERGENGY: 5 . . 3 Name .......39muel De Zehrung ow. RELATIONSHIP... Lather. pO Abpress ....... 3an_ Rae Gardona, R. Ry 11 Dayton 9, Ohio USA. — j . {Se and Number} ™ ep) ere Stated (Cuantey j POTN CCS LR RN td ante ah EEE OST IT, OR ET EE LR, SE a tae te ge RD St PE oe ee t 27, YOU ARE INFORMED THAT THE CORRECTNESS OF ALL STATEMENTS MADE - Src. HEREIN WILL BE INV STIGATE dD. 3 ARE THERE ANY UNFAVORARLE INCIDENTS IN YOUR LIFE NOT MENTIONED ABOVE WHICH : MAY BE ODIXCOVERED IN SUBSEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY ; INVOLVED OH NOT, WHICH MIGHT REQUIRE EXPLANATION? If 80, DESCKIBE, I NOT, ° ANSWER (NO.” ree ” - eee, WPAN A Sete meh en atom coume ewe ee SE NNR EES, ° + Dennen bee state eu eaten cane ner nen ee sane WON Een ne nnaennn ees {Pe RTT TLE BS TR UT, SUE we : a _ no woe co aati mo ieee) SOUING ANSWERS ARE TRUE AND CORRECT? TO THE P,ANDTAGHEE THATANY MISST.A VTEMENT ¥ AC TOWILL CONSTITUTE GROUNDS FOR IM- IN OF MY APPLICATION, See, 28. T CERTIFY THAT TILE FOREC BEST OF MY KNOWLEDGE AND EELI OR OMISSION AS TO A MATERIAT. MEDIATiC DISMISSAL OR REJECTIC “? af ay ce a) Ae ys gd ng.8 acul Slated one a5 Dseten. 5 A Rha, Cowen! EE Oe or Sa Tee alee ai teticieg asin Fal OW:etneesé sSenature of Apeteneis aa Mn ct tener merits eaten eaten ry ne me eye USE THE POLLOWING PAGES FOR EXTRA DETAILS, NUMBER ACCORDING Tu T ne NUM- BER OF THE QUESTION TO WHICH THEY RELATE, SIGN YOUR NAME AT TEE END OF THE ADDED AATEL IF ADDTTIONAL SPACE Ps REQUIRED USk EANTRA PAGHS THRE SAAB SIZAS AS THESE AND SIGN BACH SUCH PAGH. $e cPBbe DL wledecwtar melas we Beads eo @ sustainment eaentnnre en ete ta ON a ae Aarti renee se, Thee ee ee pate memnimy aoe e neineneey
Say Ro Pale a te we veh 7 ae Motes en bt 28 ments + een Sed | coh Seoallleed_eneeneneneeneaemannnnessansaaneeananans Soo. lL © ky. JLy cohrung, Sr. Unclo. oa \ . USA 1210 Wilson Dr., Layton, Ohlo USA Hechanical Engineer - Wrig:t Air Field, Dayton, Ohlo Ves RRR tom tt eects mpatenawe esd 2am ersce eemmenn nm
14-00000 te tres, as . : ¥ a“ CONFIDENTIAL yy Ny SECURITY APPROVAL” JS o bate; 16 Octe 1951 Chief, Govert Fersonnél Division Your Reference: L2u1y Ws Chief, Security Division ‘ Case Number: §68h0 SUBsE2T: ZEHRUNG, Charlotte Louise 1. This fe to advise you of security action in the subject cease ag indicated ° - | below: ("HJ Security approval is granted the subject person for access to classified information. , . Provisional clearance for full duty with CIA is granted under the provisions of Paragraph D of Regulation 10-9 which provides for a temporary appeint- mant pending completion of full security investigation. The Director of Central Intelligence has granted a provisional clearance for full duty with CIA under the provislongs of Paragraph H of Regulation 1C-9. , ; Z. Unless the subject feracn enters on duty within 60 days from the above gate, this approval becomes Invalid. Subject 1s to be polygraphed as part of the ZOD procedures. pond 4, COaP lOO rian Pro. ef. awh S83 Ao 398 <
"CONFIDENTIAL £ po} ~f . . \ INTEROFFICE MEMORANDUM 7 Date: lk August 1951 10: Chief, Covert Personnel Division FaQM: Chief, Security Division QvOJECT:: ZEHRUNG, Charlotte Louies S68h0_ 1. Reference i9 made to your request for security clearance of the subject , person who ie being considered fur employment in the following positions : 2 This is to advise you of the following security action: a. (CEJ Provisional security clearance is granted to permit aubject's employment on a temporary basis in the following urow or in the following capacity: D Street Pool This clearance lia granted upon the condition that subject: 1. not have aecoas to classified msateriul; 2. “Aut have ueceanu tu secure gress: elf au 2 . 3. not be fusued a badge or credential;-4. not rupresent hin : CIA employee; und %& not be ausipned ty any uneclosoified duti . than indicated above. . rf] Hume-cheeksa hava becn completed on thie person. Arrangements should now be made by your office for an interview in thie Division. Upon completion of this interview further consideration wlll be given te the ree quisted Limited clearance fur ueceso to information «laasif ied no higher than teeret. If subject haa not antered on duty under a freviougly grantcod feu- the Interview should be arranged after entrance on duty. @ ef other ¢iuaonal gleurance c.f Jcupfect in aceurity approved for temporary appointment to 4 pesl- tion requiring accesy to information classified no higher than lecret, Officials of the somploying office uhuould be sdvised of trie rity limitation andahauld be Instrueted to supply Puture cunersiger advice a3 to the limitation so a5 to insure eontinued somrl Shoe "Ss ath te Security action to effer. full opproval in continuing and gaur office will recetve advice of full clesrance upun aumpletion of this action, Unon receipe of full seeurtty clegrance, the present larites:ion will ba rescinded and vupervisers should be advised scecording];. ade ° an _ ont ay 4 ¢ CORFIOEHTIAL FES ne. pa, 4034 25-886 aes
14-00000 emma tet manasa Lica ean Aaa e Eh elbitd © gare MRS, lend «teeth Ut Wien = a Js & iste whe ot & & os a wa — 3 TA eee acre erent teats olga sant cose an
14-00000 FF NR EA Me NE NE ne AE EN ON OT OES GOR I Gh, GEL ORS A OD ST PAE ES ao UNAIRED ANS AAR Maem ems SENG GR ND ORD med ors AN Se SL OR OTH ’ UNITED STATES = IMENT OF THE ITERIOR a fae hed SAY OP PLIBG.. 0 OSTEVTION AND MAMALE EP aD WASHINGTON, 0G Date of Acton ° Journal : nate gooo pooo Res Yieg Chaghetso Le Zebmug oho ah: 300, Ocou of oO 000° ove” Sen Rus Gardena, Meite 11 Dayton 9, Chie cer or Otis ia AUTHORHY \ 6&8 Certificate te, | He2590 dated /ib/oie Acta ourienen IMDEFI BIYe aProlatian?® Effective Date: 1 2, 1982 Wissilassssik ko, a April 26 oe sill nal 9 Chie 7 Position - Statigsical Draftenan Pp W an Grede end Salery - @f~$, 82650000 per anmas isis a , (G8 1555-3504) _ No. &.. : Buresu OF fies 1 aM soovetary aa aE AIG s CHANGE “ . Airs Branch Pivteien af Geog raphy Ld Headquarters Haghington, De Ce EF ortiee, p ental : Ue 70's : Pied Departwantal REF PORION "| or Field _ : Ge Te o Maruhsn Be Koid Vite Sine Abd, Nbc rthCl see thie appoiateent iw sulgeet 60 a trial perled of ono yoare Mere ippthe BeRaid dubleas 9 tosesbiveblate y _GeoL BS Sa BCS ‘ traley thie eppsinineat goa will ho severed vy she Pati ean l §nalel Feaurity 3; Gti, erases 8 vn = aly . oon TELLIER — 67 atl. ayrrgh ufcieear (Nag? a. — Mil, itt tn Sag eo ia Occ nad Pansat sl pep ope apne seve epee nae Unler, Adwiniger @ braioh | Offiey of us Seeretary a i | | i 5 tan Tistee 432 3 Fs Pp 2. Appropriation Tole: ERS GRhGo OE Vorgim, Fund, lvssvier, fears on Geo reitia Seta, Gendtyy 2 ds AGTVICATION omhaa eter 37 estental rtatums for the action crcamerndeds Bre ge er? os See te Fat, ier) reo S900 solegied for epyoimiads3 SAH FIRES Soryice Ceriisias w7 thd, . Hep Sivil Seryine seceps, salisnd ceri’ f ete, ana fara 45 Ped q at g fa, &F * 7 on fay presigeraiakcenb loyalty ong: ave ¢ i ‘, } ARR ses. Sas i Soctal fecurtty Uses. — 2E5-2h-3138 { : alice Atace ASEOWES = t an i . ta : ~ PTET psctetse BKEAU NOTMMICATION COPY i eet - Fe er RR tle pew teem A ee ate reer remem tee see
Or aNo en aEe nares “+ UNITED STATES 8 Crvit SERVICE Comet SION \RTMENT OF THE INTERIOR ge cola 3 Rey Orrick oF THE SECRLTARY oe” cho 8 (Ot ea NOTIFICATION OF PERSONNEL ACTION 2. RPA (Rem IGE M RG FIRE PI OO INITIAL—LAST? 8 DATE GF BIRTH | $. Joven, of Acton Na | 4& DATE LAs Charlee ng _ “This ia to notify yox of the felloring action affeding your employment: sleek teneihlin nial, naan @. EFFECTIVE DATE | 7. CIVIL SERVICE OF OTHER LEGAL AUTHORITY 9 NATURE OF ACTION (ust STANDARD TERMINOLOGY? (fe esospt Rrooytoa pps . th Contra: Ligon O/ eas. FROM A one: i . TS (G5=1853-3-503 ) G58, $2950.00 por anmm 8, POSITION THLE ® SERVICE, GRADE, SALARY Office of the Secretary Davisten ef Goapraphy 0 BEoIaNATIONS Ragearch Branch tt. HEADQUARTERS Hashingten, De 6s . { } FI { ] DEPARTMENTAL 12. PICTLD OR OCPT | I FIZLO { | DEPARTMENTAL Sh GEE hbald one ee: © Meapleean ceprmnnay onmepreee necting ina Set tate hentai tte th CAL TR a ee merits ee ntteeeermnnmranes a » 18. REMARKS Ang leave rezabning te your eredi$ wlll be trenaferrede yeparabsd vithons reungleymen’ rightos “tint 4 Ea cP aE : ON CLANSIFICATION ac TON te VETERAN & PREFERENCE cs Post Tawa ferr +s PE a OCTET aE S| teiw Wye Dna i aen | pan eeeye een nena reece i i ry Ly peter j pea Panaon H | oid __| ms naar aay TST APPAOPRIATION — 2s SUGIECT TOC Sha WT GATE OF OATH BP TEGAL aasidenca ” oEX re RALSCUE. OSS Berking RETIQEMENT AGT 1 acccamonn one? at vag te | | vo Pee Bs intarlers Office af tha emnnesrrnmnli cts at a i ‘ 4. PERSONNEL FOLDER copy. ‘ ie. falas seat} }
14-00000 ; : é —— cee ee ets wee tune cnet mw et weet ne- Sromine 7 etten |» ng 8. _ APPOUNT IAC t at the . FCS Las th it Ge gi ent aed Chariotte | he | Zenrung 21 (ar Goede 178) ean Ftd ty 2 ; | Statistical Draftaman_ ee BD Ge teeta Gide ete ro 3. DATE OF arn 1/29/29. HAS AM APECIRT UIT OM ne gene ee AT. We AT THE SUIPAE CHEEKLO BLOW. ‘ieteh (Time! 4 [U] exorruscrocaat 8, ("] on oyn 2 TT pace it, [—] nutertion [] vropatomy to [7] suanicat ec, 18, ["] oinmardioce . [7] wesican is [7] protareee ss, 0] gear. Eat aE Cr Ae . oe rae tient MEoIEAL APPOINTMENT A4D REPORT tp ay ar fis Eee FOL, yah ad -- ee wt
Pea neds ew ie a STANDARD FORM 6f inevisio arent tsa? PROMUR GATED BY TVR Sexi ce COMMISION CHAPTER AG FEDUS A, FES ON NEL BARLAL APPOINTMENT AFFIDAVITS IMPORTANT .-- Before swearing to these appointment aftidavits, you should read and understand the attached information for appointee hea T 0 GLP ic ALCO AL, SUL G wu. BOYS MISHLR P00. PCr (Department or agency) Geese s¥y vf division) of employment) I, ...-.. Cans ho shert saen seneveennanane , do solemnly swear (or affirm) that— A. OATH OF OFFICE « I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to, the same: that I take this obligation freely without any mental reservation or purpose of evasion; that I will well and faithfully discharge the duties of the office on which I am about to enter, SO HELP ME GOD. B. AFFIDAVIT AS TO SUBVERSIVE ACTIVITY ANO AFFILIATION I am not a Communist or Fascist. I do not advoente nor-am I a member of any organization that advocates the overthrow of the Government of the United States by force or violence or other unconstitutional means or secking by force or violence to deny other persons their rights under the Constitution of the United States. I do further swear (or affirm) I will not so advocate, nor will I become a member of such organization during the period that Iam an employce of the Federal Government, C. AFFIDAVIT AS TO STRIKING AGAINST THE FEDERAL GOVERNMENT Z am not engaged in‘any strike against the Government of the United States and that I will not 80 engage while an employee of the Government of the United States; that I am not a member of an organization of Government eriployees that asserts the right to strike against the Government of the United States, and that 1 will not, while a Government employce, become a member of such an orgunization, 0. AFFIDAVIT AS TO PURCHASE AND SALE OF OFFICE Ihave not paid, or offered or promised to pay, any money or other thing of value to any person, firm or corporation for the use of influence to procure my appointment, E. AFFIDAVIT AS TO DECLARATION OF APPGINTEE The answers contained in my Application for Federal Employment, Foria No. 37Z....... ‘ dated 0. Ae Once eye, 19, filed with the shove-named department or agency, which I have reviewed, are true and correct as of this date w ith the exceptions noted in the Declara- tion of Appointee on the reverse of this form. (If no exceptions, write “None” on the Declaration of Appointee.) bese: A rctnthee. we. Done ae Co (Signatuee of Eppuntec) Subscribed and sworn before me this 2.2... Gl. day of ..ce Ay Ao cocccce ccc wy ALO 19 Sl *) i] * Cit ny (Seated vi vi is {sear} tg ; ole Fev renee” a seeee eee ns Y cae LALA 4. ek Ce thay ne Ay 4 wpa NOTE.—-If the onth is taken pe. a Notary Public the date of exptratian of his fl bo shown, i snmissién shou! 36> BSAD- 9 ies BE 2 Se a aa Bele PE ee 4 1 ers ae gs ae) npRITINY ee ears ime W ' bs é Sa He A ay wt ty a ae
VECLARAMON OF APPOINTEE This form is to be campicted before entrance onduty. Question 3 is to be answered in all cases, atherwise answer only those questions which require an anawes different from that given to the corresponding questionvon your application form, If no answers are different, write "NONE in item 10, below. Any false statement in this declaration wil be grounds for cancellation of application or dismissal after appointment. Impersonation is a criminal offense and will be prosceuted accordingly. 1, PRISLAY ALOAESS (etree? and eusmber, city and State) ‘ foe cy S80. 6G HS aby - Washing fon De aed an et pet hh Ef7ert 2 () bate oF siaTe (8) PLACE OF BIRTH (uliy of town and Erele of country) . t+ ag wy fo CO, | Wt. 5A & (A) INCASE OF EMEAGERCY PLEADS ROTIFY G2) PRLATIONSHIP | AC) UTAET AND NUMBER, CITY AND STATE (0) TELEPHONE FO, od a é 5 > Swrtudl 0 Z2Zehrur g Pith ert| oan Wed Garycns: (0K Wa SPF+ ge PB ? @. DOES THE UNITED BTATES GOVERMENT EMPLOY. IN A CIVILIAN CAPACITY, ANY RELATIVE OF YOUNES (CITHER BY BLOOD OR MARTIAGE) WITH WHOM YOU LIVE OA HAVE LIVED WITHIN THe past a montHs! [_] ves . 1f 90, for eaah euch relative Allin the blenks below. If additional apece fa nevesary, complete un 1) POSITION ¢) POST OFFICE ADDRESD nant (ive street number, it ang) DEPARTMENT OR AGENCY IN WHICH Qi socesameeecnn seonausmenenarnennmannananae 8 cessaceccnescccensemmocesscenannsaacanes 10, SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS WEITE 1h LEFT COLUMN RUMBLAS OF ITEMS TO WHICH DETAILEG ANSWERS APPLY NDICATE “YES” Of “NO” ANSW age [an an INDICATE “YES” OR “NO™ ANSWER GY PLACING “*X ves| no bara IM PROPER COLUMN | 0, & ARE YOU A CETIREH CH OR OO YOU OWE ALLEGIANCE TO THE UNITEO OVATE . x & ARE YOU AN CFFICIAL OR KMPLOYFE OF ANY STATE, TERRITORY, COUNTY, SA an ewanpe sees +0o by CONDESA ORY TODO Lea ee EEE a SDE ORTaaerronat Cnet Or ese v emo une vet hwet ere the aie MUAICIPALITY? .,. Omer eR ene arene e eee aA Len ees weneuaserwannenne yee errr x Sf your answer ie Yes", dive details in ltam 10, ED YO AP CEIVE ANY ARAUITY FGM THE UNITE O STATS wie DINGS ee H CLV ATR G2 2'7F ALT UNDE TE AMY fet ELE ALS ACT OR ANY PDI 8 i GUT ee eeeps et ree RAD EP AL re CrP AA AL peer ge ‘ Yeu, giv on fem {0 reasan for relicamient, i 1 { i t = | sessed sae ssevenans Sosteutsnteeter toe ya te Ff proces ariaseag is thal ts, age, optional disatiity, of by toasen af vobintary nee ee Ge anventuatery separation after 4 Gant actewe, aguune of rotlrament pay, wad undne what fatnomane act, and rating, sf patised fing piifitasy oo paved aorvica, ff ycuranswerrs'' Yes’, Aveda ltam 10 tha naoie arid addeage alenployer, Sale, anth cawsaas tf) onch sade. ' i ' { Ot UNGATISEAT Glee GLAVICE PAG AMY PO IONE le eee ceed | xk | & SEF Ve ETH BIATHORY, HAVE POU VER BEEN BARDS ELD CMEC ES, Oi | SUA OBE OD PTE CE AS A DEES HOANT SM ao chek PREM eR ay Coe COE TEC BONED OR MEU es Le OR PLATE DN ORATION GUHA GL £642 FUER EEN OOP EEG TO CLOUT WAIL ORC A LATO RAL Pitbe EE ott 9 Tied CHAICL LA OPO SPECULATION CA GKORAN LE (OMCL TINS Mibaat DAP VIOLATIONS FON HCH AE IRE UIC PORE Es TUrk OF POUR LLSS WAL EMP OSE Ggt f6 yore anewor is fea’, font atl auch cates under Frarea £8. tings sagach cate (1) fhe data, (7} the nature of tha otonis ae viedlation; (3) the name and hnation of the court, (4) the penalty wunpoised, if any. o¢ other thispusdion of the cace flappuinted your fingerpaunta wil be takes y sceanaeieaahen naeebadenemdemeneaeneemanadeetnem tmaentanatiduadl Somme u . e ' _- . INSTRUCTIONS TO APPOINTING OFFICER The aosvacting offlecs before whom the feremong certificote ig misde shalt 02) Crtsaaneship ~ aypulatiag office is reaponaitte for obterving the determine to hoger avcisfartion EbSt tls appointiacnt leech be le. eer dormutlce @tirensinp pa scnaie of (i) the Covel Sersme Kuba and €4) pppreparathem acts i Mapa! ad id Rocegitable puroat ed Ferm @f corsinees an atitavet fi ue ality whe se, baa edoubrlol cused the apphe able Cevih Seavice Kudes arnt idegula’ one aid ance bos Boe ee cured Coes LO anperrttas ek, étternelip alate & of otter pronation, autatakey vs cone PI pe abaner t Wage OF METS, WIE pT teary tee the tre sert.dyis: with tie Civil Serve Act avis of Ceagress pertaining This farm should le cheehecd far hobs petien with any fecond of recent dia faticewin ig. (is ddanery of appointee -- The apnonites’s simaturm nd fendarveing are to he pampered wth ihe ppl ests olor ether pertine.. geauer, The wherrree Chere ape already ply acul wp wracenre anny be alyrabed gga.oat che imedicul «ants ate The Dppende teas wlare bt epucstionedd on bis pe cpanad history for pertersent @.th hae Previaus retements, (ho Aga of denaite oge Umite hove been eatebhaled for the peter, be satesriuir. thar a, pheasat get antantc tee dae fibtae dec agyer Bored sus h cdetecinmetead te mele, tha apps nut be eteeussiaicd, SF Brean ad Cwraten. CEPI | LG ELLE en a) SE Nd The onrtewe she hs EE PN yes biTbedb oF fS) Afarmhore of Farewh ~-Sertien 9 of ¢ ‘ HOME TF She nt the vara petitice or prebattant sd of perrnedit. Sppionriis od persone fe ure not gubjek io lia te greaent, Phe rocnders- sweet apply tu Crease ary a gectaisrecs, ss 2) fe Ace the ng reqarale oitico of the Civil Scovice Coo. stad fos deci ns ae athe Ve pet at crores tp
14-00000 en ane meh bee vagy . . ro . UNEEO STATES 7°" TMENT OF THE INTERIOR ad ONTSON OF PERSCR 5 UPEEVISION AND ALAN AGZEARNT WASHINGTON, 0.6. « Bore of Ades Ret Lise Chariecte E. fehrung . San Rae darniena, AR. 11 “. Dayten 9, Chie Boo INDEFINIGS APPOINDONT f ca 8 f i ~ Effective Date: PS AC EGG T TTT 4 . To Position : Statistioal Drafteman Grade and Salary | GS=3,. $2650.00 per annua (GS=1533-3-504) Burees Offiese ef the Seoretary Branch : "| Division of a raphy . pe serads aosehe Headquartes . Washington, De Ce org Repartmental ae, # ‘a O. I. © tMartha &. Reid shies appolatuont is audjoot $0 | a trial ‘peried of one year’. tye 4 Subjeet te investisation. , Under this wpolntnant you will be cavered by the National Sselal Sseurlt, o:ace:, (89) THOMAS H. Signed, Rural Part Agrowltca Tice UIROGH,OO1 Working Fund, Interier, Beard on Goosrachioe Nana, Sundry, 1251, Aa urel ae ilo - . Y US HCA NOR Wosbee war Sp a te cat o rerians for the eet cennes abel t Miga Sehouns hae been aslested | for apvolacnent fron Civil Servise Certificata N-d580.- - Yer Civil Seiwlce eavars, nedival oersifivate, and Fora & for praegpointcen’s deyalty ohoole are attached, Attechacntea, vette os . - foley Carte . me i? 3 < t af. wee et xo, Ae —tttheittentin wlipinetinayerity feheny aniana Mey AES WOR Meret nem “whet Nt enh ystefe ARI, sBrtth, mst, METS Retin Nome SE IE GNtten FER ta, ., a cy y _ downed Permanent civ EVE Ch ORGG UGAL hOowty CS Certificate No. wun tetiod Regular Tate oh oo eee! Basi dpe EAL statue CHANGE —— R APPOINEMENE Eftecthe ot » i cy Rating Natuse OF POON Vice Se Add, tenttctlamne Nevo Martha B,Reid “+ GS41653-36504 . Realivsstton ee  beWememes, = Jagecarond. abaoYal ne men af tog “7592-8. ret H=2580 dated 1/16/51.
Tennent see 1760 exe, -agnaH eat ferent SAER as aticiesb rrr entire At ras siteen anal Ste AS mh wk STAR Sete see nem te Rha OM le HMRC RW adn 860s ” top! te eS a * omens emer BERNE REQUEST FC ORT OF LOYALTY DATA ON AF «ANTS AND APPOINTEES Chet here tee Oosraiiadag —— (Utepiw 2 FOF Ro CASE SERIAL NO, Ft. FOS TO BE USE ONLY POR APPLICANTS ABD ACCOINTELS (Aa! sase andy) MGs RECORD CHECKS AND INGBHTHIES ARE CONDUCTED BY Cl¥tL SLEVICE COMMISSIUIE (PART lmmLarcutive Oro 9839) YO: The following information ta firnicha-d for identitteation purpores on tha pore named Pelow, Kindly furnish a ropert on any loyally information euntained! in gear fies UP he fecerprnte of thhy percen ave attached > (Aliidle of ltt Bamren) tL Fut. NAME {initints and (Ui vent nara} ore et eral, pane Charlotte Loui se z ALIASES AND NICNNASELS, 2. DATE OF Teg REQUEST Sherr) 2/l/si & SPFcikL NUNGERS KNOWN TO REGUEST 6G AGCHCY (FHT muauatac ie FEE Ale sisrtes, passat pumabor, Arug of Navy serial usaabes, scamsan’s oreliGrate of ide. Liffcatiun, abe tegisiteiies musi0et, Berna boul y "puinber, ete, Mpaaity wileh) Soeial Seourity Kos 069-2-3138 &. PLACE OF BIRTH GOATE OF BIRTH 3. TTL OF POSITION : Day ton, Ohie . Jane 12, 1929 Sceatietical Drafcsnan SENS Mvision of Geography) B SLX $. MARITAL STATUS ta HF MAHRILD, GIVE SPOUSES FULL NAME. AN® DATE Anu NO PLACE OF BIRTH + [7] mare CF sinove Kone gaz 2 FFMALE | dathiiies Th DATE Ot APPOINTMENT 12, x % ie git (] excepren - beh JMBrayy fe Al PL “tee Civ dere vTeoe or atte f | erather es of HE mattverltyy Galione®. WIT Wittced ie OTHER O OTHER THAN RELIGl RELIGIOUS OF POLS OR POLITICAL AL OKUANIZATIONS OR THOSE wiicnt SHOW RELIGIOUS OF FOLITICAL Delta Gazza Sorority $4, DATLS AND PLACES OF RESIOLNCE FO Ths LAST 80 YLARG Frow To Hitredt City Stale Wl - Of San kas Gerdons He Ne Ll Day ton Ohio: or) ome OF, spoon Yak eelmet Aves ooo or Syracuse 4/7 -=- af - eR rhe Ger Oe ees eee ee Tay ten -- fet meee noe uhio wa ere | Hees pn NA Na laat Ut -—-~ we ce nee: MUPAGUBE -- L, Ye wo 1 7/hA = Wal yor Calle Vonlenta _.. Guatecdla City... —iluntemala Code . i = Of OOL Ualsut Ava@e ; Cyracige a Tes Cargong Da eo x ertedsiygh 2VGe— —  -- we teen ne vyPadisé cee sete je El «3 Ne ea at [1 BATIS, HAMLS AND ABSA OF EM a pred. er TO rarconis Me Eg A ® du whdifrea . mens tora d orior %o the Mites 7] Vg) {ti a Matrr relent 72000 0. Lay en 9, Shhe Ui fs hag . (hesiployed — . eee eee ee te cece tite 6 ps eco f Vi oan Bf! _¢ upants Diss ehere Ynarbasing) | byrrauee, Be Feo “| | i, Uren Loyed cee scare a vee enw tenn pun ene | ; van Rao Sardona, Re a, li _. say ton, vhto ce eee ee | Unerty leyed we a Metupeeas yt yee BE genet [A wos ES ine enc Peanut Counel )_ oe 3h} beer ‘pirate te “Pidees _. 5/59. BAR Bee verdens _ sytem, ble nnn cs TURRISELYG Of Thee AGLNCILS INOUE GH Oe AUR THE LG ALT? igen TO BATE OF REPORT PO ence a tie wine heen sence na + j - = wee oe } | H ere See es | conten Pool. ee { i corer somacpenannerinune rece mmr era scent manson orem . CEN Foderiorp ML WAME No te aor Rene Sh. CP TLIS NEP Veh BE SEEMED TOR BET : > PO WUnNCY Wabi Tob Onur y aN. Yarsunnol wi Pioer Forts ilar 18 DEV ELOrcp Cffies aF the “Nera tary leparbor6 of the invertor Saahsineton os, oe Ce Oh £5 EEE $0 Wise Pod MuPOTs ON CAGLS WIAA Lanst er aE EA TIO TAL OWED
14-00000 be ares - tae gs MAME (Leet, firat, e¢ddie} PROPOUED PUSTTEOR, ORGANI cATIOWAL NES! Galion, tion tory empl er lacumbent check has been completed. working days after the appointee enters on duty (1) epplication, (2) file coveriag any in- vestigation of inquiry ennducted by your agency on 4 preappointment basis, and (3) Standard Form 87 (fingerprint chert) unteas fingerprint search has already, been mele aa shown by iten DA helow. 8 fe vided an the back fer your convenience. sary to transmit forme in thie case. Ro . we "oe = ae STATES ©. SLRVICE COMAISS 10 se Seong ees Bae DIRECT CR REGTOS feGleF IFES SLES PoURTH U. S. CIVIL a TD OME Ge re wea RY norLptnG a OPV GF PERSO 2s Rt TEMPORA aN RIVE sg. 8, weld 3/14, SS ard &. JEFFS i , 3. PROPOSED Altice a ett REL pd NENT LOYALTY cHEeK «WAR 15 195! PRELIMINARY REPORT OF CLEARANCE ON INITIAL CHECKS ge o a & Pe e PERSONAL fersonnel officer Cf£fice of the Seaty Depte of the Interior ~ °° 7. ||: AND wothe 26, D. Ce COHFIDENTIAL & COmPets Ti ug oe < & and Pare oF f4P comes? o Preappolntment loyalty check hos been made on the shove applicant for a ‘sensitive’ posi- + Purguant to Chanter €2 of the Pejera!l Personnel Manuel. . This check revealed ne deroga- information regarting thls perran’s loyalty. No fuether pavers are required if the proposed action is the sppointiment of a persen ayed hy another agency and you heve determined from the losing agency that the aprointes For any ather type of appointment action, please submit to this'office within three FINGERERINT SEARCH WAS REEM COWPLETEO 45 PART OF THE PREAFROINT WEST LOVALTY CHECK, ‘ ‘ eect EMR ET FINS bQPata ts wed HOF Susmb YEO AS PaRl GF tae PALAPOSI AT eLet LOrAL TS CuECH, FIMGERPQLMTS WERE UVCLASSTFEABLE, YOU MAY ELPHE® if) whEE THE APoDsareEAT aT ONCE smQ S7FS1? BRANT S BLIm Tel GIMER OFOYERED PAPTAS, OR GS) BETMNOLO @FPSi at ATaT 28O Gece sh PEF GIRTS SFOARATERE TPR COMPLE~' eOU OF CFNGLAPRINT SGahtn BEFIAEL Toy OFCEOE MiCinfe %o aFPoies, MNCL ASSIF ABLE Hingrasaimts [) ame atracneo, ., (writ e6 ronwaecee ue vecreor eagw Qua conta, Crete. | Plhleazs use the copy of thia notice for your transmittal or reply. Space has been pra- A reply ia required, ever: though it aos Hot be necwa- * REGIONAL Di RECTOR -_ ores RQ A aeBP oe Bet!
14-00000 am mH é . ee sc FET Pc EEE SET (neem To: BPRECTOR, Ul, 8. CHVIR SERVICE eC GIGR : ) f uf . hl. Porme ettached as tequested, Peéposed personnel sation olfected i$. en “4 I silted 4 bane a. Forma not site 106 becevse proposed personne! sation dropped from consideration. 3. Pore fot submstted becouse thie be an appointment oi thout breck in services of « person whe wes eaplayed by snother agency and it hes been detersined from the Officiel Peveonnel Poider ar the Soatng sgency that the appointee or incumbent check hae been compl eted. 4,- Reprints on Standard Pore 8? attached. Decision regarding appolntaent wlll noe be aede wsital the results of the FHI fangerprint search hove been verel ved. HEMARRS: Forme 37 and 67 attached,” v ‘ ° i , 4 ‘ rd} april 9, 1952 priites@ seiag'3e B 6 ae OF APPOISTiRG OFFICER GFFic#ay Vitué i (au.) oe ty. Sb Personnel ppebii Stary ty
14-00000 wrt Si dome meet en aes BP ten ve mom wane Meee St ame oY * at ° “ — THOMAL POs Ee nO. 8 AOGRCY AMD ADORERK { Htret, cpg, ae iy we pieawere i . Hise kmthilda’ C. Reveer oa _ Return this | Chief, Administrativ® Branch (EUPERSEDES COC OEM PORD INQUIRY AS TO AVAILABILITY =“? * | paves or. of Coseraehy — | Washington 6.2 statistical : Mies Charlotte L. Zehrung Drafteman ce ATION . San Rae Gardens, RRL Dayton 9, Ohie ; : . tw of arowteme «= Indefinite - ¢Plence correct addres if d{fforent from above) (C1) erosancna CC) ramponsey ram This office fe considering you armang others for the employment deseribed. Please fill our the “Aveilabiticy Stotement” below, indicating whether you would accept this position if offered, and réeturn the entire sheet ts this office. Appointment would be subjcet to the Civil Service requirements described on the back of thie letter. Wheeler you are available or not, please coply withla consseravctore scone Gays in order that one of those who are available may be selected as promptly as pos: sitleto fill-the vacancy. Pailure to reply to this inquiry will result In the removal of your name from the register af cligibies until sich time as you request restoration and furnish the information asked for in the statement below, THIS 19 A LETTER OF INQUIRY AND NOT AN OPFER OF EMPLOYMENT. [If reflected, you will be notified end given further inetructione, Other information: - c oor Chief, Admin. . Branch AVAILABILITY STATEMENT g 297 on avsiistie and wish to be considered for the position degeribed abave. 1 ean report fae fury serthia LD evovenn days after narification, fam now employed by asf t Wate Pi. ntnceecansane steosacwe ¥O1 dof not wish G2 be considered for thé position deseribed above, T am n giving my resesms am the. other sido 5 of -~ this forst. ( LE request that my name be removed from tho active fist of eligibles untit I report that fam aienlinble for oppointment. it Gr Cousider me available far other aprointme nta, subject to the foilowing conditions: F The position must pag at teat $.. te y BPO... per 187 Cha ed. (year, mgach, flay, or hour). i om willing to work: (FT tn Washington, D.C; () Anywhere in the u. ‘8; (C) creme cae a will eccept appointment in the following locations enty: .. Pan mo iz months, ‘eben eget. peewee inne tans amen feat @ 9 & fkoece) ’ eae ad
vr hey we eB coe Sab Sey Vaek de whe ete tales Lee Dee ee BAR ate ota oa 1 PhearsS, AEBS CCA RIE RTL 2, “RRS HO RROC EKE 8 BERN Fee RE. Oe Oe De aoe a Se ee ee a. a ed a ae are rar eons ne STANDARD Front 78 ~\ £0 STATES CIVIL SERVICE COMMISSION FEOF RAL PERSONNEL CERTIFICATE OF MEDICAL EXAMINATION MANUAL CHESTER Ml . (Applicant must supply information below to heavy line) . . iTypewrite, or Priat ia ink) #. HA, * (PiAST MAME) (MIDNA PUTUL) “ RASS 2 DATE OF GIRTH nes pe mn Qhaorlotte Le dsehrumy; Jiuu.ry ld, lied 8, ADURLSS "| & WILE OF PSI TION Steua iu. uv ut. PUG duvtun J, Yule Statistianl Draftenan’. a wages . oe @ GLPAR CRT OF BURL ALI WHICH ¥ are To ge wi) tetar 7. BOCATION . ce ig Secretary - Interior « Grice s of bog raphy Rashingten, De Co NO. UF YOUR ANSWER IS “YES.” GIVE THE DATE OF YOUR ORIGINAL APPOINTMENT TQ 0 « . 6, ARE YOU NOW LMPLOYCD Ih THE POSTION SHOWN IN ITEM 5? [J ves JHtS POSa TION: 8. (A Rave YOU ANY PHYSICAL DEFECT OR DISABILITY WHATSORVERT VES by BO oF YOUR ANS ALA 13 “VER,” GIVE DETAIL Ss f ray HAVE YOU EVER necciven' DISABILITY RETINEMENT FROM THE U 5. CIVIL SERVICE COMMISSION? Oo VES | - so, . Tk ° 7 Sign your name in INK aa it. eppeare ist appli-] SIQNATURE OF ee cation In: the prescave of the -physician for purpose of ‘identification. DOCTOR: All quenions on both sides of thie certificate and on the lower half ofthe attached Health Qual cation Placement Record must be answered. Before beginning the examination refer to items 9 and 10'on the Health Qualification Placement Record so that you wil have knowledge of the phycical requircments of the position to which the applicant is ta be appointed. Sign both thie certificate and the Health Qualification Placement Record. i neiour; —-— 4. FECT ‘ WEIGHT ee a0___. POUNDS, 2 tvee - 2 x a ‘a . + (Ay DISTANT VISION (SNELLEN): WITHOUT GLASSES: RIGHT/r+ LEFT 1¢¢ WITH GLASSES, IF WORN: RIGHT; 5 LEFTS. 2 (0) WHAT 15 THE LONGCST AND SHORTEST DISTANCE AT WHICH THE FOLLOWING SPECIMEN OF JAEGER NO. 2 TYPE CAN BE READ BY THE APPLICANT? TES? - LACH EVE SEPARATELY, WITHOUT GLASEX _ WATH GLASSES, iF USED: employes in tho Fedorl classified mervire.as may be, poqurated . , wre r : by tho Chit Service Comunialon of ite authorized repecaentative. Le “ft ‘ 284 "Jhle ander will supplement the Executive Orders of Mey 2 and R NTO ". Roos TO Jus 14 188d (Everatte Order, September ¢, 19349, , >- 4, : ‘ teed IN, TO IN, be oom It TOA A in, : . (C} EVIDUNCE OF DISEASE OF INJURY: RIGHT anes a renee gp COLOR VISION: 15 COSIOR VISION MOWMAL WHEN I-HINARA CH OFTHE COLOR PLACE Vest RS Use? 0 YES ci hO if BOP, CAN APFLICANT PASS LANTERN, YARN OR OTHER COMPARABLE TEST? im] YFS r ] NO eaten enter ar nd 9, LAIG. (CONSIOER DENOMINATORS INDICATED HERE AS NORMAL, RECORD AS NUMERATORS THE GREATEST DISTANCE HEARD) ORDINARY CONVERSATION: EVIDENCE OF DISEASE OR INJURY: RIGHT EAR cad iowtume LEFT EAR miedo nef’ * PUGHY EAR i 2! LEFT BAR nelle arm. mT, & MOUTH AND THROAT (A) HISTORY OF PEPTIC ULCER: “A vis 3 RO 1F ee is ULcER: a] Metive Q QUIESCENT (CT) neaceo #0 LONG?________. DATE OF LAST X-RAY ; , SYMPTOMS PRESENT, 1F ANY (Seresdip, frequanuy. ote )! — TREATHEINT (Lise apece under “Remarke” &f aseded}: . 2 PARA WASAL SINUSES 7. GASTROINTESTINAL i a Sear et & HETANCLIC DSORDLKS (INDICATE ANY ABNORMALITY OF THE FOLLOGING GLANDS AY A CHECN It THE APPROPRUATE BUX, AND EXPLAIN UNDER “REMARKS."). ( mrvaoo {(] pancecas 7) ATUL TARY (J ovarian 1O—~ 258928
tne a Tee Te eee eRe Late remanent ert rere EE nee : OO ATOMS sete ne NR a Mart nt = os (a 0 reagan anatase sen ate treme et oe er ee ®. MEANT AND BLOOD VESSELS)” " $0 tpe eben W BLa08 fe: evsrouc MM.NG oastouc 7 &) IF ORGANIC HEART DISEASE 13 PRESENT, tS ie aL GomtIGATEDT @) 3 ORGANIC HEART pIsEasE Present? =) ES [K] no Cvs (]xo ©) PULSE ATC. -_ — oat SITTING oat. IMMEDIATELY AFTER EXERCISE (UNLESS CONTRALNDICA TIED) aspect ut meeereememnenr-r nearer rata FWO MINUTES AFTER OE RISE eet CARDIAC RESERVE pare. {eQ00, FAI, OR POOR) i ta Lunes, “Rica peter FP A. se anaes - wmsroRY oF TuacacuLosest [7] ves (f] Wo. WF “YER” HOW LONG HAS THE DISEASE BCEN ARAESTEDF oo IF THERE 1S HIS. ORY OF TUBERCULOSI’. 15 ANY TYPE OF COLLAPSE THERAPY BEING RECLIVED AT present? [C] yes (C] mo. uf “VES” Give FULL DETAILS UNOLR “REMARYS.” 1S MELSCAL SUPLRVISION NECESSARY? ["] ves [[] HO (IF X-R8Y 1S MADE, GIVE REPORT UNDER “REMARKS. . . Hi. HERNIA: (] VES [RX] WO. SF “YES,” NAME VARIETY: INGUINAL, VLNTRAL, FEMORAL, POST-OPLRATIVE, ETCs if PRESENT, 19 17 SUPPORTED BY A WELL-riTTing TRUSS? [] ves [7] NO 2 VARICOSE VEINS: [“] VES [ANO. iF “VES,” STATE LOCATION AND DEGREE ces $2. FEET; 15 FLAT FOOT PRESENT? Cl vES R NO. IF “VES,“ STATE OEGREE OF IMPAIRMENT OF FUNCTION. ° {IE SLIGHT, BOOLRATE, SWE RT) 14, DEFORMITIES, ATROPHILS, AMD OTHER ABNORMALITIES, DISEASE NOT INCLUDED ABOVE 4 One ~ ' 18, SCARS OF SERIOUS INJURY OR DIEASE «_ > 7) Grn _- : . 16, NERVOUS SYSTEIE: (A) [MCLUDE SYMPTOMS AND FULL RISTORY OF ANY MENTAL, NERVOUS, OR EMOTIONAL ABNORMALITY (UGE ADDITIONAL SHEETS IF NECES- . BARY Js PevIie . G HAS APPLICAITT EVER BEEN HOGPITALIZED OR TREATED FOR A MENTAL ILLNESS? Cy ves 7] no (0) WHERE QUAME AND LOCATION OF HOSPITAL): (0) DATE OR DATES OF HOSPITALIZATION: Fs) DESCRIBE ANY RESIDUALS OF PREVIOUS MENTAL OR NERVOUS ILLNESS; ; : . MARKS FLA ie ARL MALL, Civé OLTOILS UNCER MREMARKS,”* (FP ANT HITTORY OF EPULE Te | oF FAURLOG SPELLS? { ] vis ¥} NO, IF SO, GIVE DETAILS ONCE 47. EVIDENCE G8 ps OR f OF VEMLFEAL oH, TLASE IF BLOOD SERCH OGY OR OFA LABORATORY + ri AMTAAT; 4) Orn kL . 16. UPUNALYSAS GF INDICATED): SP GP eee ener ALBUMEN career eeencere creamer premncen TAIGAR as ceerncaneamntae CASTS BLOOD een meeeemene PUG ee 1 HAVE FOUND THE /PIQIC ANT ARKOR IAAL UNDER THE FOLLOWING HEADINGS: . 4 REMARKS, . Pi ove jrgacewt Bongia tego, Si piriwaaE $&aLé at Atal ‘, + / . ‘ ZL - DATE | 2 /a/51 NAME TYFLD OR PRINTED 19 SIGNATUPE GF PHYSICIAN OR EXAMIMER . Libby ZA Kia 49. ADGLSS OF DXAMINING PrvCacialt (Ty ped av permted) 916 Harries Bidg. Davton 2, Ohid Albert F. Kuhl, M.D. WFO You Haye FELLAAL CLSIGRATION? aa iF YES, sn LEIGRATION? [7] ves [8] no TA FULL TEBE EC BASIS arg bins dest et
Pp tine Solna Shr t sn dense sand ba atte sok ty ee Sp ‘akin k tarmecme RELY Settee itm IANSAEE gad wh ceRInh et din dash adindan dd ae vtenel sure Bay SCO Se ee ee Lee A ee ate -fe Na, om ¥ \ HEALTH QUALIFICATION PLACEMENT RECORD CThia section ts comparable to Standard Form 90 promulgated March 1946S by Bureau of the Budget Circular A-24) LMR {futs? MAME) O41pOLe wUTIAL) LAST} é& EGE RTH 2 MALE wR Git riutte bee et OURS JEnUeTy ld, lau Seat & ADDRESS . . $. THLE CF PROTON Sia awe GLPuend, wey TOR 9, Vble Statistical Draftsaman & DLPARTMERT OR SURLAL IA wate PS tHe a reeys ary 7. LOCATION Interior - Avision of Ges raphy. . Nashington, D. C. @ ARE YOU NOW EMPLOYED IM THE POSITION SHOWN IN FILM 52 { | WED St fea UF YOUR ANSRER s3° YL GIVE THE DATE OF YOUR ORIGINAL APPOINTHIEAT TO THIS POSTION: TO BE COMPLETED GY APPOINTING OFFICER: Secheas 9 and 10 () BRAC? OUTLINE OF WHAT WoRREA DOES «i PwrsiCAL OLMANDS OF THE POLITION Bor the phyviclan's use, eet down in brief and elmple terme whet the employee ff Ie Becting 10 below gocincte the number of those factors which are canential to ders on thus lncluding environmental details sh ae stairs to dimb, dhatauce | the dutice of the puastion far which ths thie # epplicant le belng conektered, The biaak fo rest-room ‘ties, cafeteria, wos k-aheh, ete, en Section # below.) apaces may be uand ive special lated, & TLE GF PORTION AND OUTLIAE OF WHAT WURKER DOES fe THIS PUSITION (adie am q dhdloacry of wrcapaneudl tiles es guida 6s applica iia} Pa Statistical Dreftaman - To assist in the performance of drafting, lettering and incidental statistical clorical work in the precaration and revision of index zaps, showing the location of approved and disapproved nares and the extent of features to which names apply; charts, graphs and other illustrative materials in connection with the functions of the Research Branch.and for administrative purposes. . YO BE COMPLETED BY E: EXAMINING PHYSICIAN: Sectlons 10, f HH, 12,15, 14 and 15 INSTRUCTIONS The iter. ciel bo below indicate the plydest requirements cl | relating (u physical reqa rerucate not encincted of not cavers! by thig foo, Inticate Tutuele theimtivniuel’s - these onder “Remagha) on te ceverse asic. Whenever PARTIAL capacity hes the pas ton for who thee tbeividual la beng vomanieret phaagcadl capa ities for thie praiticn by hetiiee an Moin the agprojaiate ctacin been Indi ated, ehploa uader “Remarka,” giving apeciie quant tins, ivihual bos any other pry aacel hettations eppowis the nunibers enmerte i Tl the an PHYSICAL REQUIREMENTS mm ERROR MENTAL PaCtORS CAPACITY CAPACITY “[rantian ; _ __ "raat, FUL | rARTIAN ROE, fh ve < ire jal WM NOUNS PA TE Be tweed MIFOTS OT VES 2B WORMING ON LADDERS OR BCUPFOLOING 3 CUTSEe SH RCPALCI ES VIRAATROR WORRU CLOSELY GIT OTWERE a, Lakinstel ALONE oh PROTRACTED Of TRROGLAAR WIE CF WOE Ky tore PALIT ¢ ad SRE ay Cot Lowe eee aS TMA ED § a * Soren acenee ceienmeearanete etre termes erm pcan an ote ante nent er eA NE A OTE
ort ae Senne . 4 . soe se, a Osrcivie sevice comnlestem Ab. svATION FOR FEDERAL EMPLOYME.... te SNSTEUCTIONS Im cader to evevent deley kn ronenteration oe rs app. snetructiens on the ateneesem card pees Arepesition of thie application. if yeu ace applying for an UNWHITT ERM esommation, mel thie agplic ation COthr, enewer every guests co thee form clearly and complies! Type ertite |x print in 4 Be aepiying 0 @ apecific mtee) Btates Civil Berenice Ro the effice ns in the anmenuncoment Fe eure to mel! te the same office esernation, read the egernnetion anne-unrement carsfully and follow elf ems other forme roguirsed ty the annourmement, Nutify the office with which re a WRITTEM esemmnatun. follow the oy file thie application of anp shenge om pour widrese duertune if you are epplyin MAME OF LAAMIMATEA LR RIND OF PUDTION APPLIED FOR . - . DG MOT WRITE IM THIS BLOCK sh Geta lys Lice Dpto ob + fea Use of Chl Service Coasmission Only tow Beier roe ON -ey 8 ; = 5 “VY RACE o tna otureyl ieiio boa (Cup and Stare! Bate GF Tid APeLICATION ¢o) cr. 5 Sap be Lo & Feb fo es . kD 1908 Heme as a — f ony - 4 3 = Che te Lon Loe obra Te Gel Arte fa 27, muetR (4, RY APPROVED: : _van Ieee. O. redens 7. a, 01s) ee | Parte, Tavow "(Gs CITY OF Pat CHreLe uding guetel sone) AND $Ta' . options Gnane RATER ence, RATING Dag tev Chie : pa) h asl 4 ; ThisAL ORAUT IO RIAL (atare UD OFFICK PHONE | 15) boul Priced GEL. Le \evocieoss hd fon ceenene a 2 2} emara 2 consacensovezcesees lyeoensesoc| secaracces Oe oeoenee fpriaiaset bs ty and girs (fa. domo a nane olty and countey) oO ee |p tcenesesssesdquscrsceiecornsers “PY bale GF Behr ” (aonthe lay, Peas & : CO §l Ohio | ge road) Da Ly L Onio__ . , . axing —, TTT Caan THOT Sika PF RaGHT wit HOUT BNoes: ey Beis hoe secgenores fe, eemmones 18 Go HAVE YOU KWEA BLEN EMPLOYED OY THE FELLKAL GOVEANMENTT o ves (J no vy at {fo IF $0. GIVE LAST GRADE ABD DATE UF LAST CHANGE 1 ORADE "nets mre bE SO aD) CHEEK IF YOU WILL ACCEPT APPOINT MENT, I OFFERED: Jt rae in rier. 52, menen LP somos accmmmeaeel 101% a5 Cee Oe 1% w WHAT {9 THE LOWEST CATPRAMCE SALARY YOU WiLL ACCEPT? 9 oe POR YEAR, . You wal aot be oonederad fos any pation with @ lower eateance {Hn WASHING OH, O. G. | ANTHHEGE ie THE YMTED STATES ealary . 1B) CHECK IF YOU WILL ACCEPT Sev70T TERM APPOINTMENT IF OFFERED, FOR QO Outaog THE UBITEO STATES 0 4303 MONTHS C) 3708 MONTHS 8 10 12 MONTHS 1 Hahee wild, ACCEPT APPOINT MEAT SH CEPT#IN LOCATIONS ONLY, GIVE ACCEPTAMS NOTE. Acceptance of cafusal of 2 temp sary ghoetctaray apsenntnond wilh not affect yuut apportunity (a ohlain @ probational appointment ©) WF You ARE WILL Tes TO TRA #6, SPELIF F dhap yg : rake Het oop tt ela CCAM Lp eb iia Oe SUMstAmTLY Ot os eed — _ Q8 exprairace ft le wnpeystant fre gers bs farnun all eH anfermation requenatet fetpous, sivle, welfare, Of oferiastle at setivity whith you hove performed, fe without conmpenssticon, skewing the number ef tomivs grr week bekrw In suihoent detarl to cuable the Cant Service Coramissug and the eithog apponting otter: of agence tee ghee i full cacdit in cletermising your and wegie MBit d Lie a9 which yina were engagid in euch activiy, Milptery quelficatione. Use :" peporate ee cack porate. een wt Ib yous etpecrisnedy shirt betdeneribed ti the spaces Letow it ste groper erquencs,- MET E yaitiess ard wore @, eapleuung cles principal athe whic 4; vou Performed in each postin, Accounting for aif persote of unemployment, wl? fre eiteny epeoves an rates ee unvier Ea eery sifferany Cocasse Wihereuce gainrd mure than 4 a ago which 16 not pertnent tu the week ourk’ for gach ition, the reas Bite ‘ ts, POR UMOLT eecription tf yaar Ge whish you are sppiying mas ecommerized in one ng more of the blucks, ia Bou a Fane teed. Id yours duties changed malarsly orinie worling tor the same empluyes, uae (6) Uf you have never been sinpkrved cf ase aow uncoployed, bydiivate avepuate bhuk do describe each gpowtvey. You may inehile any pertinent that fact iN the apace provided belcew ba Present Poutian.”* nee Se ne we ent ienny cine mente SEE eS emer PRESENT POSITION ' “bars OF EMPLOVEERT Crnoneh, yeard neat VLE Ww Yun PRASENT POUTON tiarzie CAAGE Of ] SAAR? CR EARNINGS, OO | in Pedarat Serves) SEARTING. § PER 1D POLSEMY Time | FRbstnt, 9 Pra FROM “PACE GF EMPLOY SINE a assy Sand Stated oaenmgrenine bee arena ee os rey eevee | FAME AND TLE OF TMUEGIATE Shieta ice “Kat AMG ADORESS OF EMALITED (Aem, organization, of person, if Pederal, | KING OF DULNFSS Ui CAGAMZATN (9 @. Wholeseio ik, snauranes efency, name dopazimont, biuseau us otsablhermant, Gd dixiseony enanulacturce uf bathe, ofa} F econemmenernenenemaannmieeenmeneneespaanaeememtimienianenetadiound soa mat | eiaatteniemimetnanmeerennmmteminaiememmamemneneanedl * “RAGGA FOR RUBIN TO Chance TRAD Beer Nene nea SSE tae PRET OE ERE TN Ee eee CNR ome ete Mee NH AED RRR On NTE RPE RS OED ESSER OED OEE ERD I HOD TARE LORE EET AP RET TUN ME REE Ae eee E EE eee Ne ene aN Re EE ERAT ROT SHEER E Eee PLEAS Ree ee tn REA ER ERAS RARE ERROR RNR FRE He SND Rite he DRE Tn enn TT er ev ene tee oe ae pment Oe nee ENE eee eee nn Os REO RNS EROREE TOE be Da NeE COR DONO FEOF EDS DERE TEU A CLOSE OTE ROE OEY OEE EEE CEOS Ten ES EU ET Et TOE O ORGY a MEG OER OE EES Oe ROMER Re en nen en ea an Pen Cane, See oe ot ne ten te oe te Oe. ot Sethe ent Deans ht tne Ot itn ene en Bien Se Ren etn nn ee DO fone te oe Let ane Ty Onan Dee Renee nn Rene ee EE EE ee HADES ETS DME SD CCR EE UH HEREC OEE YM TSU EAE See Fue LORE Chav GORE DEO E DENIS FEE eee FETE TUN Hwee EDD O EE eT OmEL ee Bess l tee be éare-p (CONTINUED ON MERY PAF}
14-00000 spe a erate ale NOI Ys eee He GE Hh) whe ay PC ae! dew th Re Fae ae ‘8 LONTINUETY GQ) tenor weks “Yeeweth, seas OT | mo lane ver Sept ie? mee OF EMAOUMERT Cer “gd Brave. Port ia ae : & OEE NS we SES 4 Be ove, PP RE HSe, OP gNeT ese rn re epee Eeetent, Buran it valabdiaA ment, are trereran} Rearresd, ; ay F Mehechnié . Ras Gerdens -Dayton exe tft Mei iste BY TOU [* RL AGIN ROR La Ga “RT Tine OF WA AEE nl “ela ear akan RAC eS) OM BARS Ulan Federal secrere)! crantics § PER —edeck. ee: ee ee wie aN aw TES we ANE DATE SLPLRVIgOR : won like GerdessCe. ewe: Mey —E.. Melweh nic. overage} SONS SE RESTS CR ORGANIZATION EG. @ Sens a imauesnce egensy, wee of douda, of.) RUMSER AND BIRO OF EMALCTEES wwe hl GT BESCRIP Thom OF TULR HA. LAD ACES... CLASSIHICA TION GRADE Sau Vey Ot ZARRINGS: * (din Fodoratacrvice}! gyaniina g PER Gra}, $ sR OATES OF EMAL YMEAT Qsonsnene n row of tort 7 ait Beph— PLAC OF UMPLoTM TRUE OF YOUR ROSTIOR | J] RONE SRS THLE OF TR MED ATE SUPERVISOR (e: hie. Eciqidaine.... “RES ESAS GT TUITION To Ge halal SUNT IniOvenes agenere” “waMe oes OF EMALQSER [spa organisation, OF ‘name departmence, darenu or establahmeat, and Givsron) meaeulacture af locks, eto.) Fricideire = “Daut ptom <Q. menu facture of Frigndabras “RUMBRAND Kiso OF Tans SPCR DB BEESON FOR CARS one. turn to acheal “cain B) YOUR WORK TINS pk rs eee RNA SOR eC OmERER EAR URROHERTERAT EHTS RORERE AORN ETA EEET SEER EEE DS TONED ENTIRE NEM RIEELEREO RARER ON ONE OH OES STUMMONE AD ERASER EDS ATURE NEES N ERT ROER TERE RODEN EDEEN EROS & eee TTT Etat eet eee Cree TT Teter See rere Terror ere ne teeny OnE Xe Sen oe eee neer ens open c econ sensotegoes tense anew euenaes edna hl coseeeageeseqesaeegngee ot sessapemenennnenengennneocene easeeesenegacennecatet recs Co fnk in, shtice.. IY chee ani cal. Vabara ter OY ocrnecnnnnnnn ton THe . Orertete ek Petreot tettl Lo Stee eer tT Teter tier ete TCC erer trerttertrer tere: Per leveececoeneececy date cn reensereree reser ee ee rer errr reer wo eo ERE CRAG AITATION GRADE OF Gee kete STERN: Gifin Fedoralacreiwa)! stasTind b ren ima 8 mR CNAGT TitLe ce TOUR NRE RTS mL ANGE WS THE OF THAT E sureaviada Liye Te ATS ESS Ga NIGAM ATION (ogy wholeasds oik, Gngurance agency, Sramucarzure vf kvae, ote RaGa ater re Allon, oF person, 1 Fedatah < game department, Surtau or establishment, ath? Cie raran) . eee “REN Pa Ea NUMBER AND RIND OF EUFLOTES He AVRSIRLD BY VO eevee wh men a meena en nnn eee enreteneneinintinl nent te tema nanan een mite nae mates $e puna anangareneterntemnnetnstnne
teehee ates a ee om oy oka O-1a hfs, HW. \ ow Gorn be. 2. > Wire MAY 10 1950 LS) &aee7 oe = hy Meds tt wf e _ : . petted eet Loats seplct sed sha pote a gna le beat vein pense ese eenareesceneetn, i OK fied in Cn BD CMP Le OL bes Poke 3 emma Ctl H Mery wa Pheets ~o 430, i ans TORT . j QO. ath. precede, potent Cee wt i oss LO a a a ae tote aapteey a a CLO nl j ge Seen ar, an o- ee : o OAL ae rag cot td SD wpe CE Lith et ee ° bom mee FEL PO trey Nee eA eee ote tee? 1h 6 che “ et ’ “A “Hw. lk. hg he hopes “tte etons Ot ok. Ve ha Of ~~ fla fe, yy S ?. a : fy rd CO deer bouse 5 te tm ” wd. ‘ fe Ah Aeette natal heen ee tow? ” tA dam Fea Cha hn came Ale tone’ 7, Gotan 06.40. #4 a , ele a rae aor Mae by glint cid “ead, “, Senco. | ea ae . a rm “ Pie el tee - > eat a y recs ” hw eepias a ae hat bree, wa
TR EEN 8 FEO BER RURAL, SOIR Te VaR arth A Sem meee PROO IE RAE ake Seok EER a Pont stot What "ep stncsmunnsetomemnasmemnesns Rg, PP canenoranatpenepadttnnntetseh eet . ? \ UN. tu STATES CIVIL SERVICE COMMISS. ON a RATING SHEET—RATING PROCEDURE NO. II1. (Handbook %=103) , . d eter MAME OF APRICANT PREFERENCE APPLICATION HO. . ; CT torr. ¢ . i oO. wh ~ . QUALIFYING EXPERIENCE BASIC RATING c & | aopiTionat. Poms a 7 g LARNED RATING VETERANS PREF ERENCE VETDRANS' PREFERENCE FINAL RATING FINAL RATING DOAMINER DATE _ Cuniner, eye hd €. co ws “(8 63D LOE REVIEWER BATE REVIEWER DATE COMMENTS: ~ Pood Thon ETL FOUMGN THLE “ANNOUNCEMENT NO. ee “QUALIFYING EXPCRIENCE | ANNOUNCEMENT NO, QUALIFYING EXPERIENCE GRADE BASIC RATING BASIE RATING AGDITIONAL POINTS mee nemo ee racecar #4 ites ones ra ADDITIONAL POINTS SARNED RATING Y FARMED RATING VETERANS PREFERENCE . VETERANS’ PREFERENCE oom —— mene are ererener semester tag nae eterna cmee ff asin rietntattsn ty eerege rere fee a ETE cat te tr Ber orate j 7 FINAL RATING FIGAL RATING “AMI S””S””S:*CA EXAMINER DATE REVIEWER OATS CO™S™~—CSS”S”S”””Sd WR DATE COMMINTS Ra feta (st Foau 4909 BEA bad
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14-00000 ., . a, oN . cod ‘eeety Besemm ent Faceel so46 ‘ UNiED STATES CIVIL SERVICE COMMISSION Dates Baraca Buster 00-RUSD ‘on , PROOF OF RESIDENCE | Areticotinns for aggeantinont Le the aggectioned deyrrtmeetal sargice must be dee cmecenaed tap oy partite rte rhyming beral oe weiines teatlanee in tha sate on Terns tery cerimmn$ bre ot feet one posse mee? gryrmemiieys thm efits of mahi erpgdls cehtets  Tbumgeteore, Ho pees lamre erag dayent in ihe eogeeati esd sSupenrtrremesies) amryicde fie billverey queens preyed Par anaweret, cel the furst ang Oticer a Contttienste id Poa fare a bakew grset se @soiiog  Futhire te wubesit this berm, prqeety eae cuiet, “wtih pour sepgdsesatimn resp tmoclt in hse od crongtideecstion for ap peontmand jv the apqecrtenord errvicm  Argblerguts whe now Weki permanent fwrtions in the opgertivoned degeirteential asevtee gre net rented to barve the Oiliens ¢ Cortina of heculone esanutet tad steesid write on tt Am in the ee ger ty eserd gave vie “* * Ure! eume) AMidldey Udrexhem, scary) (hast |. 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G¥ea “Ke rom nea an ee aee oo ahdcaan aes “UN Prennl pod llc adlres W paral of guatiaa AE ter thay feollerwtney Pohanhe rian F “Length +d euch fosidence CY Of TOWI aaa cnrasareresrrassearsconsrcemsanen CaUnty . rec ccsce cess corsesceoeecsaaescenenseoess Digte wcvccccerccosevse0e Prom... ule parece Henne 18 cre ce gece cee BBs, 22 | COUN crncssacececres i i a5 ata) , uate) ure e a married women, fil in the fuliswing Masha: ite ol mariage “GT Logal tei tones of “fa a) ns ip ho @ voter in thul = Uy Tanith of such romlerce Tr, es ee es | See ee eid ed iste) ttej “Wes Gis “Siiad™ $9.50 Wesencon sone con cr Mantis fr FPO wee ea ew eee (Month? County oo ac accnee nae cu eerecenaneserscerensenore JURAT (OR OATH) . eaten trl mde Vert bad ax iuningte, ot her obliver aulierlied ws orkiats se ‘This jurat | for oath) muat be axacuted Pafora anv iney pes thera cet ory ota Ysitend f tar cathe bor ye dopa ye ues befere whem the applisand siual anpeud im peveun. Fi} BM) st the atulemnedta oaks Ly ine in atewas 9 tLe Vrogting quottions ore bull ams tue to the ket fo my ep oe gpbepted Llane. Coe Ty ath ite bene span, aa a Sige e seria bey nora TSU Piha uedeert ed DX? TOLLEINLY O80 Ae ke AFF hinweinehge O.nd Lett of “Mra " cod if tarirriad, ure “Base” oF M * Ment a Siete" ff imnaln, prefe Sianatura ¢ ed agg ticeret a ae : eee LE von Ory 8 “Y i a Soe naees HALLE wiper aetna Chm oo ed eemmsenren dhtavenyrimeces Gnd Pile fey T pe erty Aha MH pet ecntar eerie ap eetiee wren Mer en eewcremecene te Bok ps ere A Pk Te MOTARY PUBL Tg eee oe aS ié : GL Sane iarsY ee Ps tote maone follicer ” yay poten i GREIRSS MADE BY, epranercecerucecrene peeraprceryees RESIDEHCE ww Ly go owdkary publi, ccusts, deur se NOMA fa batoad oy gotiny tes. ren actual mredect oad otume in the cry of oy vi anutaeter by lie picpeet Uber uninr otficial asal. OFFICER'S CERTIFICATE OF fnstructlane Real the arpbeant’e claim ts dase! on legal resudance, Hee Coctitteath muat Lee aa mayor, fusce of che pence, uP other oticar in tha county oo rity i whic ho the appliunt claim retrlates. Biuat be roc uted by tha repietear ad eaters of ether sfieer ed tha Beuntol Blagtene fn ether cai the alae s chiimad toy Uhe apeiieint ond tha corticata wnust beere hia official aeal, vi. be Huw tharent, cerbhosnen 2 pa 4 The applicant (a not raquized ts appear in person before the alfless whe sseoutas this ctriebignte, bet the otftcar shouk! subsly hiaenit from crekcie aed aiapetent ovens ot. hice to which be cartilies, ha... anor es) ree eer of the cenunty of _Konbgomery......... ard hate co Terntorn ob vo QUO ot ceecnescereceeceneeeue ¢Orte) dea grb Nfs ere Hart ot te... L, _fehr Yr the applicant whe oc.uis fe 620074 bh Dennen wih G chvil servies eussmcston, do henby vertty thot. |. LGPLOGGS.... dee GBIPUNE....--. o testis Tee crite cRactly with a aime aagiven abovet * # . tenowa... LAS one : er row leat ; the ceninaty of .mONnLgomary wen eean eepsaree nevnccene ss, Gnd State tae Terntiry} och “tas tf, Ne yal and vue”) oh Pema c eee eee eee ew eee n eens tke hee bers auch reatent ing. 21...... yours awe eeee months nest preceding tha dats herod fe ORL: Banal at oc... Heaek. Carrol ton. sun of. HONE GOMBIF..02.. ec ceecee ee cee ond Stata for Ferment Cb ecenenene ee eer ODEO. ceeneeencesceesceceeecsensebesecsnseuneeseveneseeeeccerecceree ce 4 STUDD. dar of wwe Peabruarys..590 {OFFICIAL SEALY _My_sommineion exiree July=Ig= 18 esanure of corection ia made tn the “Olices’s Cart. Lerts,”” cambtcation musi be mode we raargin fey the ities The Oilictal cant must not be omittad, whe arrcutes the ceriliwate, showing ouch go.zection. BG Honan beRh PaSaTIVe Wr iCe ba 88-8
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14-00000 16 RUE TO NITS Leet cheese poooene hving im the Uniiet States or Terviteres of the United States whe ace NUT retated to vou and who heve definite Bnowledge of <a amd Ainoes fr the positoan fe hich you ate applmmg De nod reprat names of super enone luted under bem 16 (@ XPRRIRIECR), Amman — = © ce ee a ee a mee oem ee 1 Pern! RUIATSS Ga ey Al Saagsy . ae | (Gave complete curcont address, inchudeng otros and awmber) i BUTANE YS OR GCCUPATION yew gon . + stag, wae Bh sa Theadasiw Moratt..  Caxzanavi Seed 8 od tate x re rs 4 ca) ned Me, Beebert Hauldeomen! tere! imDIcATd “VES” QR -WO" RAIWER OY PLACING “EIB PUOrTE Cosme | TES | 80 segucaTe “TEE Ge “RD” awa ate G7 PLACING “H" 1% PROPER COLYER vas { ae | 38 APF YOU AN OFFICIAL OR LY PLOVEE OF ANY STATE PEARITCEPY. COUNTY. OA MURICIPALITY? _.. . if your anewer . || 3 DOCS THE UNITED STATES GOV CR NME NT EMPLOY IN 4 Civitsem COPaerry AMY RELATIVE OF YOURS (AY ROOD OM MARRIAGES WITH BHOt You uve OR HAVE LIVED WHEW EME PAST 26 MOMIHS? | SH WAY Dey BE WATT OF YOUR PALSERT eerover Rtaaronga your CMRTACTe QVALITICATIONS ETOP... oe. nee ake YAR CVTIZEM od OA OD YOU OWE ALLEGIANCE TO THE uarteD ans. aan - 27 ASE WA om OM Mave Vou FvER BEEH, A HESUER OF THE COMMUNIST uf your anewer de Yea.” cha im fee: ‘A RAAT a 8 OR ANY COR MIST ORGAMIZATIOMT |... rofatero (4) full aame, (2) present address, ve) velarionehig: ” . io Department ar Agency by whieh employ. nd (33 dem - © of ap aad POA E SPECIAL INSTRUCTIONS FOR CLAIMING VETERAN PREFERENCE A. OF you are cleiming preference a2 ® PRACR TIME VETEVAN who has been awarded @ campaign badge oe eervice tibbon, ov a9 @ DISABLED VET. BRAN, co do the WI re OF A DISARLERO vaTekan, ow 96 the WITS OF A WAR OR CAMPAIGN VETERAN. ettech Veterss Preference Claim, CSC Form t4, together oth vAect therela. ®. if you ave a WAR-TIM VET BRAN not claiming doatdiity eference, should NOT submit your iuncheree enth thie epté:catien. Prelerence tentatively credited to you sad if eppainted, you eanull be required rence wit te the e; vane Offiece prior te entry of duty, official evidence of a tion from active service in the armed forces of the United Bestes im time of oar. ag 27 ab wernt YOU EVER IM THE GRATED STATES MILITARY OR MAYAL SERVICE |" 4 OURING TIME OF WAR? .. eeaeGoe - (i 18 THE WORD “HONORABLE” OR Til WORD “SATISFACTORY” U2ED it YOUR DISCHARGE OR SEPARATION PAPERS TO SHOW THE Ted OF YOUR DISCHARGE OA SEPARATIOND | Cs WAG SERVICE PERFORMED OF AN acting rou Tis BAS WITH ra! i i MILITARY PAY AND ALLOWANCES? «Di | DATE OF ENTRY OR ENTRIES INTO SERVICE cate OF TEsapation Ut TAPARAT ICS 8 ART RR UNG altahie vou (ves Beem. A MEMOER OF A PASCIST ORGAN. RZAT RI 2D ARE WN EME OR MANE TOU EVER OTE A MEMBER OF ANY ORG ANITA TION, ASAATRA ANE MERT GAOUP OF COMBINATION OF PERS WHICH AD. WOCRTES Swe Sa € RT wee OF OUR CORSTITUTIONAL FORM OF GOLITRAMENE, OR OF 88 OOLAULATION ASSOCIATION MOVEMENT GROUP OR COMBINATION OF PERSIA BNET MAS ROOPTTD A POLICY OF ADYOGATING OR APPROVING TNE CO WA OF ACTS OF FORCE OR VIOLENCE FO OF NY OTHER PERSONS THEVA RISHTS MOTE TRE CONS PIT UTION OF THE UNITED STATES OR OF SEEK. 6G TO AL TTR Pl FORM OF GOVERNMENT OF THE UNITED STATES SY UNCON. STULL TIONA, WEE? | Hf poor savee to question 37, 38, of 29 above ta ’yes,"” state in tiem S the names af all such organimatcans, associatrona, AAOTEMEAIR groupe, oF combination of persons and datea of - jete dedatia” of pour setiviioa Ratiot pou deare regarding awe grembecshio of activities therein BP SheE RET BIRTHDAY HAVE you FYVFR BLEN ARRESTED INDICTED OR SUMED OTD COURT AS A DPPLIDANT 16 4 CRIMINAL PROCEEDING OR COAVIONLS ST4ED CR IMPRISON U OR PLACID OF PROBATION OR HAVE YOU EVER SOV ESTED TO DE ROSY BAIL OR COLLATORAL FOR THE VIOLA TION OF ane Law FOUCE RFGULATION ON ORDIMANCE (CRCLUOCING VINO TRAFFIC VRRA LIONS FOR WEE H A IRE OR FORFEITURE OF £29 OR LESS WAS IMPOSE OT, t teawenanaperesenee venmeseeseneasane es ff four znswer "fiat ail euch oases under tem 39 Gave im each case (1) the date: (4) tho mature of the BAANCH OF SERVICE (Army, Navy, | SERIAL NO Gil none, giva grade ov ifasine Corps, Coast Quard, eto ) tating af time uf separatian}. beitcow offense o¢ vwrietron, (3) the mame and incation of the court: (4) the pens ty ampoesd, if any, or other disposition of tho ease Tf anpunted. pour Anger printa will bo taken. tv 1 40 " : 33 1A) IF YOU SCAVEO IN THE UNITED STATES MILICARY OR MAZEL cee UIE [OE areas TASATLEACTORY SUAVICE FROM ee ee ye TOnT On MISCON. DURING PRACETIME ONLY 9D YOu PARLICIPATE (MA CAMPAIGN CA ESFESL TH your answer 19 “Vas,” give in team 36 the name and TUM AND KECTIVE A CAMPAIGN BADGE OR SEAVICE AIDBONT 2.0 cae ceo addrass of emplorer, date, 4nd raasuin te sah case - i ee (Br ARE YOU & CiSARLED VETERANT.......... stpeerces # seeceee | i ff ea, and you hava not hated your deabivi ia ansysr tq | 5 ftem 33, explain in dtear J? below | wv ‘ ve *0 r wre puants tts aivedates of and reasons for 4€) ARE VOU A VETERAN $ WIDOW BHO HAS NOT ArMARRIES? i cee ees cre renner cree me pase ae | ere ES AAD VG THE PLOT AS STEPAM AND EAA SERIE Conn ae *t PaRmCar eke Of OTHFR DISARLT Yd { seen creak tan Ut FOCI Shoe OF apn carare - Somat MR IM A tories TOU FO AORAE —— — . ane -a Foe, gee plete datas iv tens 3890 / . THES SPACE FOR USE OF APPOERTMG OFF EA ONLY seratien oan be given to your phytcal finesse for The information contained te the suswera (6 Question 37 above hes Ween vera ya tee wcuve aM ARMUITY FROM THE UNITED STATFS OF DISTRICT ; fied hy comparreay with the dischatge certificate om. 2.0.00. 202 6 ee ee Bee MEME URDER ANY {CT EMENE ACT Oot ANY PER SION vd CR OTE Neer on FOR MILITAAY O8 NAAL WAVICER ceeecees cv ees cee weeee a neee aren wees sedet eens ene H you aneeres sa Yor," Awe complate dotaiie in dram a9 Agency’ The: eens aaa srr ovtrceniet merase SIG GTR QUESTION, Uadicate item nunasbers to hi: hal snawors applyy eee ee nee use cea ene ee . ark ty ceeees cme come mame eeet e aout ehecgusmie tp vepaeweeuea-e httech te prec. "Write on each ¢ ehect your a name, taddes,, date of! arth, aad caaminebya tele rae nace th pequared, & wee peper the same cire a3 of thre artes ate. Before ayning thu opplication check back over it to make sure that you have answered ALL questions corerctly. LCERTIFYW that the state:nents made by me in this apphcation are trus, compicte, anil correct to the best «f my knowledge ad are made in good faith, - ea a » ; aE on this application +» signarune oF arpucant. dead Xt asa hie,, (Ege pour sa nein INK fone qven .- alal gp tpecets, and ear nace. ag feroale, Moen ra Mtrp amd Wmarnes use Fou Gan geen name es “Bee Macs, i. Dene 5 oa and beust, , Patee wtatrs ganehate by Law (U, 8, Code, _ 4% ay TS, Section Sup proka bas COVER KAT PaunTing Cepxcg ricd-<>-@329? > a