cn Sete, 1 NAME _... 0° 2. 513 * By Shee PRESENT, OR LAST, ADDRESS ..... 213 +02 aes UPd Vseysrac ist. and Nemier} (Cig) "EStatel * a ee) GERD 9. MOTHER-IN-LAW ° a \ qAbibiles Soy aS LIVING OR DECREASED (| oo SDATE OF DECEASE . ze wea eee Gilg = ~o: ware ae itountry) DATE OF BIRTH LAB. PLACE OF RIRTH CRS2A%2 ily IF HORN OUTSIDE U. 8. INDICATE DATE AND PLACE OF ENTRY 20 tt Ree cccesceneeene . .-¢ - + ype? citizensmip 20 wien acquirep? S220) wierrs.. — ; cy) IPATION (2: ote er ee : Sec. 10. RELATIVES BY BLOOD, M MARRIAGE OR ADOPTION, WHO EITHER LIVE ABROAD OK WHO ARE NOT CITIZENS OF THE UNITED STATES nromerseoemeee RELATIONSHEP o.. CITIZENSHIP 00 ee ceeescceseeeee ADDRESS . esses, “Tet ‘and Number) ae city oan (ie and ‘Nemberd aig) Stare tStated Country) (Counuy) (Country) SESE ET 2S ER a OES SS RELATIVES BY BLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE OF Bt. end Nurloep ag yatate) i AGE iwantry ‘ TYVE AND LOCATION OF SERVICE (EF KNOWN) oe ccc ce came eeteesateem ree cuwevenes cunnaunet CITIZENSHIP ns nee . ADDRESS... ij CITIZENSHIP ooo eee ADDRESS Sec. 1b i THE U.S.OK OF A FOREIGN GOVERNMENT: ANAM Becerra YO RPA TIONSHIPS. ; CITLZENSIED Coens remanence ADDRESS | 9. NAMB coc cacsc ceceecseeeeeeseese seeeenunseoneene CITTARN SEED 0. cc eeeremeenesnee ie « ADDRESS... : TYEE AND LOCATION OF SERVICE CIB KNOWN) ou. Le RELATIONSHIP 0 0 0 CUIEZENS HOP oe ADDUESS the eek Bemis) gettee | 1 Beast TYPR AND LOCATION VF SERVICR CaP RNR Nd oo, Sven rett tame etee ne a] RELATIONSHEP Joo cette 1:34, mead Be wovsens , qe Apa pDuaepe —_ bh aah he.t is ONL
MG ete een Laat qe So oma (6) IZ. POSITION DATA Ly a, A.RIND UF POSITION APPLIED FOR SO gle te. teh does. cueney BRWHAT IS THE LOWEST ANNUAL ENTRANCE SAL ARY YOU WILL ACCEPT? $ oy (You Will Not He Considered For Any Pos‘tion With A Low: vf Entrance Salary.) CF You ARE WILLING To TRAVEL, SPEciry; OCCASIONALLY set eeeeeceeesntestpeena ress nutesoeeeeneeeee D. CHECK TF YOU WILL acce “oT APPOINT MENT, if OFFERED: IN WASHINGTON, D.C... ogee ANYWHERE IN THE UNITED STATES | + OUTSIDE THE UNITED STATES .. dgrreeeelecee EP YOU WILL ACCEPT APTOINTMENT IN CERTAIN LOCATIONS ONLY, SPECIFY LOCATIONS: Se oe FeO ea SS tes ees ce ey Sec, 18, EDUCATION ELEMENTARY SCHOOL owt Uozad .. ADDRESS _ FMERICEy.- BOK e- Shane Gacy DATES ATTENDED QS 9 cee, GRADUATE? aragag. ence oc. HIGH SCHOOL! ae <p et ee ADDRESS sede Sty Senza y- ars a ioc GoS - . vtec Sg | ORAL pares ATTENDED | rOMODg . 193Le0 6 RADE ores TEs ey 6 OC 2g t3y33! COLLEGE LD apg. . <pbRESS Sen ee 10a... fia “orirrses ~ dees 7 MAJOR AND SPECIALTY Sue tneaa,. Unidlossme ee “ARS-COMPL: ETED 8 jeanwauee DATES ATTENDED |g he BG we cay ADL. DEGREE... H05- teplenmakneyg LLEGE Gadvowesrsdicg.. oo arena... : RESS |. 5; tetay oo eee COLLEGE Bilvoundoy Gee Giing-- ADDRESS (AP Sg” “ORKS, ek iCauatep) MAJOK AND SPECIALTY Sunda ROB. cad: WeteX BAWACOMILETED webb ccccecee ALMA DATES ATTENDED |. fra too ho) 1 DEGREE lov Guedaggn 3 . AD Dn as oo oon = CUIEF UNDERGRADUATE COLLEGE SURJECTS OCB Byte crore] Teeedumne.. ~ : CHINE GRADUATE COLLEGE SUNJECTS cteedepe gy eteeeeeeceee cae Se anes -. . 4 ‘ eek ee
20 seat. 14. ACTIVE | U.S. OR FOREIGN MILITARY SERVICE 8 secre he erate) OL - : ™ {tos ‘acaeay LOL JE (Dates of Service) IF DEFERRED GIVE REASON .....W0. Sec. oa ne HISTORY OF EMPLOYMENT FOR PAST 15 YEARS, ACCOUNT IMPLOYMENT. 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.) ies CLASSIFICATION GRADE "ORONY OL UF IN FEDERAL SERVICE) 203000 FOR ALL PERIODS. INCLUDE CASUAL EMPLOYING FIRM OR AGENCY ......8¢ seen ceceecceseececsecesensesensnsueenvesee weveneed “ececenecqencasseeee - appress —...920 Yeettie ive. . Galitoenia USA tot. and Sumber} al re (State) iCountry - i pape , : oe : KIND OF BUSINESS GECGLS Ge NAME OF SUPERVISOR .0..02E Moo cc ccceccsceecnceereeeee 1m . AA TITLE OF JOR coEOe eee SALARY $4090 pe YOUR DUTIES... * mien duyes tve S4old REASONS FOR LEAVING 70 Pemenser duvestig tive fiele mf CLASSIFICATION GRADE fh | ceseececesee TO oh ot seepucmenneunees (if IN FEDERAL SERVICE) m0 FROM. “ a “hy r fo Tye Petes 4 Beye EMPLOYING FIRM OR AGENCY _.2 @le-CL -RDoau Of Snvestig tfon: ADDRESS cocceeeececc cece ceeecreer ee PEBBLE GON, Ye Ce 0 OA (3t and Number) rates) (Baten YGonnery 9 Oe KIND oF nusiness .. SWertlLs LivQaye or SUPERVISOR -, L. ( Specdnd “com SALARY $0.80 0 peR_<RWRED r, ye doe te in ae a Pee toe your putixs 22 Svessin to violisiona of “odoval fewe TITLE OF JOB. So mites mdvese baginesr 7) REASONS FOR LEAVING ceene te epBab-t 22 non Lae |