Norwich bulletin., 1917-11-15

Grade reached in school-Years in high school-Years in college.
 Name of college and subjects of spe- ciafization
 Years in technical school-Name Of school and course pursued.
 Underline the languages you speak well: h-French--German.
 State any other languages you speak.
 In the columns below draw one line under those occupations at which you have worked; draw two lines under those at which you are expert. After each underlined occupation write all so the number of years G. e., 2, 9, 5 of experience you have had in that occu- patton. ->-..-
 Then follows a list of S7 occupa- tions.
 tion not mentioned on the blank line mentioned, write it on the blank line provided.
 Have you ever been convicted of a crims?
 If your preceding answer is "yes," state (a) the name of crime; (b) the approximate date of conviction; Co the name of the court
 Are you now confined in prison or refor ma tory,- either (a) serving sen tence CT tb) awaiting trial?
 Are you on bail under any crinin al rrocess g If so, state full details.
 Important note-If the registrant is an inmate of an institution and is un- able to answer the foregoing ques- lions, the executive head of the insti- tuition is requested to communicate the information immediately to- the local board.
 Physical Fitness.:
 Instructions-Every registrant must answer the. first two questions. If he answers the second question "Yes,' he need not answer the remaining ques- tionS. If he answers the second ques- :ion "No," he must answer all ques- Y. -s- l. ~ end of this series of questions.
 State your height and weight strip ped. A. 1. Height- Weight : Are you in sound health mentally and physically? A. 2.---
 Draw 9 line under any of the words below that describes any ailment or physical deficiency you may have.
 Blind, deaf, dumb, loss of limb, ep- ileptic, paralytfc, insane, withered or deformed limb.
 State in detail the names and ad- dresses of the physicians by whom and the institutions in which you are being treated or have been treated within the last ewelve months, with the dates of the treatments.
 Are you an inmate of an asylum hospital, or other institution on ac- count of any physical, mental, or ner- vous disease; disorder. or injury? voUs disease, disorder, or injury? Gro be .yes"Sor "no.") Ha
 If your answer "yes," state (a) the nature of the ailnent, and (b) name and location of institution.
 Important Note--If the registrant is an inmate Of an institution and is un- able to answer the foregoing questions, the executive head of the institution is requested - communicate the in formation immediately to the local board. x.
 =. .. =. Concerning Dependency. .
 Particular attention is paid the mat far- <af 1a,1o >f >t This section is as follows: Instructions-Every registrant must answer the first question. If he an swers "no,'' he need not answer the remaining questions or sign his name. If he answers "yes," he must answer all the questions and sign his name. If he intends to claim discharge from service on account of having dependents, or if he expects any pc<- son to claim discharge for him on such grounds, he must secure the sup- porting affidavits annexed hereto of every person over Is years of age named as dependents. He or any other ot5 s person ss ] may also tand if the To- musO file with the local board ad1i- tional afhdavits, which must be 1egi- ply written or typewriter on one side of white paper of the approximate size and shape of this sheet. : Have you wife, or child, or aged. infirm, or invalid parents or grand parents, or brother, under Is or sister under IS years of age. or helpless age, mainly dependent on your phys ical or mental labor for support?
 If your answer is aNo,o do not an swer any other questions and do not sign your name.
 State whether you are married, single, widowed, or divorced.
 If you are married; state ta) the place. (b) date, and tc) the person by whom the. ceremony was performed.
 Give the name, relationship, ad- dress, and age of each person mainly dependent on your labor for support Which of such dependents live with you, and how long has each lived with you? M CTS do not live with you, state which Of them have lived with you at any time during the past -12 months and for how long period.
 If any such dependent is stepchild, an. adopted child, or a foster child state as to each when such relation ship to you began.
 As to each dependent, state when you began to contribute to his or her support.
 State both (a) the approximate to- tai. and (b) the average monthly of your support of your wife and children during the last 12 
 I1Oh HuCIl nave yOu Lo the support of each. other dependent during said s12 months?
 As to each dependent, state wheth- er such person, is wholly. dependent on your labor for support.
 Has any dependent (other than your wife or child) a brother, father, moth er, uncie.5 aunt. husband, wife, or child? If so, give name, age, address, and occupation of each.
 What was your total income from all during the last 12 months, cal in cash. or. CD in other thing Of value?
 How much of this was the fruit of your labor,. mentAI-or physical?
 Give a full statement of all prop-