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cat FOPFIERERTAT SETS OF FORE Ox: SUPPLEMENTAL SHEETS OR FORAWBRIERe = * Answer all questions correctly and fully 19. Ifyou have ever beea employed By the Federel covermment as a ceva, 20. Burch place give your Last: re or Stace (or Forerg Country p: 22, REFFRENCES, — List three persons who are NOT retated co you and who have definite knowledge of your qualiScations and fitness for the position for which you are applying. Do not repeat names of supervisors listed under Item 18, EXPERIENCE, | 22, Legal or voting residence it] 46 Per BOC b7C Per BOC Business or Occupation Lt. Co? b7C Per BOC Lt. usm Present Business of Home Adscess (Number, airect arty, State and ZUP Code) . RENCE, A. Have you ever served on active duty in the United Scates military service? (Exclude sours of yw tbite Buty for bratRing Ahh reseresst OF GUaTGIMIND knee eee eee Pete et HERS CREE ER Cee If "Yes." complete [tems B through E below. MSGT USMC Yes] Ne | xt} ROS mE b6 Per BOC . Have you ever been discharged fromm the armed services wader other thaa honocable coadiawons? (You may omut any such discharge changed co hoaorable by a Discharge Review Board oc sienlat authority. sp cesrcaaecoeriagen UV ers gre detarls in ltem 34 « Do you claim S-poune preference based on acave duty i the armed Forces? vcs, a ceeee tae tueeedeeeretenens Uv ea yow wall be required to furnish resords 20 tupport your alarm at tle time you ave appuanted E, Do you clags 10-pone preferetae? sine coareege ame en ea ee UY 03," complete and attach Standard Ferm t5." Claim Serial of Seevme Numbee for 10 point Veteran Prefereme,” together with the proof pe walled re an that form ANSWER ITEMS 24 THROUGH 33 BY PLACING AN "'X“ IN THE PROPER COLUMN If "No," give county of which you are a Citizen: 25. Before answering this question read Item 25 in the attached instructions. A. Are you now, of within the base cen years have you been, a member of: 1 (3) The Comimunise Party, U.S.A., of any subdivision of the Communist Patty, US Adccccsccerssenesteneeneranns 7 2) An orgamzation that to your present knowledge advocates the overthrow of the constitutional fora of government of the United States dy force of violence of other unlawful means?, cascee reese sn enenere re ee cevensseenateurane B. If your answer co Iter A(2) of A(2) is “Yes.” wrice pour answers co the following questions in Item 34 of on 2 separate + piece of paper: ; . (1) The name of the organization? (2) The dates of your membership? (3) Your understanding of the aims and pure poses of the organwzation at che time of your membership? 26. Toinsure that you are not placed in a position whith might impair your health, or which mught be 2 hazatd to you of to others, we need information about the following: Do you have, or have you had, heare disease, a nervous breakdown, epilepsy, Tuberculosis, OF dibeces2c cg eee ee ree eect eee ee ee eee eee E SEED EO REN ERAN RUDE E OG eS eR E EERE Oued Uf your answer is "Yes." conceraing any one of these, give detatls an Vtent 34. , 27, Withny the Tse five years have you been fired from any job for any reason? vice c teen sence nner eater ee naseene 28, Within the lase five years have you quit 2 job after being notitisd chat you would be fired?an vs ecrees i: rogtte employer, Uf your answer to 27 of 28 shores "Yes gree detarls in Trem 34. Show the name and address (trcluding ZIP Code) ¢ approximate date, and reasons in each case, This information shonld agree uith your ansuers in Ttem t3. EXPERIEN Fac earnest enereemaneaatiemmmminemmenenamet ceeetcaaee tata eten etree emer aee eee magenta al a = 29. Have you ever been convicted of aa offense againse the Jaw of fortened collaceral, of are you now under charges tor any aifense against the law? (You may omit: (1) craie violations foe which you paid a fine of $30.00 of less; and (2) any offense com: rotted before your 21s¢ birchday which was finally adjudicated in a juvenile court o¢ uader 2 Youth Offender law.) ian eeas 30. While in the military service were you ever convicted by general court-martial? cece eee cee em ent n eens ue aeesueneens Uf your answer to 29 or 30.8 "Yes." aise sletatls in Item 38 Show for each offense: (1) dates (2) charge: (3) places (4 court; and (3) athton taken, ames emmeememnestetmeemenene mapenenetagemarmnerer naam tar tr a em a eo eran BIA. Does the United States Government employ an a civdiuan capacity of as a member of the Armed Forces any relative of yours (by blood of marriage)? (see Ice 32 in the atcached sasceuction Sheehan seca ns Peer e ens teen ev ete ster ener ress B, Do youl ive with, of within the past 12 months have you lived with, any of chese relatives who are employed in 4 civilian t RAPA! a eecccncnen eres Petar dp eueevaetevr tau e te evar esr ee vovomenn evra ee pane ones ‘ bee oad Uf your answer to Aas "Yes. gite in Vem 34 for inch relatives: (1) fell names (2) present address Cintluding Z1P Cude); 3) relationship: (4) departivent, agency, or brinch of the Aemed Forces. If your wasuer to Bois Yet,” also guia the Rind of appointaent held by the velatriels) you hie with or hase Lied with urthin the past 12 months. 32. Do you reveave or have you apried for retirement pay, peaswn, oc others compensacon based upon nuhtary vs Federal crvilian ice? ot iS eee gas aeuvern, Seem nearer hers emer em etter eRe rower anew ke PHT PRPS CCE soe per eter ren eagy f a . 4 7 ee if your answer 8? Ya. ane deails in Wen 3. 33. Are you an official of employee of any State, Coreitory, COUNTY, OF MUNKIPILVP reece Cente center teers Cen ege ners Uf Va” gure type of pasiteex or name of ofue, and cocation, ta Uten Ad Undade cdbether leted 7 appointed. >