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14, HAVE YOU EVER BEEN DISCHARGEO FROM 7* a rr a IO, -4€0 FORCES UNDER OTHER THAN HOMORAELE corm , Oves Bo. , * fame Llf anewer ia Yee,” ive details in iten . Co eaves any rete OF ROTEL IGEN UN FTAL Pn SE tr me ne rn yc am a 35, EMPLOYMENT, (Liat ALL employment dates etacting with your present eraployment, Give Both month aad year for all dates. Show ALL cates and addresses when unemployed. Give name under which employed if diferent from name now uaed. 7 NAME OF EXPLOYER Fi; ADOR: a e . . Ci —~, FROM TO + AND SUPERVISOR Ch ree EF ny en DORE add | TYPE OF WORK PEASON FOR LEAVING 11/01/70 Present Unempvloved b6 Per BOC ‘ * ‘eceeomenpes * * } 7 » . al . a a * « * a 1 - ¢ a “€ , _ t . _ ‘ so ‘ ' ‘ 2 1. HAVE YOU EVER BEEN DISCHARGED (FIRED) FROM EMPLOYMENT FOR ANY REASON? CJyes ENO. 17, HAVE YOU EVER RESIGNED (QUIT) AFTER BEING INFORMED THAT YOUR EXPLOYER INTENOED YO OISCHARGE (FIRE YOU FOR ANY REASON? Oves NO. Uf your enower to 16 ce 17 above ia “Yea five details in item 28. Show the nems and address of employer, enpprorimate date, and reseone in each cece, This information should agrees with the elatements made in item [S—EMILOYMENT.) 13. HAVE YOU EVER GEEN ARRESTED, TAKEN INTO CUSTOOY, HELD FOR INVESTIGATION Of QUESTIONING, OR CHARGED BY ANY LAW EXFORCEMENT AUTHORITY? (You may omit: (1) Tralio violations for which you paid a fine of, $30 of Jose; and (2) anything that happened before your léth bitthday. All other incidents must be included, even though they were distnissed or you merely lorteited coftaterel.) TYES . KO, iF YOUR “YS" : ‘ OUR ANSWER IS “YES." GIVE FULL DETAILS EELOW. LAW ENFORCEMENT DATE CHARGE PLACE . AUTHORITY , ACTION TAKEN z ceeceerene nr earaetnrrwenenen eee ermeee = Db Cadpen2io3 US, GOVERNMENT PRINTING COFICE | 1804-765 147 #18-€