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Pay “ ar ¢ 71. YOUR EMPLOYMENT ACTIVITIES Fill in your employment activities, beginning with the present (#1) and working backward 15 years. INCLUDE: AUG-31-1994 14:37 FROM @ UNIT TO © WMFO “ * all full-time work + all paid work + self-employment + all part-time work + active military duty - "= all periods of unemployment IN THE NUMBERED ACTIVITY SECTION USF ONE OF THESE CODES IN THE CODE BLOCK: - Active military duty stations $ - State Government (Non- 7 - Unamployment (Enter name 9 - Other 2. National Guard/Reserve Federal) employment of person who can veri 3 - U,S.P.H.S. Commissioned Corps 6 - Salt-employment (Enter 8 - Federal Contractor (list 4 - Other Federal employment business name anor name tractor, not Federal agency) ‘of parson who can verify) FOR EACH ACTIVITY SECTION, provide information requested. For example, if you had worked at XY Plumbing in Denver, CO, for 3 separate periods of time, you would enter dates and information conceming the most recent period of employment first, and provide dates, . position titles, and supervisors for the two previous periods of amployment in the approoriaie bincks helow that information. (For locations outside the U.S,, show city and county.) Your Positen Jie b6 Chief Juage b7C uy) Ste 2 Code viephone Number 333 Constitution Avenue Washington ( 202 237-95 veet Address oF Job Location (7 diferent than Employer's Addross} ce plepnone Aumbor { ) Upervisors Name & Sueet Adcress (i dijaiant nan inp Locating) —— a9 — Yolenhone Numbs Cirwuit Executive- a PREVIOUS PERIQGOS OF JHE SAME ACTIVITY AND LOCATION - ‘CONTINUATION SHEET #$ USED, SHOW BLOCK # o Your Position fide & Supervisor's Name ow Il preva bl ved call ithavad ' locts ich « ne ws te Zorn pie met or 25. mployer's Name/Miltary Service/Unemploymerit.or Self-employment Venter | Your Position Ite iy (County) i‘ elepnong Number “Street Address of JOD Locaton ( cimerenmt ian Employers Address) slephone Number Hlephone Number ( ) Supervisors Name & Street Address (if different than Job Location) upervisors Name a | =mpoyers Name/Miitary Service’nemp oment or alf-employment Venter | Your agiton Te ity (Country) pephone Number . y treet Aderess of Job Locapon (i different than Employer's Address) ny (County) slephone Number upervisers Name & Street Address (if diferent than Job Location) ity (Country) elophone Number Pree PERIQOS OF THE SAME ACTIVITY AND LOCATION « IF CONTINUATION SHEET IS USED, SHOW BLOCK # arr = : MoniivY Gay; MOniivY Gur Your Positon life & Supervisor's Namo our Position Tike & Supervisors Name Enter your Social Security Number before going to the next page | 7% i304 |-la6l- 17 Page 3 AUG 31 °94 13:16 f62 Se4 1373 PAGE.@a?r