PERSONAL HISTORY STATEMENT - MILLS, MONTRELL EUGENE

• Document Type: FOIA
• Keywords: MILLS MONTRELL E
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001308684
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 14
• Document Release Date: February 19, 2008
• Case Number: F-2005-00558
• Publication Date: February 20, 1951

 PERSONAL HISTORY STATEMENT Instructions : 1. Answer all questions completely.  If question is not applicable write "NA."  Write "unknown" only if . you do not know the answer, and cannot. obtain the answer from personal records.  Use the blank pages at the end of this form for extra details on any question or questions for which you do not have sufficient room. 2. Type, print, or write carefully; illegible or incomplete forms will not receive consid- eration. HAVE YOU READ AND DO YOU UNDERSTAND THE INSTRUCTIONS?  _?s 1. PERSONAL BACKGROUND A. FULL NAME     ,dontro 9.      Eugene - ----------------  --      - :--   - (First)                 (Middle) (Use No '           S. Initials) B. NICKNAME                -------- WHAT OTHER NAMES HAVE YOU USED?..---'---'--'- IT-Wi - ? Home --------- ---------- loo6-D Birch Rd. !Ast Lansing, ixiich*'   Ingham PRESENT ADDRESS -- -------------                           ----------- ----------            -------------- - - ---- ------ (St and Number)         (City)                  (State) PERMANENT ADDRESS (Conntry)-.- 51P. i orth Fairviovt,Lansing, diai.     Ingha --------------------?----------------------------------------------------------- ________-----_-__ (St and Number) (City) (State) (Country) HOW LONG?g?___.._______ IF A LEGAL CHANGE, GIVE PARTICULARS ..RA'- - -  - -- --- -  -----?---??----------??------------------------------------------------------------- (Where T)                                                         -(By what authority) C. DATE OF BIRTH ' an' 3113,9 4LACE OF BIRTH, pv 'uCa Texas       U.S.A. . (City)               (State)             (Country) UA              Yes                                I--A. D. PRESENT CITIZENSHIP                 BY BIRTH?                BY MARRIAGE? (Country) BY NATURALIZATION CERTIFICATE NO.       ______-._ ISSUED __3A `     BY  NA. (Date) (Court) AT -.-- ITA       -                                   ----------------------------------------------------------------- (City)                                          (State)                                                     (Country) HAVE YOU HAD A PREVIOUS NATIONALITY? ______._O (Yes or No) (Country) HELD BETWEEN WHAT DATES? --------- __ TO  ''ANY OTHER NATIONALITY?__ t .' __-__ (Country) GIVE PARTICULARS ..___.. ~'         --------------------------------------------------------------------- ----------------- HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP?        GIVE PARTICULARS: ITA. Telephone: Mills           Office ------ ---------- ------------------- - -                                                                        Ext.    .t-r_ FORM R0.                                                                          APPROVED  FOR RELEASE SEP 1950 38-1                                                                     DATE:  NOV 2007 (2)                      - E. IF BORN OUTSIDE U. S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY?         -------- PORT OF ENTRY?             ON PASS PORT OF WHAT COUNTRY? ..__?I '  t_. LAST U. S. VISA ---- ---=-----=----- -=-=------------------ >:.___:= - = ---------------=-- (Number)             (Type)                 (Place of Issue)                 (Date of Issue) AGE 2.7----------------    SEX+tb..@------------ -   HEIGHT I1?WEIGHT .13S   -   - EYES _#]AZIQ ----------------- HAIR O-d --------------- COMPLEXION F?,'. S'________..___ SCARS BUILD ._ 416n.C14r________ OTHER DISTINGUISHING FEATURES -_AA-.._________________-___-.___-__--___. SEC.  3. MARITAL STATUS A. SINGLE ; __-------- --_- MARRIED                    DIVORCED    ._-_  -_.___ WII)OW.ED STATE DATE, PLACE, SAND REASON FOR ALL SEPARATIONS, DIVORCES OR AN t$Litilrt~iaS           i- --------------- ----------------- ----------- - -'    -r - -      -   -                                 -~ - - ------------------ ---   -- B. WIFE OR HUSBAND (IF YOU HAVE BEEN MARRIED MORE THAN ONCE-INCLUDING ANNUL- MENTS-USE A SEPARATE SHEET FOR FORMER WIFE OR HUSBAND GIVING DATA REQtYIRED BELOW FOR ALL PREVIOUS MARRIAGES.) NAME OF SPOUSE LIar jo .O-           ---- - GJ.. pl          ol`,=;~_  _: ------- "$ (Last] --------- PLACE AND DATE OF MARRIAGE                              ___-__.J           3,.__ HIS (OR HER) ADDRESS BEFORE MARRIAGE LIVING OR DECEASED Li.v g.___.. DATE OF DECEASE..                   , ------------- CAUSE PRESENT, OR LAST, ADDRESS 1OO6-va-Bi rob RA + i''  t;                 .iLS..A. (St. and Number)           (City) -         (Sts (Country) DATE OF BIRTH,XUM_.2P,3,-                              ,ACE OF BIRTH     'iS(C,t                   ( A. IF BORN OUTSIDE U. S. INDICATE DATE AND-PLACE OF ENTRY CITIZENSHIP.L.Z,_A, .______ WHEN ACQUIRED?  % (City)  (State) (Country)- OCCUPATIOIu6dC#),l__?CI12t .CIQIL,AST EMPLOYER j4gp- zG'x'OVO SahO?l EMPLOYER'S OR BUSINESS ADDRESS Q ? _:?. 4 011__  p ids-- a                                         -an -g ~-_`?  _ -~  C ?__ (St. and Number)-       (City)            (State)        (Country) MILITARY SERVICE FROM __-          TO          ___ BRANCH OF ,(Date)                  (Date) COUNTRY -M,  __-      -------------- DETAILS .OF OTHER GOVT . _ SERVICE,. U._ S. 0R_-FOREIGN ---------------------- 114L-4---- ------------------------- -------------- ------ _-------------------- ----------------------------------------------- 16-62856-i SEC.  4. CHILDREN OR DEPENDENTS (Include partial dependents) : Joffory Ly=  14illr                        Son                Jeans 1. NAME - - -    - ------??--------?------------ RELATIONSHIP ..--------??---?-------- AGE t1                              1006-D i3x'C.2 Rd. East LC:1u       :lick, CITIZENSHIP                        ADDRESS -  ---  --- - - ---- -  -  s      ------3-- ' , (St. and Number) (City) (State)       (Country) US A 2. NAME ----T:x,---------------------------------------------- -- - RELATIONSHIP   - ?=- --=--------- AGE ----------- CITIZENSHIP ----------------------------------- ADDRESS ---------------------------------------------------------------------- (St. and Number)                                                     (City)                        (State)       (Country) 3. NAME ---1  !----__                   -_:        RELATIONSHIP ---=------.__----____-: AGE CITIZENSHIP        - .____- SEC.  5. FATHER (Give the same information for stepfather and/or guardian on a separate sheet) FULL NAME'_ o)            An S'ew             Mille -=-------- - - -      -------------- ---    - - -------------- (First)                                                                       (Middle)                           (Last)      -Y INA                       E`TA ?                - LIVING OR DECEASEDL 'K4416..___.. DATE OF DECEASE ....._?_-_,_____ CAUSEi____.__ PRESENT, OR LAST, ADDRESS jy 4 Q  [.___ t         C,~2 ~'+Q +'a1 Zus- 'eXA.~`iy__ USA. __ (St. and Number) (City)             (State) (Country) DATE OF BIRTH _,QO__________ PLACE OF BIRTH     _SSUiS ??__ (City)                                         (State) (Country) IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY    =1A I CITIZENSHIP -_"WHEN ACQUIRED?       ~A~     WHERE?     . Farmer                                                                      Unl 20 n OCCUPATION --------- --------              LAST EMPLOYER EMPLOYER'S OR OWN BUSINESS ADDRESS  Route ~. Wichita                                                    `ills, Taxas.USA4 (St. and Number) (City)         (State) (Country)- NA. MILITARY SERVICE FROM                      TO   BRANCH OF SERVICE (Date) (Date) COUNTRY                              ''?_-.__---------- DETAILS OF OTHER GOVT. SERVICE, U. S. OR FOREIGN ?1A.: - ---------- - ----------         ------ - --------------------------------------------- -------- - --------------------- SEC.  6. MOTHER '(Give the same information for stepmother on a separate sheet) FULL NAME _laud ------- LorOanC                mill ------------------------------------------------- ---------      - (First)                             (Middle)                                 - (Last) Livin LIVING OR DECEASED             DATE OF DECEASE ......... NA '                                                              CAUSE -tjA _?_______..__ PRESENT, OR LAST, ADDRESS $__ _?_. ' lehitaFA -lS,__2f3x^Sf_--US  !---:,---,- (St: and Number)           (City)            (State)                                                   (Country) DATE OF BIRTH 1'905-.----------_- PLACE OF BIRTH -_---?---_---_Texas.                                       USA ?^ CITIZENSHIP Uf_S ?' ?  IA, _______WREN ACQUIRED? _ WHERE? ---=-----------          --- (City)                                                                                        (State)    (Country) NA. IF BORN OUTSIDE U. S. INDICATE DATE AND. PLACE OF ENTRY _~ `        ------------- __ (4) ~__ OCCUPATION                 --------------- LAST EMPLOYER _       Q 12l ------- EMPLOYER'S OR OWN BUSINESS ADDRESS                                            --TEA. '                                                                          _  (St. and Nui6ber) ~ity)        (Sta~~ (~onrq) MILITARY SERVICE FROM                           BRANCH OF SERVICE 4  T..__-___.-______ COUNTRY                                                              __-_____-._DETAILS OF OTHER GOVT. SERVICE, U. S. OR FOREIGN 1 C C i PRESENT ADDRESS                                 ---------        _________________--------_- '~(SC itn Numb  )         (City)'            (State)            .(Country)'            (   izenship) SEC.  7. BROTHERS AND SISTERS (Including half-, step-, and adopted brothers and sisters) : 1. FULL NAME                                    f~t)           -Qf3- (Midge) ..-$?----Mast) AGE PRESENT ADDRESS ---:D----- '(f~~nir                                                                                                                                                              c         n 2. FULL NAME 1yZ      )- ~    ~ . -            -(Middle)  -  - -  - -              AGE vLs i                                          -- - 3. FULL NAME                                                                                       AGE -t    (First)                                 (  fiddle A`'L. - -  - - -     - - )                         (bast) PRESENT ADDRESS                                                         &53-------USA ------------------ (S .and  amber)          City                                                                            (State)            (Country) -          ( i izenship) - - 4. FULL NAME ........ NA- t-.-rat)-----?---- --------------------------- (- M-iddl--e--)-        (Lst -     -  -  -      ---- a---) AGE ( i PRESENT ADDRESS - -     -                                                            - (St. and Number)         (City)             (State)            (Country)            (Citizenship) 5. FULL NAME                       t PRESENT ADDRESS --------------- ------------------------------------------------------ --------------------------------------- (St. and Number)                                                                        (City)             (State)            (Country)            (Citizenship) SEC.  8. FATHER-IN-LAW FULL NAME _21111jiMi - -     ; rth ----?---- t 11     n '~                                 gl! _ - -------- ---- -- - (First)        ddle)                               (Last) LIVING OR DECEASED .Li#     __ DATE OF DECEASE   y_:_..__-_______ CAUSE   ; r___-=_ __- PRESENT, OR LAST, ADDRESS (St. and   umber)                y               (fate)             Coun   ) DATE OF BIRTHt1                    ,. j ' ? -1 99'LACE OF BIRTH _.OhLQ _------------------- ------------------------------- IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY ___.._ CITIZENSHIP _ M.A -.,_________ WHEN ACQUIRED?                                   __------- WHERE? ..__ (CIty   (State)   (Country) OCCUPATION .C)4x0y ,.   j?___W9 J_{;a14&T EMPLOYER                                      {        _ g_.b`4 :~9 A ____ to--a    i 4 -0   1 SEC. 9. MOTHER-IN-LAW FULL NAME Bgrtba ---?----- - . - --          - -- = = : 5           !  ------=--------=---------- (F first)                                                           (Middle)                               (Last) LIVING OR DECEASED Living ------- DATE OF DECEASE                      CAUSIT:TA.---__-___-_-_-___ PRESENT, OR LAST, ADDRESS 2---               be QS  LA.I(c i'~ -=-(s    n---- <t ------ DATE OF BIRTIAjap.r7 ---J-&qq_ PLACE OF BIRTH ~  a ' 0__ i_i C1 r                               AT2___--___--_ IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY __jyA -~                        T, A CITIZENSHIP TI:_k?        WHEN ACQUIRED? T __t_..=____.__-- WHERE? .__ ((Cit----- _-______ (City)   (State)    (Country) OCCUPATION                         LAST EMPLOYER                       ------ _--------------- ------- SEC.  10. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION, WHO EITHER LIVE ABROAD OR WHO ARE NOT CITIZENS OF THE UNITED STATES : 1. NAME _1T0120----?-- -_.__--_-------------------- RELATIONSHIP .-------------------- AGE ------------ CITIZENSHIP                                                     ADDRESS ---- ----- -   -  - ----------------------------------------------------- (St. and Number)      (City)         (State)        (Country) 2. NAME              .- --??------------ -----------------_- RELATIONSHIP ---------------------------- AGE ----------- --------?------s:L~ CITIZENSHIP   ---------------  ADDRESS                   ---------?------------------------------------------ (St.andNumber)                  (City)         (State)        (Country) 3. NAME                     ---------------------_--__- RELATIONSHIP .------------------------- AGE ----------- CITIZENSHIP                                    - - -      - ------- ADDRESS ---- ------ -  - - - -    - - - -    - (City)         (State)        (Country) SEC.  11. RELATIVES BY BLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE OF THE U. S. OR OF A FOREIGN GOVERNMENT:...,. 1. NAME M a,'i-_ 1,44 .113 - =--..---.-_,..--__-_- RELATIONSHIP'    sil _...... --- AGE   ..--_- CITIZENSHIP. USA.*. ---------- --- ADDRESS ___ =II I`       - - - - - -   -                                              -- - -- (St. and Number)      (City)         (State)        (Country) TYPE AND LOCATION OF SERVICE (IF KNOWN) ~5---------------------------------------------- ------ 2. NAME -        -    -                      -  - RELATIONSHIP ----------------------------- AGE ------------ ------------------- CITIZENSHIP              --------- --- ADDRESS TYPE AND LOCATION OF SERVICE (IF KNOWN) -___-___--___-___--___-_______________________________.--------------- 3. NAME 1-7-4-1 --------         --------------------------------- RELATIONSHIP --------------------------- AGE ------------ CITIZENSHIP                    -  -     -   -- ADDRESS ----------------------------?------------------------------------------------- (St. and Number)      (City)         (State)        (Country) (5)                                           16 (12855-1 (6) A. KIND OF POSITION APPLIED FOR 7'3V0  -     L I-VC)           --------------- ------------------------------------------------------------------------ B. WHAT IS THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL ACCEPT?  $3500. Por y1 i (You Will Not Be Considered For Any Position With A Lower Entrance Salary.) C. IF YOU ARE WILLING TO TRAVEL, SPECIFY: OCCASIONALLY s1-1 -_--___--_____ __ 1 ? FREQUENTLY       ----------------------------------------- CONSTANTLY r~ .V ,   _____ D.,CHECK IF YOU WILL ACCEPT APPOINTMENT, IF OFFERED: IN WASHINGTON, D. C. ANYWHERE IN~ THE UNITED STATES ---- ._--------- OUTSIDE THE UNITED STATES _ - --------- - E. IF. YOU, WILL ACCEPT APPOINTMENT. IN CERTAIN LOCATIONS ONLY, SPECIFY LOCATIONS: - - - --------------------------------------------------------------------------- - ---------- - ELEMENTARY SCHOOL            --------- ADDRESS __ `7 ca~?ita Pall? TOXV.s    USA. (City)                 (State)               (Country) DATES ATTENDED                                    GRADUATE? _19-9 -------------- -                                                          - HIGH SCHOOLb.3_kb1=0_t'------------- ADDRESS In.'Ii?LL?'nott Texas. U.Q.A.------ (City)                                                                                                                                             (State)               (Country) DATES ATTENDED                         ------------- _ GRADUATE? COLLEGE=;9X' G    a  s     Q '_- - ----- ADDRESS                                              .Q=_Q j1-LQ                -8? ? 3& --- U.S.A. (City)                 (State)               (Country) MAJOR AND SPECIALTY                           YEARS COMPLETED DATES ATTENDED                                DEGREE Ilona _------------    ---------- COLLEGE r*?i c 'zi                               n S    fta Y-------- ADDRESS i 't3 e__.I.t? n  ja&   iOhlg 4     13-AA- (City)                                                                                                                                               tate)               (Country) MAJOR AND SPECIALTY Pollee   rh*.z?ir~3tel?_Ii "itD,MR.S COMPLETED _+[.Q_   1Lt,`.I__tlarOOl a DATES                                                            I -5..__, Q1iaQ_..Acb d..ni2 vrt3 L? CHIEF UNDERGRADUATE COLLEGE SUBJECTS CHIEF GRADUATE COLLEGE SUBJECTS                             j,=_.Qp':gpa------------ 111 SEC.  14. ACTIVE U. S. OR FOREIGN MILITARY SERVICE .~ i x~j ta~3__    tt~  -----------AAr_ Forcu             t.LioubQn _it 1943 to 19J 8 (Country)                          (Service)                               (Rank)                      (Dates of Service) -io.  t ablo -                                                        - ------------------------- (Last Station)                                   (Serial Number)                               (Type of Discharge) REMARKS: -                                -  - -  -                  - --------------------------------------------------------------------------------------------- SELECTIVE SERVICE BOARD NUMBER __34_____ ADDRESS Is,XI_ ?1     1 Ch  7' IF DEFERRED GIVE REASON -----3IAs--??-------------------------------------------------------------------------------------- INDICATE MEMBERSHIP IN MILITARY RESERVE ORGANIZATIONS ..lnaatiV?Air ._------------- ------ ----------------- --------------- ---------- LL - -- ------ SEC.  15. CHRONOLOGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT FOR ALL PERIODS. INCLUDE CASUAL EMPLOYMENT., ..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.) FROM -~~1 , .19~`@b              CLASSIFICATION GRADE    jA ________                 _..--_-_-(IF IN FEDERAL SERVICE) _-_......... EMPLOYING FIRM OR AGENCY A C 3 ,. QY2 _St- t? Co11 QS( ------------------------------ ADDRESS                                     --------     USA* -------------------------------------------- (St. and Number)        (City)                  (State)                   (Country) KIND OF BUSINESS 001-1.. ;o----------- _NAME OF SUPERVISOR A!F.3ra nc scatter TITLE OF JOB..__-8t ,lCtL3I2't---------------_--_..___ SALARY $.. S3I     ------- PER __=_  ? ------?-----?-.- YOUR DUTIES ..3  ,,    -----------     --------------------------------------------------------------        - - - -------------- - ------------------------------------------------------------------------ --- - ------------------------  - ------------------ - - -------- - ---------------------------------- REASONS FOR LEAVING.._ _Gx du(t ng-1n March ___                                                             ........  _ - ------------------------------- CLASSIFICATION GRADE .   1st. Lt. FROM sT.l]21fl___1_L'.3__-_--- TO             9--------- (IF IN FEDERAL SERVICE) .-_-___---??--_??------------ EMPLOYING FIRM OR AGENCY -~ S2f  4I__ t  t %3_ A  '__ Forco --------------------------------------- ADDRESS L      IQ - - - '  +   - -  -     -              - -               -- - --------- (St. and Number)                                                     (City)                  (State) (Country) KIND OF BUSINESS .._             --------------- -- NAME OF SUPERVISOR TITLE OF JOB -A~        -         -                            SALARY PERK YOUR DUTIES                                                    aircraft sand _azn_il nod ground - --------------- 1r1r;3_e_ -  - - ------?-------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- - ----------------------------------------- REASONS FOR LEAVING..__TO-_CO.121.^ 4O                                                          eo11o`,e - - ----- - - - --------------------------------------------------------------- (7)                                                       16-628155-1 CLASSIFICATION GRADE  . ~L ------------------------- EMPLOYING FROM]:. ljP----------------------- TOi-~----------------------?--- (IF IN FEDERAL SERVICEY! FIRM OR AGENC-liA2'a3L'13..`i' __.x-UmiS?2- t].1.4 ', 0 ----------------------------------------- ADDRESS ..T.t                                            -    _t 11 ? ------------     - ------------------- ------------------------- ---- (St. and Number)        (City)                (State)                 (Country) KIND OF                               NAME OF                                          -__..______ ?                                              S'r                     T.i Ei TITLE OF JOB                    t d..f:I12t-_-_-_             __ SALARY $. 3 Lt   -----___ PER t  __ _ ----------.---- YOUR DUTIES .11A -- --- - -------------------------------------------- ------------------------------------------------------------- REASONS FOR LEAVING. R-GS Q$?VQ__ called to -active _ C iAV ------------------- -_____--------- CLASSIFICATION GRADE FROM1taC- -------------- - --------    IN FEDERAL SERVICE)   -__--___--_-_-__-____-- ~------------- -------TO~~ -----------    ........................................ EMPLOYING FIRM OR AGENCY }Ux` ----------------llig-h s'i~OL3Y'IlG$   i=.??:L 6. - ~-_-                                       - ---------------------------------------------- ADDRESS                                          U.S.A . (St. and Number)         (City) (State)                    (Country) KIND OF BUSINESSIAs--------------          NAME OF SUPERVISORT!__-_----_-..-------------------- c                                                                         I  mo--- --- ----- PE & _--------------_..__ TITLE OF JOB _~?tII,aQnt ..____---------------- --------- SALARY YOUR DUTIES           --------------------------------------------------------- --------- - - - - - ---------------- - ------------------------------- - ----------------- REASONS FOR LEAVING.                                                     ------- ---   - -      ---------------------- CLASSIFICATION GRADE FROM LA               TO     A+~            (IF IN FEDERAL SERVICE)       _ _---_______- EMPLOYING FIRM OR AGENCY                                  -- -- - ----- - - -------------------- ------------------------------ ADDRESS                              ------=-----------   = -----=-=-----------------                --------------- (St and Number)       (City)                    (State)                  (Country) KIND OF BUSINESS ..___-_-_-?---.-------------- --?? NAME OF SUPERVISOR -----------------?---------- TITLE OF JOB -----------------------------?--- ---------------- SALARY $------------------------ PER - - - -     - - REASONS FOR LEAVING ------------------------------------------------------------------------------------------------------------- ie-02855-t SEC.  16. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSI- TION?  HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? GIVE DETAILS : ------------------------------------------------------------------- ------------------------------------------------------------------------ SEC.             17. GENERAL QUALIFICATIONS A. FOREIGN LANGUAGES  (STATE DEGREE OR PROFICIENCY AS "SLIGHT," "FAIR," OR "FLUENT") LANGUAGESP_                SPEAK   _7A______________ READ. lldlt-_-___ WRITE     -------- --- LANGUAGE ---------.---------------_ SPEAK _----------- ------- READ ---------------------- WRITE ---------------- LANGUAGE -------------?------------- SPEAK -------------------- READ --------------------- WRITE -        - - B. LIST ALL SPORTS AND HOBBIES WHICH INTEREST YOU: INDICATE DEGREE OF PROFI- CIENCY IN EACH: roa b 3~.--_    aar---     -g.x__--- ,~1 ya r colla   "'i?ac vv_a~3  e for hip atbai.---'e                 --'3caol~,__grr_           v_~encvec3 _;scha  hi, t nc r:11-f a3.r  _ rp jZ c z end   Golf-Low -- ejzhtjgLqA C. HAVE YOU ANY QUALIFICATIONS, AS A RESULT OF TRAINING OR EXPERIENCE, WHICH MIGHT FIT YOU FOR A PARTICULAR POSITION? A B.S. degree in-Police Adminia  ation=advise from people _-- ----------- asaociat,rd with    in-:s rvia?  ro r   that Investigation--would be xq bq    1-614-41    - - ------------------------------------------------------------------------------------------- D. LIST ANY SPECIAL SKILLS YOU POSSESS AND MACHINES AND EQUIPMENT YOU CAN USE, SUCH AS OPERATION OF SHORT-WAVE RADIO, MULTILITH, COMPTOMETER, KEY PUNCH, TURRET LATHE, SCIENTIFIC OR PROFESSIONAL DEVICES: x'Uot of sinale..twin alp  =u.2t _- L4,glae__a rer - t. ------?                        -- ----------                                --- ~ c  U o oi~a or __ 1? Oo~nsa8 . APPROXIMATE NUMBER OF WORDS PER MINUTE IN TYPING ---------- ---- _ SHORTHAND ------------- (9)                                                                           16-0 285.5-1 E. ARE YOU NOW OR HAVE YOU EVER BEEN A LICENSED OR CERTIFIED MEMBER OF ANY TRADE OR PROFESSION, SUCH AS PILOT, ELECTRICIAN, RADIO OPERATOR, TEACHER, LAWYER, CPA, ETC. IF YES, INDICATE KIND OF LICENSE AND STATE ___,_~_____ ________     --?------     - FIRST LIC. OR CERTIFICATE (YR)             LATEST LIC. OR CERTIFICATE (YR) F. GIVE ANY SPECIAL QUALIFICATIONS NOT COVERED ELSEWHERE IN YOUR APPLICATION SUCH AS: (1) YOUR MORE IMPORTANT PUBLICATIONS (DO NOT SUBMIT COPIES UNLESS REQUESTED) (2) YOUR PATENTS OR INVENTIONS (3) PUBLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCE (4) HONORS AND FELLOWSHIPS RECEIVED - - - - ------ I A. ---------------------------------------------------------------------------------- - ---------------- - - - - - ------------- - -- G. HAVE YOU A PHYSICAL HANDICAP, DISEASE, OR OTHER DISABILITY WHICH SHOULD BE CONSIDERED IN ASSIGNING YOU TO WORK? IF ANSWER IS "YES," EXPLAIN: --?--------  -------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- - --------------------- ------------------------------------------ - --------------------------- H. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT OR ANY PENSION OR OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICE? IF ANSWER IS "YES," GIVE COMPLETE DETAILS: ------------------------------------------------------------------------------ Col . J "t.. ' 3 _a . S zvt^M SEC.  18. GIVE FIVE CHARACTER REFERENCES-IN THE U. S.-WHO KNOW YOU INTI- MATELY-(Give residence and business addresses where possible.) Street and Number        City           State Y~?3ovos~ `fx t~ r~~z^ z                          I," oir1 n,t}    jr A BUS. ADDi_=         ..-1 -----  - =s -----------    ' ---- ----------- RES. ADD                                                   ?'_~I3A                               'f:LT1_-Anton o .     oX#?.t? 2.                     -------------- BUS. ADDR3 000-  v__ -rte- ;I: l-_I. c1~3 zne   r------ 3....* __!-__ IaO ':,:312'? Evert .1.3.osnox and business addresses where possible.)  . RES. ADD    1_ -#3 sr x  an - bon-4oJ ;PqgSgj~ ----- BUS. ADD'                    i9914--bu 'J~bt  4 t, pox. RES. ADD. RWIR- bt971O %' -24 . tp-?--------  - - - BUS. ADD. _ Ur-b-   not t Q'1in-_''  V.Rt=8--_-__ Bvs.~ ADAQ line Ad, Do t "Xjq                 tgtq- College RES. ADD7#;p' 19. NAMES. OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THE UNITED STATES- NOT REFERENCES, RELATIVES, SUPERVISORS, OR EMPLOYERS-(Give residence Salter T., Lloyd Street and Number        City           State BUS. ADD.-eh3.+2Y3 Stc~?ll~                  -     - RES. ADD.  0_------ B U S. ADD.            _.State 0'0 =10-m                                                                 - - - - _QL'.yl_tt7ta~_L>2$r__SI.} RES. ADD. BUS. ADD.  k Ctio l                          - - ---- RES. ADD. `inoa U#3 I1 .e,  ~1aFII:.YI~ yton                                                                - -- -__- Lorof C. .filler                                                BUS. ADD    oWn 4- _--------  -----                                                 - -     -     -- - - RES. ADD1' ()                 -- '1 8 31     a-:A.i3hf2T $ ,.Loo - A. Rarlo  -- - -  -- BUS. AD1           1-7a pt _  .. ri AL. -Anthoxv-sL-1daho SEC.  20. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE U. S.- (Give residence and business addresses where possible.) Street and Number City           State i. rsu 4nr__ =rroe - -   - -         Bus. ADD  S~    L'k:~__ tc~tc~---Ca lag      --------------- ADD-S~Q 2-+ ~? .rph  i E?'ia -          2:~    *_<s1 Cll... RES. 2.vi#xl E3'.. fluss - - -    - BUS. ADIUSt #           =._-$t tC_-("e3.2           - --------- RES. ADaQ                                                 61-1. 3.  iF32W --}? Ot i I -  -    -   BUS. ADD. i1 .G' U ----- State ~i'c7   3 Q      - - RES. ADD. -        G.. DI-91a Rd. East         I1ft~?1 is . SEC.  21. FINANCIAL BACKGROUND A. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY? .-..... IF NOT, STATE SOURCES OF OTHER INCOME ?.Qd-----       __--_-_--------------------------------- ---------------------- --- B. NAMES AND ADDRESSES OF BANKS WITH WHICH YOU HAVE ACCOUNTS 11i:1f'1ri can 5? e~tsR'1eS3,_u(~Y'~ .'  2;     n~~ 2 -t    F a -a --- 'c T?3      ---   ?---------- (11)                                             ia-$zsss-~ (12) C. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY? N& - --.._-._____----------------------- GIVE PARTICULARS, INCLUDING COURT: ----- -------------- ------------------------------------------------------- -----------------------------------------------------------                -------------------- --------------------- - ------- D. GIVE THREE CREDIT REFERENCES-IN THE U. S. 1. NAME }-'--------------------~ ----~---n------------- -_--- ADDRESS RJ                                                                          ( QL N ~ r)Ji~~Q   (G~i f2XQD _      (State) O cko s   of  Texas 2. NAME ------------ - -    ~? -    ; ;    ADDRESS               -                                                                                          -+ x.  -          - uT?C-"a~. ::101%43    AliC:3 JX1CE3  400'1.anb~`t~f'(~(Cik ?r~'i --- - (State) ADDRESS -------------------- -            ------------------------- 3.NAME -----?----y -----__ ------- ----------------------------- nti       -owlBank                                                                 (State) SEC.  22. RESIDENCES FOR THE PAST 15 YEARS FROM ---------------------- TO ----Present Oct 191s.9              iurx~ - i     :~,a:    Ma1  - :c   y    A. = - - FROM ------------------ TO ------- - ---------------------------------------------------------------------  3[ . June 11;.9    et: 19149 913  t       . Hr. ~(ityEast LO  Lng,                                                Ehl   WA -             - - - -- -----= -------=------------- - ----=--- F R O M . , * - - - - - - - - -       T O - . Jan 1949     June 191.9 5225'1     r l?I  ? Lans   l Uchp                                                         ,. FROM --------- - -                    TO .------- - _~_-~--- - --- - - -  --   - -- -                        - -_ 19)4.9         `.n )rv .~# ' Lansiz4 ; > i:ch, cc?>                                , Sept: 191      an FROM -------                          TOAc -                    - -     -                                  --~ }ug.I),'~  rcpt; ~3   Pt7a'd,36Y5rs~''ilC FROM -   -                            TO .---------- MY 1 ji 7   ug.   9T~7       ! a pia                                    x tyS    An~1   tO   OX Cout~6 - ^r~ FROM ----------- -------- TO C.-------------- 1 fit ~t          -                ---~ Q                --------- - Jan 1911111-0 9wf  19t.~.? .L V  ndi"~'o                                tJ Cict~   i ~   te)               {JavSistry) - SEC.  23. RE       ~' L3                        TE       I                                 e TIES A. FROM --------------------- TO ------------------- --------------              ------ 181.7            ----- u (     Lnd, i .8        .  Llipp in sjco                                 rs, a= ,j.ug?.  dept. 1L': TO ----- ------- -- ------------------ ----------- --- ----------- ort ujoroxbisod          Rabaul,(                                         ui-.y with <    ) orce. --------- - -----               --------------------- - (Cityor,section)               - (Country) (Purpose) - FROM .  -    - TO -  -..~                                      - - ----       ----------------- -------------------- -                                                - .       -                            (City or section)              -  ..  (Country) i .  . (Purpose) FROM --------------------- TO .._-_------ city or section)                                                                                                                 (Country) (Purpose)    . SEC.  24. CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS  ? LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCIETIES, PROFESSIONAL SOCIETIES, EM- PLOYEE GROUPS, ORGANIZATIONS OF ANY KIND (INCLUDE- MEMBERSHIP IN, OR SUPPORT OF, ANY ORGANIZATION HAVING HEADQUARTERS OR BRANCH IN A FOREIGN COUNTRY) TO WHICH YOU BELONG OR HAVE BELONGED: ~I~pse~Ia~-~a~%'r:aa,:         u:iS~t;r~zu~Q~i D     A44PO11Wi$EASHIP :.-_-- --------------------------------- ------ 2 . ---------  - -     - -    - - ---------=                                          ----------------------------- ----------- j+(Name and Chapter)               (St. and Number)                  (City)                 (State)                 (Country) DATES OF MEMBERSHIP:..____-__. 3- ----------------------------- ----------------------------------------------------------- = `------------------------------------------------------ 131!'1.ame and Chapter)               (St. and Number)                  (City)                 (State)                 (Country) 1(T? DATES OF MEMBERSHIP: ------__-_.___-_ 16-62!56-i ---------------------- _1_-13-t-----------------------                      --------------------------------------------------- -----------           ------try) (Name and Chapter)               (St. and Number)                  (City)                 (State) (Country) DATES OF MEMBERSHIP- ------------------------------------------ ------------------------------------------------- = "IA . (Name and Chapter)               (St. and Number)                  (City)                 (State)                 (Country) 14A. -------------------------------------------------- - --  -------------- -                                                                              (Country) (Name and Chapter)               (St. and Number)                  (City)                 (State) DATES OF MEMBERSHIP- ------------------- - --------------------------------------------------------------------------------------- :1: s..                                            ------------------------------------------------------------------- (Name and Chapter)                                                              (St. and Number) , (City)                                (State)                 (Country) DATES OF MEMBERSHIP:.._..-------- ------------------------------------------ ----------------------------------- ----------- -- SEC.  25. MISCELLANEOUS A. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF, OR HAVE YOU SUPPORTED, ANY POLITICAL PARTY OR ORGANI- ZATION WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOV- ERNMENT IN THE UNITED STATES? IF "YES," EXPLAIN:: -  - -------------- ----------------------------------- ----------- --=----- ------------------------------- B. DO YOU USE, OR HAVE YOU USED, INTOXICANTS? _-__#Iit------------------------ IF SO, TO WHAT EXTENT? .. -'          ------------------------------------------------------------------------------------ ----------- C. HAVE YOU EVER BEEN ARRESTED, INDICTED. OR CONVICTED. FOR ANY VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION?  IF SO, STATE NAME OF COURT, CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE: -----------------------------------------------------------------  - - ---------------- -----?----                                                             --?---------- D.                                         - HAVE YOU EVER BEEN COURT-MARTIALED WHILE` A MEMBER OF THE-ARMED FORCES? IF ANSWER IS "YES," GIVE DETAILS BELOW: x--------------------- ------ --------- ----------------------------------------------------------------------------------------- E. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FOR EMPLOYMENT SINCE 1940: -.?t I (XIiO------------------------------------------------------------------------------------------------ (13)                                                           ~u--czsss-i F. IF, TO YOUR KNOWLEDGE, ANY OF THE ABOVE HAS CONDUCTED AN INVESTIGATION OF YOU, INDICATE BELOW THE NAME OF THAT AGENCY AND THE APPROXIMATE DATE OF THE INVESTIGATION: tJ7L" ?1   T1 --------- - --------------------------- - -- - ------------------------------------------------------------------------------------- SEC.  26. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: NAME                              -------------------------:---------------- RELATIONSHIPS - - ADDRESS 5512 41orth-?$,~mr8~;2=(ityE3'(sisie) i ~(Coantry) ` SEC. 27. YOU ARE INFORMED .THAT THE.CORRECTNESS OF ALL STATEMENTS MADE. HEREIN WILL BE INVESTIGATED. ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE NOT MENTIONED ABOVE WHICH MAY BE 'DISCOVERED IN SUBSEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EXPLANATION?  IF SO, DESCRIBE.  IF NOT, ANSWER "NO." -      ------------------ ------------ -- SEC. 28. I. CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND I AGREE THAT ANY MISSTATEMENT OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE GROUNDS FOR IM- MEDIATE DISMISSAL OR REJECTION OF MY APPLICATION. SIGNED AT --5~iM. i---isle.C.higEII2.-----------------------------------. DATE s" #3  2.2#iS-':_--c.41..q_t- (City and State) - -------------------- (Signature of Ap licant) USE THE FOL                           A DETAILS.  NUMBER ACCORDING TO THE NUM- BER OF THE QUESTION TO WHICH THEY RELATE.                        SIGN YOUR NAME AT THE END OF THE ADDED MATERIAL.  IF ADDITIONAL SPACE IS REQUIRED USE EXTRA PAGES THE SAME SIZE AS THESE AND SIGN EACH SUCH PAGE.