HR - OATH OF OFFICE, AFFIDAVIT, AND DECLARATION OF APPOINTEE - ELDREDGE, HENRY

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005400442
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 23, 2015
• Document Release Date: August 11, 2009
• Case Number: F-2009-00346
• Publication Date: April 5, 1946

Standara Form No. 61a
A
U ed Jana 26, 1943
. G D rvice C minl
OA . i OF OFFICE, AFFIDAI,
AND
APPROVED FOR
RELEASEDDATE:
07-Aug-2009.
DECLARATION OF APPOINTEE
SSUWarDeDartment Co=aunica(,ions `ashington,D.C.-
. (DeParlment or Establishment) (Bureau or Divleton) (Place of EmPlcYmenU
randldred~e
OATH or Do solemnly swear (or affirm) that I will support and defend the constitution of the United
OFFICE States against all enemies, foreign and domestic; that I will bear true faith and allegiance
to-the same; that I take this obligation freely, without any mental reservation or purpose of
evasion; and that I will well and faithfully discharge the duties of the office on which I an
about to enter: SO HELP ME GOD:
B; Do further swear (or affirm) that I do not advocate, nor am I a member of any political party
AFFIDAVIT or organization that advocates the overthrow of the Government of the United States by force
or violence; and that during such time as I am an employee of the Federal Government, I will
not advocate nor become a member of any political party or organization that advocates the
overthrow of the Government of the United States by force or violence.
C. Do further certify that (1) I have not paid or offered or promised to pay any money or other
DECLARATION thing of value to any person, firm, or corporation for the use of influence to procure my appoint-
OF APPOINTEE ment,(2) I will inform myself of and observe the provisions of the Civil Service law and rules
and Executive orders concerning political activity, political assessments, etc., as quoted on
the attached Information for Appointee, and [strike out either (3) or (4)]
are true and correct;
(4) the answers contained in my Application for Federal Employment, Form No.,
dated ___2.!~ - La c11 _1946------ ; 19______; filed with the above-named department
or establishment, which I have reviewed, are true and correct as of this date,ex-
cept for the following (if necessary, use additional sheet; if no exceptions write
"none"; if (4) is executed, the reverse. of this sheet need not be used):
---------- - ----------------
(Signature of Appointee) --
Subscribed and sworn before me this _---, _____ clay of ________________ _- p --------------------- A. D.; 19 !/--
at ----- I ----------------------------I ---- ------------------------__F~ --------------------------------
5__April 46
--------?---------
(Date of Entrance on Duty)
17 Nov. 1918
----------- ---------------------
- (Dato of Birth)
 DECLARATION OF APPOINTEE
This:orm, if required, s to be completed before enhance on duty. Every question moat be answered. Any false statement In this deoloration will be grounds
for cancelatio? of appUoation or dimissal attar appointment False personation is a criminal offense and wit be proseouted accordingly.
1. present Address ------------a'""- DL -----Rp-------------------------------A_ R!.! K~tr__a -------------
(Sired and Number) (City and State)
2, Who should be notified In case of emergency? ---__---____MR.S_---47 x.. -F Ld?13 ofa~E------ 6/bo a ------------------
a? ?Lo-_ _t?a?--Rk ---------------------------------- ~L!Y-rt.Xew ~~"
------------- -----
(Street and Number) (City and Stn )
3. Does the U. S. Government employ Ina civilian capacity any relative of yours (ether by blood or marriage) with whom you live or have lived within the past 6
months? Yes or No?_IY____ If so, for each such relative fill th the blanks below. If additional space is necessary, complete under Item 12.
Name
postaffios address
(1) Position and (2) Temporary or not
and (3) Department or ffdce to which
Relation-
Married or
Age
(Gies sired number, If any)
employed
ship
single
2. __________________________________
,-,
3. -------- .._________________________
1. ------------------------- _--------
2 - __________________________________
3. _____________________
1. __________________________________
4. placed birth ------------- VEST-_ CAP _ -- 1.A_Y__________-_-____-__________-____-________________/- kw_ Ern. x_-----
own) (State or Coun try)
Indicate "Res" or "No" answer by placing IC In proper column
Yes
N.
12. Space for detailed answers to other questions.
S. A. you a citizen of the United Sites? ------------------ _..
X --
-_
NO
Write In left column numbered items to which detailed answers apply
6. If foreign tom, have you furnished proof of naturalization or
dtizenshtp to (1) the U. S. Cull Service ----
____
_____ __
___
__ _________ ___-------------------------------------------
(2) Pais agency in connection with the aPpointment?_________
____
_____ __
____
___ _________ _________ _________ _ `- .__ -____ ___ _
2. Since you filed application resulting in this appointment has
hi
f
f
h
'..
_______
_______________________________________________________ -------------------
p, or o
a there been any chnge in t
e status o
your citizens
the Persons through whom you gained your citizanehip7---------
_._G
s/
.11____
__.,.
_______________ ___...___ ________: ________: __:_____
ft (a) D. you hold any position or office underthe United Staee
t
M
1
X
----
----------------------------------------------------------------------------
Vj
y
u
___ _____
or any State, Territory, Co=, or
or
I
d
--------
_
-___
______________ _ ____ ___ _____ _ _ _____ __ _ _______-_
u
er
tem 12.
If so, state the place, position, and salary un
. (b) Are-ouwllllng toresignsuchposneon orof0veifitbccomes
necessary to do eo in order to hold the Federal position?_________
____
_____
__
-------------- -------_ ____--_ _ _ _______ __-___ __-_
S. Do you receive any pension or other benefit for military or
--- --- --- - ---- -- ----
navel service or an annuityfrom the U S orD C. Government
X
under any Retirement Act? ----------------------------------
IE so, give details under Item 12, stating whether ou were retired
for , length of service, or dieabllltyr amount of retirement pay
age
_______
_
_
_ __
--------------------------- _-------------------------------- ----____
--------------------------------------------- _______ _________ _______
under what retirement act. and rank, if retired from military
and
or novel service.
----
--------------------------- _--------------- ---------------- ------------ --
10. Since you filed application resulting in this appomtment
_________ _____-___ ________.
have you been discharged for misconduct or unsatisfactory
ti
?
~/
_-_
_____-_-_ _
_____
______ _______
on
service, or forced to rengn from anyposi
If so, give under Ism 12 where employed, name and address ci
___
_
-_ ___
___-
________-
employer and the reason for discharge imeach case.
__________- ___-____.
il. Smce you tiled a li-H- resultng is this a /ntment
or enmraonedintoanyy dull of military
e ou been arrested
h
h
,
av
court as a defendan4 w ivdioted for or conv.cted d any offense
o
~/
(
or misdemeanor)? ________
[f eo, for each case glue smash Iiam l2 (N the date (2) the name
_____..__ _.
mdlocationofthe court (3)theaalure cilia offmarri Notation,
----
--------------------------- ------------------------------------------- _.
and (4) the penalty ti onY. tml:?oeed, or other disposition.
The appointing officer before whom the foregoing certificate is made shall
determine to his own satisfaction that this appointment would be to conformance
with the Civil Service Act, applicable civil-service rules, the War Service Regu-
lations, and acs of Congress pertaining to appointment
This form should be checked for holdingof office, pension, purchase of office,
f cent discharge or arrest promise to
suitability in connection with any record o re
observe provisions regarding political activity, and particularly for the following:
(I) Identity of eprintee with the apptlmnt whose appointment was author
1zed. The appointee a signature and handwriting era to be compared with the
application and/or other pertinent papers. The physical appearance may be
c ecked against the medical certificate. The appointee may-also be questioned
on hs pereond history for agreement with hisprevious statemens. - (2) Aga If
discrepancy aztele between the date d birth and that on applica-.
tion, and If definite age limns have been established for the position, It should be."
determined that applicant is net onside the ago m^va Eor appointment.
(3) Citizenship.-The responsibility for obasr' ovsiope d aBProPriafton
acts Pro hibttiag or rae4lcting the employmentof o. is lies with the aPPdnting
officer. The Civil Service Commiseton Indicates on applications showing foreign
birth that citizenship has bean verified. The appointing officer should verity
dtsenship if the list of eligibles or the letter of authcri from the Commission
makes the appointment subject to proof of citizenship, or the application shows
foreign birth but does not indicate on Its face that citizenship has been proved.
If the answer to question 4 of this form shows foreign birth and the app !1 cation
shows birth in the United States, the case should be referred to the Civil Service
Commission.
(4) Members o#Family.-Section 9of the Civi)ServiceAdprovidesthatwhen-
ever there are already two or more members of the family In the classified service,
no ather member of such family Is eligible for appointment in that service. Minors
do net establish a different family merely by living at an address different from that of the parents. Doubtful ce, should~ be iderred tothtvm e Civiel Service Com.
including all pertinent evidence,
meson or is duly emb ers of' of r^-, provision n d for decision. Under War Service
reacts cis for the ar or l '' provisio does net apply to temporary mtemporary appofnt?
mans for c one yeah or lees.
311-88t164-1