HR - APPOINTMENT AFFIDAVITS - CRAWFORD, CHESTER C.

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005474317
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 24, 2015
• Document Release Date: January 31, 2011
• Case Number: F-2009-01657
• Publication Date: March 13, 1950

STANDARD FORM 61 (REVISED APRIL 1, 1948)
PROMULGATED BY CIVIL SERVICE COMMISSION
CHAPTER AS FEDERAL PERSONNEL MANUAL
APPOINTMENT AFFIDAVITS
IMPORTANT.-Before swearing to these appointment affidavits, you should read and understand the
attached information for appointee
Central Intelligence Agency Glashington,
C.
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(Department or agency) (Bureau or division) (Place of employment)
Cheo-te --- v
-_o_l leS C-------------------------------------------------- do solemnly swear (or affirm) that-
I, ---- -
A. OATH OF OFFICE
I will support and defend the Constitution of the United 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; that I will well and faithfully discharge the
duties of the office on which I am about to enter, SO HELP ME GOD.
B. AFFIDAVIT AS TO SUBVERSIVE ACTIVITY AND AFFILIATION
I am not a Communist or Fascist. I do not advocate nor am I a member of any organization
that advocates the overthrow of the Government of the United States by force or violence or other
unconstitutional means or seeking by force or violence to deny other persons their rights under the
Constitution of the United States. I do further swear (or affirm) I will not so advocate, nor will
I become a member of such organization during the period that I am an employee of the Federal
Government.
C. AFFIDAVIT AS TO STRIKING AGAINST THE FEDERAL GOVERNMENT
I am not engaged in any strike against the Government of the United States and that I will not
so engage while an employee of the Government of the United States; that I am not a member of
an organization of Government employees that asserts the right to strike against the Government
of the United States, and that I will not, while a Government employee, become a member of such
an organization.
D. AFFIDAVIT AS TO PURCHASE AND SALE OF OFFICE
I have not paid, or offered or promised to pay, any money or other thing of value to any person,
firm or corporation for the use of influence to procure my appointment.
E. AFFIDAVIT AS TO DECLARATION OF APPOINTEE
The answers contained in my Application for Federal Employment, Form No.
dated ______-__~_ u K____________________ 19. 5fl__, filed with the above-named department or, agency,
which I have reviewed, are true and correct as of this date with the exceptions noted in the Declara-
tion of Appointee on the reverse of this form. (If no exceptions, write "None" on the Declaration
of Appointee.)
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(Signature of appointee)
Subscribed and sworn before me this ____ 13th __ day of __________
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--------; arch -------------------- A. D. 195_0 ___
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(State)
aapter 1 ^x ,Ea71 .M 11, Sec. 206 i c
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Apoo
ntment Clerk
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(Title)
NOTE.-If the oath is taken before a Notary Public the date of expiration of his commission should
be shown.
is-ssiao-i
APPROVED FOR RELEASE[]
DATE: 09-Aug-2010
1 % p y
AVAILABLE
 DECLARATION OF APPOINTEE
This form is to be completed before entrance on duty. Question 3 is to be answered in all'cases, otherwise
answer only those questions which require an answer different from that given to the corresponding
questions on your application form. If no answers are different, write "NONE" in Item 10, below. Any
false statement in this declaration will be grounds for cancellation of application or dismissal after appointment.
Impersonation is a criminal offense and will be prosecuted accordingly.
4. DOES THE UNITED STATES GOVERNMENT EMPLOY, IN A CIVILIAN CAPACITY. ANY RELATIVE OF YOURS (EITHER BY BLOOD OR MARRIAGE) WITH WHOM YOU L1llE OR HAVE LIVED WITHIN
THE PAST 24 MONTHS? E YES [] NO
If so, for each such relative fill in the blanks below. If additional space is necessary, complete under Item 10.
POST OFFICE ADDRESS
(1) POSITION (Z) TEMPORARY OR NOT
RELATION-
MAR- SINGLE
NAME
(Give street number, it any)
(3) DEPARTMENT OR AGENCY IN WHICH
SHIP
RIED
EMPLOYED
(Check one)
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2.__________________________________________
3.
INDICATE "YES" OR "NO" ANSWER BY PLACING "X?
10. SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS
IN PROPER COLUMN
YES
NO
INEEM
WRITE IN LEFT COLUMN NUMBERS OF ITEMS TO WHICH DETAILED ANSWERS APPLY
5. ARE YOU A CITIZEN OF OR DO YOU OWE ALLEGIANCE TO THE UNITED STATES?__
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5. ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE. TERRITORY, COUNTY. OR
______
__________________________________________________________________________________
MUNICIPALITY?__________________________________________________-_____._____-_____
If your answer is "Yes", give details in Item 10.
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7. DO YOU RECEIVE ANY ANNUITY FROM THE UNITED STATES OR DISTRICT OF
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COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT OR ANY PENSION OR
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OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICE?______________________
If your answer is "Yes", give in Item 10 reason for retirement,
that is, age, optional disability, or by reason of voluntary
______
____________________________________________________________________________
or involuntary separation after 5 years' service; amount of
retirement pay, and under what retirement act; and rating,
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______
___________________________________________________________
_
if retired from military or naval service.
_
_____________________
8. HAVE YOU EVER BEEN DISCHARGED, OR FORCEDTO RESIGN, FOR MISCONDUCT
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OR UNSATISFACTORY SERVICE FROM ANY POSITION? ____________________________
______
__________________________________________________________________________________
If youranswer is "Yes", give in Item 10 the name and address
of employer, date, and reason in each case.
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9. SINCE YOUR 16TH BIRTHDAY. HAVE YOU EVER BEEN ARRESTED, INDICTED; OR
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______
________________________________________________________________________________
SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR
CONVICTED, FINED, OR IMPRISONED, OR PLACED ON PROBATION, OR HAVE YOU
______
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EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION
OFANYLAW, POLICE REGULATION, ORORDNANCE (EXCLUDING MINORTRAFFIC
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VIOLATIONS FOR WHICH A FINE OR FORFEITURE OF $26ORLESS WAS IMPOSED)?
If your answer is "Yes", list all such cases under Item 10.
______
__________________________________________________________________________________
Give in each case: (1) The date; (2) the nature of the offense
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or violation; (3) the name and location of the court; (4) the
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penalty imposed, if any, or other disposition of the case.
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_________________________________________________
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If appointed, your fingerprints will be taken.
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The appointing officer before whom the foregoing certificate is made shall
determine to his own satisfaction that this appointment would be in conformance
with the Civil Service Act, applicable Civil Service Rules and Regulations and
acts of Congress pertaining to appointment.
This form should be checked for holding of office, pension, suitability in con-
nection with any record of recent discharge or arrest, and particularly for the
following:
(1) Identity of appointee.-The appointee's signature and handwriting are'
to be compared with the application and/or other pertinent papers. The
physical appearance may be checked against the medical certificate. The
appointee may also be questioned on his personal history for agreement with his
previous statements.
(2) Age: If definite age limits have been established for the position, it should
be determined that applicant is not outside the age range for appointment.
Until such determination is made, the appointma-st may not be consummated.
(3) Citizenship.-The appointing officer "is responsible for observing the
citizenship provisions of (1) the Civil Service Rules and (2) appropriation acts.
Form 61 constitutes an affidavit for both purposes and is acceptable proof of
citizenship status in the absence of conflicting evidence. In doubtful cases the
appointment should not be consummated until clearance has been secured from
the certifying office of the Civil Service Commission.
(4) Members of Family.-Section 9 of the Civil Service Act provides that
whenever there are already two or more members of a family serving under
probational or permanent appointment in the competitive service, no other
member of such family is eligible for probational or permanent appointment in
the competitive service. The appointments of persons entitled to veteran
preference are not subject to this requirement. The members-of-family provision
does not apply to temporary appointments. Doubtful cases may be referred to
the appropriate office of 0- Civil Service Commission for decision,
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