APPOINTMENT AFFIDAVITS - HITCHCOCK, PETER S

• Document Type: FOIA
• Keywords: HITCHCOCK PETER
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001515938
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 22, 2015
• Document Release Date: August 7, 2009
• Case Number: F-2008-00564
• Publication Date: September 10, 1951

SYANDARD FORM 61 (REVtsea AuGUSr Isas)
PROMULGATED BY CIVIL SERVICE COMMISSIGN
FEDERAL PERSONNEL MANUAL
APPOINTMENT AFFIDAVITS
IMPORTANT.-Before srvearin~ to these appointment affidavits, you should read and unders?~and the
attached information for appointee
---------------------------~~--------------------------------------------------------------- ----------------------/-Y------------__----------
(Departmeat or agency) (Bureau or division) (Place of employment)
I, _lr'e-tex_~tex~.in~_Hi~ehcock__________________________________________ do solemnly swear (or affirm) that-
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 ~EI.P ME G?D.
R. AFFIDAVIT AS TO SIIBVERSIVE ACTIVITY AND AFFILIATION
I am not a Communist. or Fascist. I do not advocate nor am T 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 GOVEI1Nb9ENT
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 given in .the Declaration of Appointee on the reverse of this form are true and
correct. '
i
------- - ~--?---s ~-r-~-'---- ~ -~ --------------
10th Sept?. -------------- A. D. 19-51-
Subscribed and sworn before me this __________________ day of ________________________________ ,
at----------------------------------------------- U~ashington,_ D. ~
~~EAL~ _I ignature~t~n~ce37
(Title).
NOTE.-If the oath i~ talcen before a 1Votary Public the date of expiration of his commission should
be shown. ~s-ss~sa~
APPROVED FOR
RELEASE^DATE:
28-Jul-2009
 DECLARATION OF .APPOINTEE
This form is to be completed before entrance on duty. Answer all questions. Any false statement in this
declaration will be grounds for cancellation of application or dismissal after appointment. gmpersona~tion is a
criminal offense and will be prosecuted accordingly.
M /~ 2 s ~+ rt ~ t-- ,
2. (A) DATE OF BIRTH I (B) PLACE OF BIRTH (oily or town and State or country)
l2~/tl~/ ~~~fs CL~VG~-Mf~i4 f O~~~o
S. (A)1N CASE OF EMERGENCY PLEASE NOTIFY I (B) RELATIONSHIP I (C) STREET AND NUMBER, CITY AND STATE
):1,IZ,1r3Erl+ G. H ITet+eoeK
M ~ R 5 rtA~~- , /a .
(D) TELEPHONE N0.
~~.33.
4. DOES THE UNITED STATES GOVERNME T EMPLOY, IN A CIVILIAW CAPACITY, ANY RELATIVE OF YOURS (EITHER BY BLOOD OR MARRIAGE) WITH WHOM YOU LIVE Oft HAVE L[VED WITHIN
THE FAST 24 MONTHS? ~ YES ~NO
h h 1 fill ' fh bl 1 s below If additional space is necessary complefe under Item 10.
If so, foz sac suc re alive :n a sn c
POST OFFICE ADDRESS (1) POSITION (2) TEMPORARY OR NOT RELATION- MAR I SINGLE
NAME (Give stroat nvmbor, if any) (3) DEPARTME EMPLOYED CY IN WHICH SHIP (Check ono)
1.-------------------------------------?-__
2?-'-'-----------------'-------------=-----
3.
I?-----------------'--------------------'---
2.----------------------------------------
8.
1.-----------'------:----------------------
S.-
?
"
10. SPACE FOR DETAILED ANSWERS T
O OTHER Q8lESTIOPiS
X
INDlCATE "YES" OR "NO" ANSWER BY PLACING
YES
NO
IN PROPER COLUMN -
ITEM
WRITE IN LEFT COLUMN NUMBERS OF ITEMS TO WHICH DETAILED ANSWERS APPLY
NO
5. ARE YOUACITIZENOFORDOYOUOWEALLEGIANCETOTHEUNITEDSTATESI__
~
--
- ---- ----- ------- - ---- ------- ------------------------------------- ------
6. ARE YOU AN OFFICIAL OR EMPLOYEE OF ANY STATE, TERRITORY, COUNTY, OR
` ,
:_____
MUNICIPALITY7_----_______'__---___"-'---'-'_____________'-___----'--"-----"__
x
If your answer fa "Yes", gfve details in Item 10.
______
DO YOU RECEIVE ANY ANNUITY FROM THE UNITED STATES OR DISTRICT OF
7
-__.-_
.
COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT OR ANY PENSION OR
OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICEI______~~_____________
r retirement
f
10
i
It
i
"
"
~
_-____
,
reason
o
em
n
ve
Yea
~
If your answer is
fhat ra, ale, optional isabflity, or by reason of voluntary
______
or involuntary separation after 5 years' service; amount of
retirement pay, end under what roftrament act; and rating,
______
if retrred from mzlitafy OZ naval aervtoe.
6. S[NCE YOU FILED APPLICATION RESULTING IN THIS APPOINTMENT HAVE YOU
------
~ -------------------------------------------------------------------------------~
--
BEEN DISCHARGED, OR FORCED TO RESIGN, FOR MISCONDUCT OR UNSATIS?
.
FACTORY SERVICE FROM ANY pOSIT10N7_________________________________
~/
/~
____:_
Ifyour answer ie "Yes", give in Item 10 the name and address
.,
_
__ _
of employer, date and reason fn each case.
---------------------------------------------------------------------------------
9. HAVE YOU BEEN ARRESTED (NOT INCLUDING TRAFFIC VIOLATIONS FOR
---------------------------------------------------------------------------------
WHICH YOU WERE FINED 525 OR LESS, OR FORFEITED COLLATERAL OF 52508
. -
_ ____
LESS) SINCE YOU FILED APPLICATION RESULTING IN THIS APPOINTMENT7__,
~
~(_
/~(
If your answer is "Yea", list e11 such cases under Item 10.
- __
Give in each case: (I) The dafe; (2) the nature of the offense
______
or violation; (3) the name and location of the court; (4) fha
penalfy.impoaed, ff any, or other disposition of the case.
______
If appointed, your fin~exprxnts will be falcon.
INSTRUCTIONS TO APPOINTBNG OFFICER
The appointing officer before whom the foregoing certificate is made shall C~ Age.-If definite age limits have been established for the position, it should
determine to his own eatiefaction that this appointment would be in conformance be determined that applicant is not outside the age range for appointment.
with the Civil Service Act, applicable Civil Service Rules and Regulations and Until such determination is made, the appointment may not be consummated.
acts of Congress pertaining to appointment. (3) Citizenship.-The appointing officer is responsible for observing the
This form should be checked for holding of office, peasioa, suitability in con- citizenship provisions of (1) the Civil Service Rules and (2) appropriation acts.
nection with any record of recent discharge or arrest, and particularly for the Form 61 constitutes an affidavit for both purposes and is acceptable proof of
following: citizenship status in the absence of conflicting evidence. In doubtful cases the
(1) Identity of appointee.-It is the duty of the appointing officer to appointment should not be consummated-until clearance hasbeen secured from
guard against inperaonation and to determine beyond reasonable doubt that the 'the certifying office of the Civil Service-Commission.
appointee is the same person whose appointment was authorized. The (4) Members of Family.-Section 9 of the Civil Service Act provides that
appointee's signature and handwriting are to be compared with the application whenever there are already two or more members of a family serving under
andJor other pertinent papers. If the appointee qualified in a written exami- probational of permanent appointment in the competitive service, no other
nation, the signature on this form should be compared with the signature on member of such family is eligible for probations?1 or permanent appointment in
the declaration sheet, which was signed in the examination room. His physical -the competitive -service. The appointments of persona entitled to veteran
appearance may be checked against the medical certificate. The appointee preference are not subject to this requirement. The members-of-family provision
may also be questioned on his personal history for agreement with his previous does not apply to temporary appointments. Doubtful cases may be referred to
statements, the appropriate office of the Civil Service Commission for decision.
a. 6. GOIfERN MENT PRi NTING OFFICE 1G-65.30-'u
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