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104-10129-10002 JFK Assassination Records Archives 1 (8/31/1961)

handle is hein.jfk/jfkarch39771 and id is 1 raw text is: 104-10129-10002 DO NOTUSE THIS PAC l ISSLFED BY a PERSONAL HISTORY STATEMENT THIS DATE (Fill In) ,ifabu4s r 31, /76/ INSTIUCTIONS 1. Answer all questions completely or check appropriate box. If question is not applicable, write NA. Write 'Un- known only if you do not know the answer and it cannot be obtained from personal records. Use blank space at end of form for extra details on any question for which you have insufficient space. 2. Type, print or write carefully; illegible or incomplete forms will not receive consideration. 3. Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful completion of all applicable questions will permit review of your qualifications to the best advantage. ur-IILKAL. rrEUAL A~nDUPRYIrA§ flATA 1. FULL NAME (Laet-Firet-Middle) 2. AGE IO ~ E~ ---TIPiM t~a1 3 ~ 3. SEX --~--tro a r' ~ rM 4. HEIGHT S. WEIGHT 6. COLOR OF EYES 7. COLOR OF HAIR 5. TYPE COMPLEXION 9. TYPE BUILD 10. SCARS (Type and Location) 11. OTHER DISTINGUSHING PHYSICAL FEATURES 12. CURRENT ADDRESS (No., Street, City, Zone, State and Country) 13. PERMANENT ADDRESS (No.. Street, City. Zone, State and Country) AND PHONE NO. 937/ F LwA .v r 14. CURRENT PHONE NO. S CE PHONE NO. & EXT. 16. LEGAL RESIDENCE (State, Territory or Country) C~~d#~F4, R-3I i '4 FLO,, 4w.4 r. 9 17. NICKNAMES A/MIA E 19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHO Fj'd A11 1f1o , ?,eSeir ,,v '9iV4ACs# /,ro A r1tqi,FL7- 49 ao9 D&cdVal ArME 20. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by What Authority). A/R. SECTION II POSITION DATA 1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING 2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL ACCEPT (You will not be considered for any position with a lower entrance salary). $ ' oo e 4. INDICATE YOUR WILLINGNESS TO TRAVEL OCCASIONALLY FREQUENTLY CONSTANTLY OTHER: S. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each Item applicable) WASHINGTON, D.C. ANYWHERE IN U.S. CER`TAIN LOCATIONS ONLY (Specify): OUTSIDE CONTINENTAL U.S. 6. INDICATE WHAT RESERVATIONS YOU WOUA.D PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA. r way war/ Lmes COAvrays we sCLFd 4WD rzml Pi/ Ly FOR FIRM USE PREVIOUS EDITION. 11-58 44 1 44) r ctrinu I - 9 e * I *

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