1. (a) for what positions do you wish to be examined?

(b) for what service (postal or customs) do you wish to be examined?

(c) in what city or town do you desire employment?

2. what is your name in full? give your first name in full, your middle initial, or initials, if any, and your surname in full.

3. are you a citizen of the united states? answer must be “yes” or “no.” if a naturalized citizen, your certificate of naturalization, or the certificate of naturalization of one of your parents (if such parent was naturalized while you were a minor), with sworn statements, on form 44, of two disinterested citizens as to the reputed relationship, must be forwarded with the application. the certificate will be returned to you.

4. (a) where were you born?

(b) what was the month, day and year of your birth?

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(c) what was your age on your last birthday?

5. name the kind of school in which you were educated. viz: common school, high school, business college, academy, college, etc. if educated in high school, academy, college, university, etc., give the name and location of the school, and state how long you attended, and whether you were graduated.

6. how long did you attend school, and at what age did you leave school?

7. are you or have you been married? answer “yes” or “no.” if applicant is a married woman, the full name, post office address and legal residence of her husband are required. a married woman, not divorced, but living apart from her husband, should state the facts, if any, entitling her to separate residence.

8. are any members of your family, or any of your relatives, in the service of the government? answer “yes” or “no.” if so, state their names, in what position, in what branch of the service, and the relationship. this does not apply to state or municipal service.

9. have you ever been convicted of, or indicted for, any crime. answer “yes” or “no.” if so, inclose herewith an abstract from the court proceedings to show the essential action taken, and also furnish a statement from the trial judge or other court officer[32] showing the surrounding circumstances and your reputation for honesty and integrity.

10. (a) do you habitually or at times use intoxicating liquors, tobacco, morphine, or opium to excess?

(b) if so, which?

(c) have you ever used intoxicating liquors, tobacco, morphine, or opium to excess?

(d) if so which?

11. (a) have you any defect of sight in either eye?

(b) have you any defect of speech?

(c) have you any defect of limb?

(d) have you any defect of hearing?

12. what is your height, measured in your bare feet?

13. what is your weight in your ordinary clothing, without overcoat or cloak?

14. have you been examined for any branch of the classified service within twelve months next preceding the date of application? if so, state for what branches, for what positions, the date, and results. the different branches of the service are: postoffice, customs, internal revenue, departmental, and government printing?

15. (a) have you ever been barred from examination by this commission? answer “yes” or “no.”

(b) if so, state when and for what reason.

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(c) give the date, place, and kind of examination for which you applied and in connection with which you were barred.

16. (a) have you any other application on file for any branch of the classified service? answer “yes” or “no.”

(b) if so, what branch and for what position?

(c) is your name now on any register for appointment in any branch of the classified service? answer “yes” or “no.”

(d) if so, for what branch, in what city, and for what position? this does not apply to state or municipal service.

17. are you now in the government civil service? answer “yes” or “no.”

18. (a) were you ever separated from the government civil service? answer “yes” or “no.”

(b) if so, state when, from what position, what city, and branch of service, and whether you resigned or were discharged. avoid any allusion to politics or to change of administration.

19. (a) are you now in the military or naval service of the united states? answer “yes” or “no.” do not give service in the national guard.

(b) were you ever honorably discharged from the military or naval service of the united states on account of disability resulting from wounds received or[34] sickness incurred in the line of duty? if so, give the name of the vessel on which, or the company and regiment in which you served, with the dates of your enlistment and discharge.

(c) give the exact name under which you enlisted and were discharged.

20. (a) what is your present place of abode.

(b) what is your present occupation, business, employment, or position.

(c) what was your place of abode (city or town, and state) during last year?

(d) what was your occupation, business, employment, or position during that year?

(e) what was your place of abode (city or town, and state) during the year preceding last year?

(f) what was your occupation, business, employment, or position during that year?

(g) what was your place of abode (city or town, and state) during the second year preceding last year?

(h) what was your occupation, business, employment, or position during that year?

21. give the names and addresses of five persons, other than vouchers, to whom reference can be made as to your character and qualifications. one of these must reside in, or be engaged in business in the city or town in which you seek employment.

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22. have you been employed in any state or municipal service? answer “yes” or “no.” if so, when, where, and in what positions?

23. (a) were you ever discharged on account of delinquency or misconduct from any position in which you were employed? answer “yes” or “no.”

(b) if so, state when, from what position, and by whom were you discharged.

24. are each and all of the answers to the foregoing questions in your own handwriting? answer “yes” or “no.”

i hereby certify that the answers to the foregoing questions are true in every particular.

(signature of applicant) ............

(p. o. address) ..............

(the following oath must be taken before a notary public, or other officer authorized to administer oaths for general purposes, and the officer’s signature must be authenticated by official seal. if the oath be taken before a justice of the peace or other officer who has no official seal, his character must be certified by the clerk of court, secretary of state, or other proper officer, under official seal.)

the notary is requested to see that all the foregoing questions are answered in full before executing the jurat.

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sworn to and subscribed before me by the above-mentioned applicant, to me personally known, this ...... day of ................ 190..., at ........... county of ............................ and state (or territory or district) ........................

(signature of officer) ...................

(official impressed seal.) (official title) .........

the official seal must not be omitted.

every applicant for examination must furnish the vouchers of two citizens of the united states, each of whom must be at least twenty-one years of age, and must have known the applicant for six months or more. vouchers will not be accepted from the father, mother, sister, brother, husband, wife or child of the applicant, and not more than one voucher will be accepted from relatives of more remote degree.

no recommendations other than those provided for hereon will be accepted by the commission.

vouchers.

the following is a sample of the two vouchers; all answers made by vouchers must be in their own handwriting.

1. what is your own age? age of voucher, not applicant, is wanted. if you so prefer, the statement that you are over 21 years of age is sufficient.

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2. what is your occupation?

3. what is your business address in full?

4. what is your actual bona fide (legal) residence? city and state?

5. how long have you been such resident thereof?

6. how long have you been acquainted with the applicant?

7. is the applicant addicted to the use of intoxicating beverages, tobacco, morphine, or opium? if so, to which?

8. has the applicant ever been addicted to the use of intoxicating beverages, tobacco, morphine, or opium? if so, to which?

9. is the applicant a person of good moral character, and of good repute?

10. are you related to the applicant? if so, what is the relationship?

11. are you aware of any circumstances tending to disqualify the applicant for the public service?

12. would you yourself trust the applicant with employment requiring undoubted honesty?

13. what is the name of the applicant for whom you furnish this certificate? first name, middle initial, or initials, if there be any, and last name, should be correctly given.

the above questions are answered to the best of my knowledge and belief.

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(signature of voucher) ......................

(p. o. address) .........................

date, ............... 190 .

(applicant will not fill the following blank.)

final certificate of naturalization of ............. issued by the ............. court of .............. on ............ i ............., was filed with this application by the applicant, and was found by me to be in due form in all respects. the certificate was returned to the applicant on ....... ........., 190....

(initials) .................