QUESTIONNAIRES 
EXPERIENCE RECORD 
D ( Confidential ) 
Do ET ar Uh Se. Susdering » Shuuge of cud er 
sure you are taking a step which will lead to your success. If any question does not apply to you wnte 
“No” or “None” et it 
ER ON co premrneStA  evr pse eemme BW  TTV sasesban mop szsares nen ana +192. 
Last First Middle : 
8 Date of Birth. . cenannrorsnssaansites anurans winenns; Se WHEE DOM vas) Sviava as) ansvendossd oa 
6. Lineage or birth (American, English, Scotch, Irish, French, Hebrew, etc)  ............ rire Nl same adine 
? Height. «uvurvee fbn isinians im Weight «. Ib % Na af dependents. Children ..Adules..... 
9 Single O Married 0 ‘Widowed 0 Divorced 00 or Separated (O. 
ia Schooling: : Name of Schaal tek fast Year 
Grammar School ) 
High or. Preparatory School 
College or Technical School! 
Special Study 
= Correspondence Courses 
: 1 Business College or Trade School 
"Night School 
11. Give a full account of how your time has been spent, whether employed or mot, since leaving school. List separately 
all different positions you have held. For example, if you have been a clerk and a salesman for the same com 
pany, list each one separately. 
TTY | Nature of your work | Place Whete eiployed of |Company by whom employed 
~1 
Figure 16a: A model application blank, page 1. 
tions given to place a check in the parentheses following the 
correct answer. For example: 
Marital status: Single ( ) , married ( \/ ), divorced ( ), 
separated ( ), widower ( ). 
After a list of answers like this, a blank space may be left 
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