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D
UNITLD STATES OF-AMERICA
FORM NNI-140
OVAH
PERSONNEL SECURITY QUESTIONNAIRE
oray
(DO NOT USE THIS SPACE)
(A)
(DO NOT USE THIS SPACE)
(B)
ampace
Jag 2019
it
5
a
Ob CONGYMA OB
mm
K
ple
(nanvr os WVBK of
your
8 mgm 3 gan
E
SCEIOS * pe (vo)
(28 9)
-
po IT 9 of pe (orrug* IC ra [OL suq ancp
1 or cpo 916 (LIIG sug 9500 LIG cpe nurceq
+
5
TO: THE SECRETARY OF (2)
Date (1)
(2)
(NAME OF ESTABLISHMENT) (3)
(STREET ADDRESS OF PLACE AT WHICH WORK IS TO BE PERFORMED (4)
(COMMUNITY IN WHICH WORK IS TO BE PERFORMED) (5)
To enable the undersigned to discharge its obligations under the Espionage and National Defense statutes and regulations thereunder, the
(3)
following facts are submitted for the information of the Government of the United States. This questionnaire is .not intended to cast
doubt upon the loyalty of any citizen of the United States, but, on the contrary, is intended to establish mutual confidence among loyal
1
defense workers by obviating any suspicion which might be cast upon them. and by making as difficult as possible the employment of
(4)
agents of foreign governments who by subversive and sabotage tactics might endanger such loyal workers and the work under performance.
(s)
VIVWE (30%)
(FIRST NAME) (6a)
(MIDDLE NAME) (6b)
(LAST NAME) (6c)
(180)
suc whose Social Security Number is (7)
and has been employed by this establishment for (8)
(6a)
years, and whose photograph is attached hereto. and is technically qualified to perform the following work:
MGII
CIAG cples
(9)
(6b)
(SHOW TITLE OR TITLES AND A BRIEF DESCRIPTION OF THE JOB AND THE CHARACTER OF THE WORK ON WHICH THE INDIVIDUAL IS TO BE EMPLOYED, AND STATE
IF POSITION IS SUBJECT TO A PERSONAL OR POSITION BOND)
(6c)
The work to be conducted is of prime interest to (10)
(UNITED STATES GOVERNMENT DEPARTMENT AND BUREAU)
(7)
(8)
in connection with (11)
From the information available to us at this time the above-named person appears to be a loyal citizen of the United States and we do not
(9)
question his loyalty and integrity However, according to our contract, if information comes to our attention which renders his employment
undesirable, we will promptly notify the interested Department and Bureau of the United States Government accordingly and in the
event this individual leaves our employ during the progress of this work, we will give notification at the time of the severance of his
em-
CONMULE
ployment Employee's declaration in his own behalf, consisting of physical description, photograph, and statements of military or naval
(10)
record. education, principal employment, citizenship, relatives membership in organizations, activities from 1914 to -1918, violations
of
2.LV.LEWE) the law, bonding, service in foreign governments, time spent outside of the United States, and references are subjoined to this statement
and made a part of it
(11)
(DO NOT USE THIS SPACE)
(c)
(23.0)
(12)
(13)
(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)
(14a)
(asp)
(14b)
(TITLE) (13)
(14c)
AGOW 10
COWLEM
(21q)
(336)
LIWEO
Ok
IHI
Number A 325114
(15)
2IVIEWE
PATENTED
NAME (14a) (LAST)
(FIRST) (14b)
(MIDDLE) (14c)
(COMPANY) (15)
Day
Ina
Elithe
11.20°
or TOO s poug (1) para
OE BONDI (ae) 00 so mucepor OL DOS AO GAGL pegu pougsg
OL
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DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Document source extras
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"ocrText": "D\nUNITLD STATES OF-AMERICA\nFORM NNI-140\nOVAH\nPERSONNEL SECURITY QUESTIONNAIRE\noray\n(DO NOT USE THIS SPACE)\n(A)\n(DO NOT USE THIS SPACE)\n(B)\nampace\nJag 2019\nit\n5\na\nOb CONGYMA OB\nmm\nK\nple\n(nanvr os WVBK of\nyour\n8 mgm 3 gan\nE\nSCEIOS * pe (vo)\n(28 9)\n-\npo IT 9 of pe (orrug* IC ra [OL suq ancp\n1 or cpo 916 (LIIG sug 9500 LIG cpe nurceq\n+\n5\nTO: THE SECRETARY OF (2)\nDate (1)\n(2)\n(NAME OF ESTABLISHMENT) (3)\n(STREET ADDRESS OF PLACE AT WHICH WORK IS TO BE PERFORMED (4)\n(COMMUNITY IN WHICH WORK IS TO BE PERFORMED) (5)\nTo enable the undersigned to discharge its obligations under the Espionage and National Defense statutes and regulations thereunder, the\n(3)\nfollowing facts are submitted for the information of the Government of the United States. This questionnaire is .not intended to cast\ndoubt upon the loyalty of any citizen of the United States, but, on the contrary, is intended to establish mutual confidence among loyal\n1\ndefense workers by obviating any suspicion which might be cast upon them. and by making as difficult as possible the employment of\n(4)\nagents of foreign governments who by subversive and sabotage tactics might endanger such loyal workers and the work under performance.\n(s)\nVIVWE (30%)\n(FIRST NAME) (6a)\n(MIDDLE NAME) (6b)\n(LAST NAME) (6c)\n(180)\nsuc whose Social Security Number is (7)\nand has been employed by this establishment for (8)\n(6a)\nyears, and whose photograph is attached hereto. and is technically qualified to perform the following work:\nMGII\nCIAG cples\n(9)\n(6b)\n(SHOW TITLE OR TITLES AND A BRIEF DESCRIPTION OF THE JOB AND THE CHARACTER OF THE WORK ON WHICH THE INDIVIDUAL IS TO BE EMPLOYED, AND STATE\nIF POSITION IS SUBJECT TO A PERSONAL OR POSITION BOND)\n(6c)\nThe work to be conducted is of prime interest to (10)\n(UNITED STATES GOVERNMENT DEPARTMENT AND BUREAU)\n(7)\n(8)\nin connection with (11)\nFrom the information available to us at this time the above-named person appears to be a loyal citizen of the United States and we do not\n(9)\nquestion his loyalty and integrity However, according to our contract, if information comes to our attention which renders his employment\nundesirable, we will promptly notify the interested Department and Bureau of the United States Government accordingly and in the\nevent this individual leaves our employ during the progress of this work, we will give notification at the time of the severance of his\nem-\nCONMULE\nployment Employee's declaration in his own behalf, consisting of physical description, photograph, and statements of military or naval\n(10)\nrecord. education, principal employment, citizenship, relatives membership in organizations, activities from 1914 to -1918, violations\nof\n2.LV.LEWE) the law, bonding, service in foreign governments, time spent outside of the United States, and references are subjoined to this statement\nand made a part of it\n(11)\n(DO NOT USE THIS SPACE)\n(c)\n(23.0)\n(12)\n(13)\n(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)\n(14a)\n(asp)\n(14b)\n(TITLE) (13)\n(14c)\nAGOW 10\nCOWLEM\n(21q)\n(336)\nLIWEO\nOk\nIHI\nNumber A 325114\n(15)\n2IVIEWE\nPATENTED\nNAME (14a) (LAST)\n(FIRST) (14b)\n(MIDDLE) (14c)\n(COMPANY) (15)\nDay\nIna\nElithe\n11.20°\nor TOO s poug (1) para\nOE BONDI (ae) 00 so mucepor OL DOS AO GAGL pegu pougsg\nOL"
}