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UNITL D STATES OFAMERICA
FORM NNI-140
PERSONNEL SECURITY QUESTIONNAIRE
(DO NOT USE THIS SPACE)
(A)
(DO NOT USE THIS SPACE)
(B)
to
asm
qua
H
promet
(LLIFE)
5
(vo)
(nanvo or of
a
(20 9)
(nanvr Ok
gro 8mm B
your
E
oppes de usa pe (vo)
-
to
or apong pg IF 12 [OL suq anop
1 angel OL oper cps 916 suq suo que of suc (a
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) (s)
(3)
To enable the undersigned o discharge its obligations under the Espionage and National Defense statutes and regulations thereunder, the
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
defense workers by obviating any suspicion which might be cast upon them, and by making as difficult às possible the employment of
(4)
0
agents of foreign governments who by subversive and sabotage tactics might endanger such loyal workers and the work under performance
(s)
S
(FIRST NAME) (6a)
(MIDDLE NAME) (6b)
(LAST NAME) (6c)
5
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:
(g)
(6b)
(SHOW TITLE OR TITLES AND BRIEF DESCRIPTION OF THE JOB AND THE CHARACTER OF THE WORK ON WHICH THE INDIVIDUAL IS TO BE EMPLOYED, AND STATE
(6 c)
IF POSITION IS SUBJECT TO A PERSONAL OR POSITION BOND)
(300)
The work to be conducted is of prime interest to (10)
(UNITED STATES GOVERNMENT DEPARTMENT AND BUREAU)
(7)
(a)
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-
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
2LV LEVE 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)
(33,9)
(12)
(21C)
(13)
(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)
(14a)
(14b)
(TITLE) (13)
(310)
(14c)
30
lavion (010)
1930
BEHAICE
CONBEW
vonseas
(isa)
wevaom LOS
LIWE Ok
Number A 325114
(15)
OL 2EKAIGE2 COL
@ PATENTED
NAME (14a) (LAST)
(FIRST) (14b)
(MIDDLE) (14c)
(COMPANY) (15)
Day
Ina
Elithe
1
(1)
pagu posgeg or
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Document 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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"coverageEndDate": {
"day": 30,
"logicalDate": "1946-07-30",
"month": 7,
"year": 1946
},
"coverageStartDate": {
"day": 16,
"logicalDate": "1942-03-16",
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"year": 1942
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"ocrText": "UNITL D STATES OFAMERICA\nFORM NNI-140\nPERSONNEL SECURITY QUESTIONNAIRE\n(DO NOT USE THIS SPACE)\n(A)\n(DO NOT USE THIS SPACE)\n(B)\nto\nasm\nqua\nH\npromet\n(LLIFE)\n5\n(vo)\n(nanvo or of\na\n(20 9)\n(nanvr Ok\ngro 8mm B\nyour\nE\noppes de usa pe (vo)\n-\nto\nor apong pg IF 12 [OL suq anop\n1 angel OL oper cps 916 suq suo que of suc (a\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) (s)\n(3)\nTo enable the undersigned o discharge its obligations under the Espionage and National Defense statutes and regulations thereunder, the\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\ndefense workers by obviating any suspicion which might be cast upon them, and by making as difficult às possible the employment of\n(4)\n0\nagents of foreign governments who by subversive and sabotage tactics might endanger such loyal workers and the work under performance\n(s)\nS\n(FIRST NAME) (6a)\n(MIDDLE NAME) (6b)\n(LAST NAME) (6c)\n5\nwhose 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:\n(g)\n(6b)\n(SHOW TITLE OR TITLES AND BRIEF DESCRIPTION OF THE JOB AND THE CHARACTER OF THE WORK ON WHICH THE INDIVIDUAL IS TO BE EMPLOYED, AND STATE\n(6 c)\nIF POSITION IS SUBJECT TO A PERSONAL OR POSITION BOND)\n(300)\nThe work to be conducted is of prime interest to (10)\n(UNITED STATES GOVERNMENT DEPARTMENT AND BUREAU)\n(7)\n(a)\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\nthe\nevent this individual leaves our employ during the progress of this work, we will give notification at the time of the severance of his em-\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 of\n2LV LEVE 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(33,9)\n(12)\n(21C)\n(13)\n(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)\n(14a)\n(14b)\n(TITLE) (13)\n(310)\n(14c)\n30\nlavion (010)\n1930\nBEHAICE\nCONBEW\nvonseas\n(isa)\nwevaom LOS\nLIWE Ok\nNumber A 325114\n(15)\nOL 2EKAIGE2 COL\n@ PATENTED\nNAME (14a) (LAST)\n(FIRST) (14b)\n(MIDDLE) (14c)\n(COMPANY) (15)\nDay\nIna\nElithe\n1\n(1)\npagu posgeg or"
}