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UNITOD STATES OFAMERICA
FORM NNI-140 10 OVAH
home
PERSONNEL SECURITY QUESTIONNAIRE
(DO NOT USE THIS SPACE)
(A)
(DO NOT USE THIS SPACE)
(B)
H
dr
grim
5
(va)
a
Ob CONNVMA OM
MILMEDE:
(20 9)
(nanvr
85mg
IT
orpet sopton - ps (vo)
with
(38C)
-
(o I's of po II 12 [OL suq ancp
or spor aps 8LG CLITG suq of 10
(aop)
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 to 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 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)
S
MAWE (988)
(FIRST NAME) (6a)
(MIDDLE NAME) (6b)
(LAST NAME) (6c)
(399)
que
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:
DULGG
01
(9)
(6b)
(SHOW TITLI ORTITLES 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)
(303)
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-
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
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)
(314)
(12)
(13)
(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)
(14a)
(aup)
(14b)
(TITLE) (13)
(31#)
(14c)
(33,8)
- 10
VEROCÍVIES
(210)
LEAW IMVILIOM (750)
VIVWE
be
SEMAICE (RAP)
(319)
(334)
COWbEM
los
LIWE Oll
HYWER Ob
LOMELOL4 or
LIE
Number A 325114
(15)
PATENTED
3
NAME (14a) (LAST)
(FIRST) (14b)
(MIDDLE) (14C)
(COMPANY) (15)
(20)
Day
Ina
Elithe
I[ 20' MUGU sug p2
MPGEUGL of unc S poug
(1)
MUSC
combona
OL (21) 200 poou pougeq
OL
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Context sent to Scholar
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"ocrText": "UNITOD STATES OFAMERICA\nFORM NNI-140 10 OVAH\nhome\nPERSONNEL SECURITY QUESTIONNAIRE\n(DO NOT USE THIS SPACE)\n(A)\n(DO NOT USE THIS SPACE)\n(B)\nH\ndr\ngrim\n5\n(va)\na\nOb CONNVMA OM\nMILMEDE:\n(20 9)\n(nanvr\n85mg\nIT\norpet sopton - ps (vo)\nwith\n(38C)\n-\n(o I's of po II 12 [OL suq ancp\nor spor aps 8LG CLITG suq of 10\n(aop)\nTO: THE SECRETARY OF (2)\nDate (1)\n(2)\n(NAME OF ESTABLISHMENT)\n(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 to 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 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)\nS\nMAWE (988)\n(FIRST NAME) (6a)\n(MIDDLE NAME) (6b)\n(LAST NAME) (6c)\n(399)\nque\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:\nDULGG\n01\n(9)\n(6b)\n(SHOW TITLI ORTITLES 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(303)\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 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\nof\nthe 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(314)\n(12)\n(13)\n(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)\n(14a)\n(aup)\n(14b)\n(TITLE) (13)\n(31#)\n(14c)\n(33,8)\n- 10\nVEROCÍVIES\n(210)\nLEAW IMVILIOM (750)\nVIVWE\nbe\nSEMAICE (RAP)\n(319)\n(334)\nCOWbEM\nlos\nLIWE Oll\nHYWER Ob\nLOMELOL4 or\nLIE\nNumber A 325114\n(15)\nPATENTED\n3\nNAME (14a) (LAST)\n(FIRST) (14b)\n(MIDDLE) (14C)\n(COMPANY) (15)\n(20)\nDay\nIna\nElithe\nI[ 20' MUGU sug p2\nMPGEUGL of unc S poug\n(1)\nMUSC\ncombona\nOL (21) 200 poou pougeq\nOL"
}