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D
UNITOD STATES OFOAMERICA
FORM NNI-140
VALMOMISED LO VONIVIBLES OVAN
PERSONNEL SECURITY QUESTIONNAIRE
(DO NOT USE THIS SPACE)
(A)
(DO NOT USE THIS SPACE)
H
.
of
(B)
dis
300
175
5
party T
(10)
a
Oh "ou
UNIVERSITY CNN
(2aq)
(nanve OIS Oh
you gman of good
E
ospes SCPIOU * pe (no)
into
(pac)
-
to su) conpequeq Il S or aporging pc II ná [OL suq
1
of SLG sug combjese gud spo of rpo 18
+
(2ap)
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) (s)
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
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
(309)
(s)
(FIRST NAME) (6a)
(MIDDLE NAME) (6b)
(LAST NAME) (6c)
(39 C)
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:
(9)
(6b)
(SHOW TITL FORTITLES AND ABRIEF DESCRIPTION OF THE JOB AND THE CHARACTER OF THE WORK ON WHICH THE INDIVIDUAL IS TO BE EMPLOYED, AND STATE
i
IF POSITION IS SUBJECT TO A PERSONAL OR POSITION BOND)
(6c)
(393)
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
question his loyalty and integrity. However, according to our contract, if information comes to our attention which renders his employment
(9)
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
VLEWEL
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)
(12)
(3AC)
(13)
(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)
(14a)
(aap)
(14b)
(TITLE) (13)
(RAD)
(14c)
AO
LEEWIVVILION (330)
GEMAICE (3AP)
CONLEW
(aix)
(336)
MEVEOM LOS
JINE Ole
Ok
IM LOKEICIA OK LOFILIC
Number A 325114
(15)
20BD1A1210M2 THE
@ PATENTED
A
NAME (14a) (LAST)
(FIRST) (14b)
(MIDDLE) (14C)
(COMPANY) (15)
Day
Ina
mithe
sugit uor S (1)
II 80' Mpsc
OL VMD MANKVACE: (ae) ge OL noc 2on usag GAGE psgu pougso OL
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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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"logicalDate": "1946-07-30",
"month": 7,
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Page context
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"ocrText": "D\nUNITOD STATES OFOAMERICA\nFORM NNI-140\nVALMOMISED LO VONIVIBLES OVAN\nPERSONNEL SECURITY QUESTIONNAIRE\n(DO NOT USE THIS SPACE)\n(A)\n(DO NOT USE THIS SPACE)\nH\n.\nof\n(B)\ndis\n300\n175\n5\nparty T\n(10)\na\nOh \"ou\nUNIVERSITY CNN\n(2aq)\n(nanve OIS Oh\nyou gman of good\nE\nospes SCPIOU * pe (no)\ninto\n(pac)\n-\nto su) conpequeq Il S or aporging pc II ná [OL suq\n1\nof SLG sug combjese gud spo of rpo 18\n+\n(2ap)\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) (s)\nTo\nenable 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\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(309)\n(s)\n(FIRST NAME) (6a)\n(MIDDLE NAME) (6b)\n(LAST NAME) (6c)\n(39 C)\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(9)\n(6b)\n(SHOW TITL FORTITLES AND ABRIEF DESCRIPTION OF THE JOB AND THE CHARACTER OF THE WORK ON WHICH THE INDIVIDUAL IS TO BE EMPLOYED, AND STATE\ni\nIF POSITION IS SUBJECT TO A PERSONAL OR POSITION BOND)\n(6c)\n(393)\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\nquestion his loyalty and integrity. However, according to our contract, if information comes to our attention which renders his employment\n(9)\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 of\nVLEWEL\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(12)\n(3AC)\n(13)\n(USUAL SIGNATURE OF COMPANY OR INSTITUTION OFFICIAL) (12)\n(14a)\n(aap)\n(14b)\n(TITLE) (13)\n(RAD)\n(14c)\nAO\nLEEWIVVILION (330)\nGEMAICE (3AP)\nCONLEW\n(aix)\n(336)\nMEVEOM LOS\nJINE Ole\nOk\nIM LOKEICIA OK LOFILIC\nNumber A 325114\n(15)\n20BD1A1210M2 THE\n@ PATENTED\nA\nNAME (14a) (LAST)\n(FIRST) (14b)\n(MIDDLE) (14C)\n(COMPANY) (15)\nDay\nIna\nmithe\nsugit uor S (1)\nII 80' Mpsc\nOL VMD MANKVACE: (ae) ge OL noc 2on usag GAGE psgu pougso OL"
}