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Personnel - Personal Data Statements
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Personnel - Personal Data Statements
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Philip W. Buchen Files
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The original documents are located in Box 39, folder "Personnel - Personal Data
Statements" of the Philip Buchen Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Digitized from Box 39 of the Philip Buchen Files at the Gerald R. Ford Presidential Library
THE WHITE HOUSE
WASHINGTON
MEMORANDUM FOR:
FROM:
PHILIP W. BUCHEN
COUNSEL TO THE PRESIDENT
SUBJECT:
PERSONAL DATA STATEMENT
As part of the clearance procedures relating to your proposed
appointment, it is requested that you answer the following
questions and supply the following information to us on a
confidential basis. Please note that federal law and regulations
governing conflicts of interest require the disclosure of the
information requested in questions 1-5, inclusive, as it
pertains to you, your spouse and any relatives living in your
immediate household. In addition, you are requested to supply
any information you deem to be relevant with regard to your
spouse or such relatives when responding to any of the other
questions.
In order that we might complete all necessary reviews as soon
as possible, it is requested that you supply this information at
your earliest convenience.
If you have any questions or if this office can be of assistance,
please do not hesitate to contact me.
1. The names of all corporations, firms, or other business
enterprises, partnerships, nonprofit organizations, and
educational or other institutions with which you are now
connected as an officer, owner, director, trustee, partner,
advisor, or consultant. Those organizational affiliations
which you wish to continue during the term of your appointment
should be noted with an asterisk. (Please note that in the
case of an attorney's client listing, it is only necessary to
provide the names of major clients and those which might
present a potential conflict or appearance of conflict with
your proposed appointment.)
- 2 -
2. The names of all corporations, partnerships or other
institutions in which you have any financial interests through
the ownership of stock, stock options, bonds, or other
arrangements, including trusts. Any interests you wish
to retain during your period of government service should
be noted with an asterisk.
3. The names of any creditors (other than those to whom
you may be indebted by reason of a mortgage on property
used as a personal residence or to whom you may be indebted
for current and ordinary living expenses), setting forth the
amount of such debt, and any additional information deemed
relevant to explain the transaction.
4. All your interests in real property, other than a personal
residence, setting forth the nature of your interest, the type
of property, and the address.
5. The names of all corporations, firms, or other business
enterprises, partnerships, nonprofit organizations, and
educational or other institutions, with which you have any
continuing financial interests through present employment
or by reason of a pension or retirement plan, stock bonus,
profit-sharing, or other arrangement as a result of any
current or prior employment or business or professional
association. Also, supply such details as are necessary for
a thorough understanding of such continuing financial interests.
Particular attention should be devoted to any severance
agreements which may be contemplated.
6. Any employee fringe benefits you are now receiving and
would desire to retain during your government service.
7. The details of any contractual or informal arrangement
you may have with any business enterprise in regard to
future employment.
8. Have you ever been arrested, charged or held by federal,
state, or other law enforcement authorities for violation of
any federal, state, county or municipal law, regulation or
ordinance? If so, please give full details (do not include
traffic violations for which a fine of $25 or less was imposed).
- 3 -
9. Are you currently under federal, state, or local inves-
tigation for a possible violation of a criminal statute? If so,
please give full details.
10. Has a tax lien or other collection procedure ever been
instituted against you by federal, state or local authorities?
If so, please give full details.
11. Have you ever been disciplined or cited for a breach of
ethics or unprofessional conduct by, or been the subject of a
complaint to, any court, administrative agency, professional
association, disciplinary committee, or other professional
group? If so, please give full details.
12. Have you ever been involved in civil litigation, or
administrative or legislative proceedings of any kind, either
as plaintiff, defendant, respondent, witness or party in interest,
which may be sufficiently controversial or so intimately related
to the area of work for which you are being considered, that
your involvement may be appropriate for consideration by the
committee of the Senate to which your nomination will be
submitted. If so, please give full details.
13. Have you ever run for political office, served on a political
committee, or been identified in a public way with a particular
political organization, candidate or issue? If so, please describe.
14. Have you ever been publicly identified, in person or by
organizational membership, with a particularly controversial
national or local issue? If so, please describe.
15. Have you ever submitted oral or written views to any
government authority (executive or legislative) or the news
media, on any particularly controversial issue other than in
an official governmental capacity? If so, please describe.
16. Have you ever written any particularly controversial
books or articles? If so, please list them, giving the citations,
titles and dates.
* Reference to "particularly controversial" is intended to
focus on issues that could be used, even unfairly, against you.
- 4 -
17. , Have you ever had any association with any person or
group or business venture which could be used, even
unfairly, to impune or attack your character and qualification
for this position?
18. Do you know anyone who might take any steps, overtly
or covertly, to make your confirmation by the Senate more
difficult or seek to attack your appointment?
19. Please provide any other information which you regard
as pertinent or which could be the possible source of
embarrassment to you, or to the President, if publicly known.
CLEARANCE CHECK LIST
Administratively Confidential
Name of Nominee
Position
Received from Personnel
Personal Data Statement Sent
Comments:
FUND
THE WHITE HOUSE
WASHINGTON
MEMORANDUM FOR:
FROM:
PHILIP W. BUCHEN
COUNSEL TO THE PRESIDENT
SUBJECT:
PERSONAL DATA STATEMENT
As part of the clearance procedures relating to your proposed
appointment, it is requested that you answer the following
questions and supply the following information to us on a
confidential basis. Please note that federal law and regulations
governing conflicts of interest require the disclosure of the
information requested in questions 1-5, inclusive, as it
pertains to you, your spouse and any relatives living in your
immediate household. In addition, you are requested to supply
any information you deem to be relevant with regard to your
spouse or such relatives when responding to any of the other
questions.
In order that we might complete all necessary reviews as soon
as possible, it is requested that you supply this information at
your earliest convenience.
If you have any questions or if this office can be of assistance,
please do not hesitate to contact me.
1. The names of all corporations, firms, or other business
enterprises, partnerships, nonprofit organizations, and
educational or other institutions with which you are now
connected as an officer, owner, director, trustee, partner,
advisor, or consultant. Those organizational affiliations
which you wish to continue during the term of your appointment
should be noted with an asterisk. (Please note that in the
case of an attorney's client listing, it is only necessary to
provide the names of major clients and those which might
present a potential conflict or appearance of conflict with
your proposed appointment.)
- 2 -
2. The names of all corporations, partnerships or other
institutions in which you have any financial interests through
the ownership of stock, stock options, bonds, or other
arrangements, including trusts. Any interests you wish
to retain during your period of government service should
be noted with an asterisk.
3. The names of any creditors (other than those to whom
you may be indebted by reason of a mortgage on property
used as a personal residence or to whom you may be indebted
for current and ordinary living expenses), setting forth the
amount of such debt, and any additional information deemed
relevant to explain the transaction.
4. All your interests in real property, other than a personal
residence, setting forth the nature of your interest, the type
of property, and the address.
5. The names of all corporations, firms, or other business
enterprises, partnerships, nonprofit organizations, and
educational or other institutions, with which you have any
continuing financial interests through present employment
or by reason of a pension or retirement plan, stock bonus,
profit-sharing, or other arrangement as a result of any
current or prior employment or business or professional
association. Also, supply such details as are necessary for
a thorough understanding of such continuing financial interests.
Particular attention should be devoted to any severance
agreements which may be contemplated.
6. Any employee fringe benefits you are now receiving and
would desire to retain during your government service.
7. The details of any contractual or informal arrangement
you may have with any business enterprise in regard to
future employment.
8. Have you ever been arrested, charged or held by federal,
state, or other law enforcement authorities for violation of
any federal, state, county or municipal law, regulation or
ordinance? If so, please give full details (do not include
traffic violations for which a fine of $25 or less was imposed).
- 3 -
9. Are you currently under federal, state, or local inves-
tigation for a possible violation of a criminal statute? If so,
please give full details.
10. Has a tax lien or other collection procedure ever been
instituted against you by federal, state or local authorities?
If so, please give full details.
11. Have you ever been disciplined or cited for a breach of
ethics or unprofessional conduct by, or been the subject of a
complaint to, any court, administrative agency, professional
association, disciplinary committee, or other professional
group? If so, please give full details.
12. Have you ever been involved in civil litigation, or
administrative or legislative proceedings of any kind, either
as plaintiff, defendant, respondent, witness or party in interest,
which may be sufficiently controversial or so intimately related
to the area of work for which you are being considered, that
your involvement may be appropriate for consideration by the
committee of the Senate to which your nomination will be
submitted. If so, please give full details.
13. Have you ever run for political office, served on a political
committee, or been identified in a public way with a particular
political organization, candidate or issue? If so, please describe.
14. Have you ever been publicly identified, in person or by
/
organizational membership, with a particularly controversial
national or local issue? If so, please describe.
15. Have you ever submitted oral or written views to any
government authority (executive or legislative) or the news
media, on any particularly controversial issue other than in
an official governmental capacity? If so, please describe.
16. Have you ever written any particularly controversial /
books or articles? If so, please list them, giving the citations,
titles and dates.
TOND
* Reference to "particularly controversial" is intended to
focus on issues that could be used, even unfairly, against you.
LIBRARY
- 4 -
17. , Have you ever had any association with any person or
group or business venture which could be used, even
unfairly, to impune or attack your character and qualification
for this position?
18. Do you know anyone who might take any steps, overtly
or covertly, to make your confirmation by the Senate more
difficult or seek to attack your appointment?
19. Please provide any other information which you regard
as pertinent or which could be the possible source of
embarrassment to you, or to the President, if publicly known.
CLEARANCE CHECK LIST
Administratively Confidential
Name of Nominee
Position
Received from Personnel
Personal Data Statement Sent
Comments:
TORD
LIBRAL