Blank Application Form, National Bituminous Coal Commission

DO NOT WRITE IN THIS SPACE NATIONAL BITUMINOUS COAL Return this blank to Personnel COMMISSION Division, National Bituminous Coal Commission, Washington, D. .C. APPLICATION AND PERSONAL HISTORY STATEMENT 1: Name (Miss, Mr., or Mrs.) (First name) (Middle name) (Last name) 2. Present address (Number) (Street) (City) (State) 3. Legal residence (State) (Congressional district) (County) (City or town) 4. Home telephone no. Business telephone no. 5. Where born When born (State or foreign country) (City or town) (Month) (Day) (Year) 6. If foreign born, when were you naturalized? 7. Indicate sex, marital status, and race by mark, thus State height and weight. SEX MARITAL STATUS RACE (If other, specify) HEIGHT WEIGHT Male Female Single Married Divorced Widowed Separated White Colored Other 8. How many persons are dependent upon you for support? Totally Ages Relationship Partially Ages Relationship 9. Are any members of your family living with you now in the employ of the U.S. Government or of the Govern- ment of the District of Columbia (if none, write "None") If any, give details below: NAME RELATIONSHIP DEPARTMENT IN WHICH EMPLOYED 10. What Federal civil-service examinations have you taken? TITLE OF EXAMINATION DATE OF EXAMINATION GRADE 11. Are you at present employed by the U. S. Government in a civil-service position? If so, have you com- pleted your probationary period? Are you in departmental or field service? 12. If not at present employed by the U. S. Government, are you eligible for reinstatement in accordance with civil-service regulations? 13. Will you accept temporary work (Yes or No) for-1 month? 3 months? 6 months? 14. Will you accept a position, the duties of which involve constant travel? 15. How soon can you be available to start work? 16. What is the lowest entrance salary you will accept? $ per year. 17. Positions for which application is made (in order of preference) 18. Locations in which willing to work (in order of preference) 19. Are you related within the third degree, by blood, to any member of the National Bituminous Coal Commission ? 16-6152 ump quzoora OT. 200