UNITED 9TIATE 
DEPARTMENT OF AGRICULTURE 
WASHINGTON, D. C. 
APPLICATION FOR EMPLOYMENT 
 
"Work quallied for: (Applicant leave blank) 
 
(It Is advisable to submit a recent photograph) Applicants must answer all
questionl. The Department of Agriculture reserves the right to investigate
all statements made In this application, and to make such information available
to the Civil Service Commission or any other Government department or agency.

/C 
 
Date 
 
Name  (Mr., M iss, Mrs.)  ___----  -  ............... 
(Print)    -  irt) 
A AwA        7 12 A 7 Is, 4      tt.4LJLXAILO- 
 
(Middle) 
 
La--  
AMA "Otz/ 
 
----------------------(L--t  -  - - - - - - - - --- - - - -  - 
 
Home telephone No.                                        4. Office telephone
No.             04 
"""'  ........."------------,. --t --------- ...... 
 t  ..                         s 
Date     o   o of i   ..... r 4(____t_,              6 .. Plac Oo birth o
 o...----._r 
If foreign born, state when and how naturalized --------------------------------------------------------------------------------------------------Height
---        -                            ------ 9. Weight ----- 1:    -  
.. 
Do you have any physical defects? (If so, explain fully on separate sheet)
----- K   ............................................ 
W hat  is  the  p resen t  state  of  your  h ealth ?  - -----.-.----------------------.....
.................. ..............---L egal  residence  ...........      
          --- _CFi% 4  --.. ..   -  - --- ..........                    
 -------(State and city, or county in which you vote) 
Indicate sex, marital status, and race, by check, thus: (V) RACE 
SEX                               MARITAL STATUS                        
       (If other, state which) 
Male       Female     Single     Married    Divorced    Legally    Widowed
     White      Colored     Other 
WOO10               7separated 
 
14. If a woman who has been married, state maiden name or other names previously
used --------------------------------------------- 
 
Lowest salary you are wi]]ing to accept--------4     i     -..-L--  e   %-
   -           . .    .      . 
Wil you accept temporary or part-time employment? ....- -----           
                               ---c 
W hat  location  w ould  you  prefer? ------------------------------------------------------------------------------------------------------------------------If
you have been convicted of any violation of law other than a minor traffic
violation, give details on separate sheet. Have you any relatives in the
Government service or in the service of the District of Columbia? _..1 l..
If so, give the following information: 
NAME                 RELATIONSHIP             HOME ADDRESS              
GOVERNMENT AGENCY 
V         V 
 
S 
 
1. 
2. 
10. 
11. 
12. 13. 
 
----------- 
 
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L 
 
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