◆ SpookStack

* i ee peemmmrmmmmaaan emer pe - ed . 26a REFERENCES (Narne three persons, not e807 employers, who are aware of your qualificaty a fines.) . Mn b6 Per BOC b7C Per BOC wy 5 b6 Per BOC b7C Per BOC 25 25 25 26d. CLOSE PERSONAL ASSOCIATES. (Name three persons, such as friends, schoolmates or colleagues, who know you well.) nates eastern ta ne unease menses astra erent seater maeaaatrceetesnt 27, TO YOUR KNOWLEOGE, HAVE YOU EVER BEEN THE SUSJECY OF A FULL FIELD OR BACKGROUND PERSONAL INVESTIGATION BY ANY AGENCY OF THE FEOERAL GOVERNMENT? 45) YES [JNO Ct your answer js Yes," show in item 28, U1) the name of the investigating agency (2) the approsimate date of investigation, and (3) the level of security clearance granted, if known.) 28. SPACE, FOR CONTINUING ANSWERS YO OTHER QUESTIONS, (Show ftom numbere to which answere apply, Attach a soparate sheet if there is not S7RUTSW'2L Agency Checks in 1952 & 1965 Final Secret Lssued in 1964 _- 2 REPORT OF INFORMATION DEVELOPED. (Tass epace zeserred for FBI wee ) ® « . as 4 ay ’ Before signing this form cheek back over it to make sure you have answered all questions fully and correctly. CERTIFICATION. . _ I Cratiry that the statements made by me on this form ar knowledee.and belief, and are made in good faith. oe b6 Per BOC Fatse statemont en this form 7 Dec, / fo} b7C Per BOC ts punishable by Law, L2 Rec (770 INFORMATION TO SE& FURKISHED BY AGENCY INSTRUCTIONS TO AGENCY: See Federal Personnel Manual Chapter 736 and FPM Supplement 296-31, Appendix A, for details on when this form is required and how it is used. If this is a request for investigation before appointment, insert “APPL” in the space for Date of Appointment and show information about the proposed appointment in the other spaces for appointment data. ‘The original and the first catbon copy should be signed by the applicant of appointee, Submit the origival and the wusigned carbon copy of the form, Standard Form 87 (Fingerprint Chart), are any investigative information about the person received on voucher forms or otherwise, to the United Seates Civil Service Commission, Bureau of Personnel Investigations, Washington, D.C, 5 'f 204%5. | If this is a request for full Geld security investigation, submit these forms co the attention of the Division of Reimbursable In- vestigations; if this is’2 request for preappointment national agency checks, submit these forms co the attention of che Control Section, RETAIH THE CARZON COPY OF STANDARD FORM &S (SIGNED BY THE APPLICANT OR APPOIMTEE) FOR YOUR FILES OATE OF APPOINTMENT TYPE OF APPOLNIMENT CIVIL SERVICE REGULATION NUMBER OR | THLE OF POSITION AND GRADE OR ras EXCEPTED OTKER APPOINTMENT AUTHORITY SALARY Applicant 7 ; 3h % PP CE COMPETITIVE (Include indeAnite and tem: S.%. Reg. USCSC t Custoss Security porary typeaol competitive appointments.) fer dated 11/23/70 Officer GS-4 OLPARTMENT OR AGENCY DUTY STATION SEND RESULTS OF PREAPPOINTMENT CHECK TO: Bureau of Customs Portland, Bureau of Custos O£Xkice of Sacurity' 2100 K Streot NW, onex (Personnel) Washington, D.C. 20226 US GOVERNMENT PRINTING OFFICE 3904-4 On 755-147 #18-€ b6 Per BOC b7C Per BOC DB Cooper-7195