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Form 100 (N.R.)                           BUDGET BUREAU No. 11-Roo4-42       BUDGET BUREAU  No. 11.R084
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Form 100 (N.R.) (December 1942)
(December 1942)                          Approval expires June 30, 1943              APPROVAL EXPIRES JUENE 36, 1944
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BUDGET BUREAU No. 11-R004-42  
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Approval expires June 30, 1943.
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BUDGET BUREAU  No. 11.R084
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APPROVAL EXPIRES JUNE 30, 1944
 
WAR MANPOWER COMMISSION
 
WAR MANPOWER COMMISSION
 
NATIONAL ROSTER OF SCIENTIFIC AND SPECIALIZED PERSONNEL
 
NATIONAL ROSTER OF SCIENTIFIC AND SPECIALIZED PERSONNEL
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Where more space is need, attach additional sheets.
 
Where more space is need, attach additional sheets.
 
(Print or Type)  
 
(Print or Type)  
1. Name {Miss Mrs. Mr. Dr., etc} Mr. James Lawrence Smith
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1. Name {Miss Mrs. Mr. Dr., etc} Mr. James Lawrence Smith | (Title) (First) (Middle) (Last)   
                                                  (Title) (First) (Middle)   (Last)   
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Mailing address 2420 High Portsmouth Virginia | (Number) (Street) (City) (State)
  Mailing address 2420 High Portsmouth Virginia
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2. Date of birth: January 17th 1883 | (Month) (Day) (Year)
                            (Number) (Street) (City) (State)
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3. Place of birth: Harnett County N.C. | (State or foreign country only)
 
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(If foreign born, give the name of the country, as of the date of your birth)
2. Date of birth: January 17th 1883
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                        (Month) (Day) (Year)
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3. Place of birth: Harnett County N.C.
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                    (State or foreign country only)
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      (If foreign born, give the nuame of the country, as of the date of your birth)
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4. Citizenship (check one):
 
4. Citizenship (check one):
    1 Native-born citizen of the United States, including foreign-born of the United States citizen parentage.
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1 [X} Native-born citizen of the United States, including foreign-born of the United
    2 Naturalized citizen: Cert. No.    Date    Court
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States citizen parentage.
    3 First papers obtained: Date    Number of Declaration of Intention    Court   Country of which you are a citizen
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2 [  ] Naturalized citizen: Cert. No.    Date    Court
    4 Final papers applied for but not yet obtained.
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3 [  ] First papers obtained: Date    Number of Declaration of Intention    Court Country of which you are a citizen
    5 If first papers not yet obtained, specify foreign country of which you are a citizen
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4 [  ] Final papers applied for but not yet obtained.
      Other (desribe on a separate sheet).
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5 [  ] If first papers not yet obtained, specify foreign country of which you are a citizen
 
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[  ] Other (desribe on a separate sheet).
5. Marital status, dependants:     (Do not fill in)
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5. Marital status, dependants:                           (Do not fill in)
  1 Single.
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1 [  ] Single.                                                                 [5]
  2 Married.
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2 [X] Married.                     Marital status                    [6]
  3 Divorced.
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3 [  ] Divorced.                   (Check one)                      [7]                   
  4 Widowed or separated.
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4 [  ] Widowed or separated                                       [8]
  Dependants (number of persons completely dependant on you, other than husband or wife)
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[0]  Dependants (number of persons completely dependant on you, other than husband or wife)
  
 
6. Race and sex (check one):
 
6. Race and sex (check one):
Male   Female
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Male         Female
  1 White  6
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1 [X]  White   [  ]   6 }  If "Other,"specify:  SEX 
  2 Negro  7
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2 [  ]  Negro   [ 7                                 1 [  ]  Male
  3 Yellow  8
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3 [  ]  Yellow   [ 8                                 6 [  ]  Female
  4 Other  9
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4 [  ]  Other   [   9
  
 
7. Physical condition:
 
7. Physical condition:
    Specify and physical defect, disease, or disability. If none, write "None." (Emphasize particularly defects which may in any way limit your working capacity.)
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Specify any physical defect, disease, or disability. If none, write "None." (Emphasize particularly defects which may in any way limit your working capacity.) None
    None
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Height  5    10 1/2      Weight    148 | (Foot) (Inches) (Pounds)
    Height  5    10 1/2      Weight    148
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            (Foot) (Inches)               (Pounds)
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8. Military serviceL
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8. Military service:
 
(a) Are you now or have you ever been a member of (check one):
 
(a) Are you now or have you ever been a member of (check one):
    No military service
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[X} No military service
    Regular Armed Forces
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Regular Armed Forces [  ] Army [  ] Navy [  ] Marine Corps [  ] Coast Guard
    Army  
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Reserve [  ] Army [  ] National Guard [  ] Marine Corps [  ] Coast Guard [  ] Public Health Service
    Navy
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    Marine Corps
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    Coast Guard
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    Reserve
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    Army
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    National Guard
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    Marine Corps
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    Coast Guard
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    Public Health Service
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(b) If you checked one of the above items, answer the following:
 
(b) If you checked one of the above items, answer the following:
    Branch of service:
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Branch of service:
    Dates of service: From      To
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Dates of service: From      To
    Rank
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Rank
    Are you now on active duty?    Yes  No
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Are you now on active duty?    Yes  No
(c) Have you ever served in the armed forces of any country other than the United States?    NO
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(c) Have you ever served in the armed forces of any country other than the United States?    NO | (Yes or No)
                                                                                                                                              (Yes or No)
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Period of service: From    To
      Period of service: From    To
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Name of country
      Name of country
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Service and Branch
      Service and Branch
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Highest rank held
      Highest rank held
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9. Foreign languages (check proficiency):
 
9. Foreign languages (check proficiency):
                                                                              Auditory
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LANGUAGE    Read Speak Auditory Comprehension
    LANGUAGE    Read               Speak           Comprehension
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Exc. Good Fair  Exc. Good Fair  Exc. Good Fair
                    Exc. Good Fair  Exc. Good Fair  Exc. Good Fair
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10. Federal service:
 
10. Federal service:
 
(a) Do you now hold a full-time position in the Federal Service?  NO (Yes or no)
 
(a) Do you now hold a full-time position in the Federal Service?  NO (Yes or no)
    If "Yes," indicate: Dept.    Bureau
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If "Yes," indicate: Dept.    Bureau
 
(b) If not, have you ever held any position in the Federal service?    NO (Yes or no)
 
(b) If not, have you ever held any position in the Federal service?    NO (Yes or no)
        16-16797-2
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16-16797-2

Latest revision as of 22:14, 11 February 2018

Form 100 (N.R.) (December 1942) BUDGET BUREAU No. 11-R004-42 Approval expires June 30, 1943. BUDGET BUREAU No. 11.R084 APPROVAL EXPIRES JUNE 30, 1944 WAR MANPOWER COMMISSION NATIONAL ROSTER OF SCIENTIFIC AND SPECIALIZED PERSONNEL WASHINGTON, D.C. Where more space is need, attach additional sheets. (Print or Type) 1. Name {Miss Mrs. Mr. Dr., etc} Mr. James Lawrence Smith | (Title) (First) (Middle) (Last) Mailing address 2420 High Portsmouth Virginia | (Number) (Street) (City) (State) 2. Date of birth: January 17th 1883 | (Month) (Day) (Year) 3. Place of birth: Harnett County N.C. | (State or foreign country only) (If foreign born, give the name of the country, as of the date of your birth) 4. Citizenship (check one): 1 [X} Native-born citizen of the United States, including foreign-born of the United States citizen parentage. 2 [ ] Naturalized citizen: Cert. No. Date Court 3 [ ] First papers obtained: Date Number of Declaration of Intention Court Country of which you are a citizen 4 [ ] Final papers applied for but not yet obtained. 5 [ ] If first papers not yet obtained, specify foreign country of which you are a citizen [ ] Other (desribe on a separate sheet). 5. Marital status, dependants: (Do not fill in) 1 [ ] Single. [5] 2 [X] Married. Marital status [6] 3 [ ] Divorced. (Check one) [7] 4 [ ] Widowed or separated [8] [0] Dependants (number of persons completely dependant on you, other than husband or wife)

6. Race and sex (check one): Male Female 1 [X] White [ ] 6 } If "Other,"specify: SEX 2 [ ] Negro [ ] 7 1 [ ] Male 3 [ ] Yellow [ ] 8 6 [ ] Female 4 [ ] Other [ ] 9

7. Physical condition: Specify any physical defect, disease, or disability. If none, write "None." (Emphasize particularly defects which may in any way limit your working capacity.) None Height 5 10 1/2 Weight 148 | (Foot) (Inches) (Pounds)

8. Military service: (a) Are you now or have you ever been a member of (check one): [X} No military service Regular Armed Forces [ ] Army [ ] Navy [ ] Marine Corps [ ] Coast Guard Reserve [ ] Army [ ] National Guard [ ] Marine Corps [ ] Coast Guard [ ] Public Health Service (b) If you checked one of the above items, answer the following: Branch of service: Dates of service: From To Rank Are you now on active duty? Yes No (c) Have you ever served in the armed forces of any country other than the United States? NO | (Yes or No) Period of service: From To Name of country Service and Branch Highest rank held

9. Foreign languages (check proficiency): LANGUAGE Read Speak Auditory Comprehension Exc. Good Fair Exc. Good Fair Exc. Good Fair

10. Federal service: (a) Do you now hold a full-time position in the Federal Service? NO (Yes or no) If "Yes," indicate: Dept. Bureau (b) If not, have you ever held any position in the Federal service? NO (Yes or no) 16-16797-2