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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.
 +
BUDGET BUREAU  No. 11.R084
 +
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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3. Place of birth: Harnett County N.C.
 
3. Place of birth: Harnett County N.C.
 
                     (State or foreign country only)
 
                     (State or foreign country only)
       (If foreign born, give the nuame of the country, as of the date of your birth)
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       (If foreign born, give the name of the country, as of the date of your birth)
  
 
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
     5 If first papers not yet obtained, specify foreign country of which you are a citizen
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            Country of which you are a citizen
       Other (desribe on a separate sheet).
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     4 [  ] Final papers applied for but not yet obtained.
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     5 [  ] If first papers not yet obtained, specify foreign country of which you are a
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            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                                                         [8]
  Dependants (number of persons completely dependant on you, other than husband or wife)
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          separated.
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  [0]  Dependants (number of persons completely dependant on you, other than
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        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
 
     Height  5    10 1/2      Weight    148
 
     Height  5    10 1/2      Weight    148
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8. Military serviceL
 
8. Military serviceL
 
(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
 
     Regular Armed Forces
     Army  
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     [  ] Army  
     Navy
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     [  ] Navy
     Marine Corps
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     [  ] Marine Corps
     Coast Guard
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     [  ] Coast Guard
 
     Reserve
 
     Reserve
     Army
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     [  ] Army
     National Guard
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     [  ] National Guard
     Marine Corps
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     [  ] Marine Corps
     Coast Guard
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     [  ] Coast Guard
 
     Public Health Service
 
     Public Health Service
 
(b) If you checked one of the above items, answer the following:
 
(b) If you checked one of the above items, answer the following:

Revision as of 23:04, 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                                                         [8]
          separated.
 [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 serviceL (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):

                                                                              Auditory
   LANGUAGE     Read               Speak            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)

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