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(Created page with "Form 100 (N.R., (December 1942)")
 
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Form 100 (N.R.,
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Form 100 (N.R.,                           BUDGET BUREAU No. 11-Roo4-42        BUDGET BUREAU  No. 11.R084
(December 1942)
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(December 1942)                         Approval expires June 30, 1943              APPROVAL EXPIRES JUENE 36, 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) 
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  Mailing address 2420 High Portsmouth Virginia
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                            (Number) (Street) (City) (State)
 +
 
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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)
 +
 
 +
4. Citizenship (check one):
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    1 Native-born citizen of the United States, including foreign-born of the United States citizen parentage.
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    2 Naturalized citizen: Cert. No.    Date    Court
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    3 First papers obtained: Date    Number of Declaration of Intention    Court    Country of which you are a citizen
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    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
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      Other (desribe on a separate sheet).
 +
 
 +
5. Marital status, dependants:      (Do not fill in)
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  1 Single.
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  2 Married.
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  3 Divorced.
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  4 Widowed or separated.
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  Dependants (number of persons completely dependant on you, other than husband or wife)
 +
 
 +
6. Race and sex (check one):
 +
Male    Female
 +
  1 White  6
 +
  2 Negro  7
 +
  3 Yellow  8
 +
  4 Other  9
 +
 
 +
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.)
 +
    None
 +
    Height  5    10 1/2      Weight    148
 +
            (Foot) (Inches)              (Pounds)
 +
 
 +
8. Military serviceL
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(a) Are you now or have you ever been a member of (check one):
 +
    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
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    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
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      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)
 +
        16-16797-2

Revision as of 18:59, 11 February 2018

Form 100 (N.R., BUDGET BUREAU No. 11-Roo4-42 BUDGET BUREAU No. 11.R084 (December 1942) Approval expires June 30, 1943 APPROVAL EXPIRES JUENE 36, 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 nuame of the country, as of the date of your birth)

4. Citizenship (check one):

   1 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.
  2 Married.
  3 Divorced.
  4 Widowed or separated.
  Dependants (number of persons completely dependant on you, other than husband or wife)

6. Race and sex (check one): Male Female

  1 White   6
  2 Negro  7
  3 Yellow  8
  4 Other   9

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.)
    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):

    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)

       16-16797-2