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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