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ARE YOU A CITIZEN OF THE UNITED STATES? (YES OR NO) yes ARE YOU IN GOOD HEALTH? (YES OR NO) yes
DO YOU CLAIM PREFERENCE AS A DISABLED WAR VETERAN? (YES OR NO) no

[[2 columned table]]
| EMPLOYMENT DURING PAST FIVE YEARS | RESIDENCE DURING PAST FIVE YEARS |
| [[ 3 columned table]]| [[ 3 columned table]]|

| FROM | TO | BUSINESS OR EMPLOYMENT | FROM | TO | RESIDENCE|
| July 1938 | Oct 1938 | [[???]] Flying | July 1938 | Oct 1938 | [[???]] |
| May 1938 | July 1928 | Self [[???]] flying | May 1938 | July 1938 | 144-94 [[???]] |
| Feb 29 1928 | May 1938 | " MECHANIC | Feb 22 1938 | July 1938 | " " |
| Nov 1 1937 | Feb 22 1938 | " " | Feb VI 1937 | Feb 22 1938 | 75 W [[???]] |
| May 1935 | Nov 1 1937 | [[???]] Flying | MAY 1935 | [[???]] 1937 | 1569 Hone AUB |
May 1932 | [[???]] 1935 | [[???]] | May 1932 | [[???]] 1937 | " " " |


SWORN TO BEFORE ME THIS ___ DAY OF ___ 19___

[[dotted line for signature]]   [[???]] A. [[???]]
SIGNATURE OF OFFICER AND OFFICIAL TITLE   APPLICANT SIGN HERE WITH INK


NOTICE AND WARNING

APPLICANTS WHO PASS EXAMINATIONS AND THEREBY BECOME ELIGIBLE FOR EMPLOYMENT BY THE CITY ARE REQUIRED ON NOTICE TO FILE UNDER OATH AN INVESTIGATION QUESTIONNAIRE. ALL STATEMENTS MADE THEREIN AND ALL STATEMENTS MADE IN ANY EXPERIENCE STATEMENTS REQUIRED TO BE FILED BY APPLICANT MAY CAUSE HIS DISQUALIFICATION. a MATERIAL FALSE STATEMENT WILFULLY OR FRAUDULENTLY MADE BY AN APPLICANT WILL AUTOMATICALLY CAUSE HIS DISQUALIFICATION AND MAY CAUSE PROSECUTION.

FEES ARE TO BE PAID BY CASH, MONEY ORDER OR CERTIFIED CHECK UPON RECEIPT OF THIS NOTICE FOR EXXAMINATION FOR POSITION APPLIED FOR IN ROOM 1438, MUNICIPAL BUILDING. PAY YOUR FEE THEREAFTEER UP TO 3 DAYS PRIOR TO THE DATE OF EXAMINATION. DO NOT WAIT UNTIL THE FINAL DATE FOR PAYMENT. DO NOT SEND CASH BY MAIL. FEES BY MAIL ARE SUBJECT TO POSSIBLE POST OFFICE DELAY AND WILL NOT BE ACCPETED AFTER 3 P.M. ON FINAL PAYMENT DATE. NO FEES REFUNDED. THE ABOVE PROCEDURE FOR PAYING FEES WILL PREVAIL EXCEPT AS OTHERWISE ADVERTISED.