Part 26, page 42

Transcript

The scan is the source; the transcript is machine-generated from it.

26b REFERENCES (Name three persons, not [redacted] ss or employers, who are aware of your qualifica [redacted] d fitness.) [redacted] NAME IN FULL | E ADDRESS | BUSINESS A[redacted]SS | YEARS KNOWN [redacted] b6 Per BOC b7C Per BOC [redacted] 5

26b. CLOSE PERSONAL ASSOCIATES. (Name three persons, such as friends, schoolmates or colleagues, who know you well.) NAME IN FULL | HOME ADDRESS | BUSINESS ADDRESS | YEARS KNOWN [redacted] b6 Per BOC b7C Per BOC 25 25 25

27. TO YOUR KNOWLEDGE, HAVE YOU EVER BEEN THE SUBJECT OF A FULL FIELD OR BACKGROUND PERSONAL INVESTIGATION BY ANY AGENCY OF THE FEDERAL GOVERNMENT [X] YES [] NO. (If your answer is "Yes," show in item 28, (1) the name of the investigating agency (2) the approximate date of investigation, and (3) the level of security clearance granted, if known.)

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22. SPACE FOR CONTINUING ANSWERS TO OTHER QUESTIONS. (Show item numbers to which answers apply. Attach a separate sheet if there is not #27 National Agency Checks in 1952 & 1965 Final Secret issued in 1966 #8 from [redacted] to [redacted] number and street [redacted] city [redacted] sta[redacted] b6 Per BOC

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29 REPORT OF INFORMATION DEVELOPED. (This space reserved for FBI use) DATE:

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Before signing this form check back over it to make sure you have answered all questions fully and correctly. CERTIFICATION. I CERTIFY that the statements made by me on this form are true, complete and correct to the best of my knowledge, and belief, and are made in good faith. b6 Per BOC False statement on this form b7C Per BOC is punishable by law. 17 Dec, 1970 (DATE) (SIGNATURE—Sign original and first carbon copy)

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INFORMATION TO BE FURNISHED BY AGENCY

INSTRUCTIONS TO AGENCY: See Federal Personnel Manual Chapter 736 and FPM Supplement 296-31, Appendix A, for details on when this form is required and how it is used. If this is a request for investigation before appointment, insert "APPL" in the space for Date of Appointment and show information about the proposed appointment in the other spaces for appointment data. The original and the first carbon copy should be signed by the applicant or appointee. Submit the original and the unsigned carbon copy of the form, Standard Form 87 (Fingerprint Chart), and any investigative information about the person received on voucher forms or otherwise, to the United States Civil Service Commission, Bureau of Personnel Investigations, Washington, D.C., 20415. If this is a request for full field security investigation, submit these forms to the attention of the Division of Reimbursable In- vestigations; if this is a request for preappointment national agency checks, submit these forms to the attention of the Control Section.

RETAIN THE CARBON COPY OF STANDARD FORM 86 (SIGNED BY THE APPLICANT OR APPOINTEE) FOR YOUR FILES

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DATE OF APPOINTMENT | TYPE OF APPOINTMENT | CIVIL SERVICE REGULATION NUMBER OR | TITLE OF POSITION AND GRADE OR | [] EXCEPTED | OTHER APPOINTMENT AUTHORITY | SALARY Applicant | [X] COMPETITIVE (Include indefinite and tem- | S.F. Reg. USCSC | Customs Security | porary types of competitive appointments.) | ltr dated 11/23/70 | Officer GS-4

DEPARTMENT OR AGENCY | DUTY STATION | SEND RESULTS OF PREAPPOINTMENT CHECK TO: Bureau of Customs | Portland, | Bureau of Customs b6 Per BOC R[redacted] | [redacted]n | Office of Security b7C Per BOC | | 2100 K Street N.W. THIS | | Washington, D.C. 20226 D[redacted] [redacted] oner (Personnel) (SIGNATURE AND TITLE OF AUTHORIZED AGENCY OFFICIAL)

US GOVERNMENT PRINTING OFFICE, 1964-O-755-147 #18-E

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DB Cooper-7195