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Story: TBA
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| # |
Question |
Answer |
|
Serial Number |
|
|
Order Number |
|
| 1 |
Name |
|
| 2 |
Permanent Home Address: |
|
| 3 |
Age in Years |
|
| 4 |
Date of Birth |
|
| 5-9 |
Race |
|
| 10-15 |
Citizenship |
|
| 16 |
Present Occupation |
|
| 17 |
Employer’s Name |
|
| 18 |
Place of Employment or Business |
|
| 19 |
Nearest Relative Name |
|
| 20 |
Nearest Relative Address |
|
|
(signature) |
|
| 21-23 |
Height |
|
| 24-26 |
Build |
|
| 27 |
Color of Eyes |
|
| 28 |
Color of Hair |
|
| 29 |
Has person lost arm, leg, hand, eye, or is he obviously disqualified? (Specify) |
|
| 30 |
I certify that my answers are true; that the person registered has read or has had read to him his own answers; that I have witnessed his signature or mark, and that all of his answers of which I have knowledge are true, except as follows: |
|
|
(signature of registrar) |
|
| |
Date of Registration |
|
|
Board |
|
