Document text
Machine-read from the scan, so expect some errors. Lines that couldn’t be read are left out.
Page 1
(b) Would you accept appointment. 11 ofieredonywhero i n tho Unllod Slaler?__.____________....x. You will not ba considwad lor posltlons paying loss. (e) I t you are wllllnq to travel. opccify: 0 Froquanlly 0 Constantlya Occaalonolly
Page 2
u nulla ch d. with your appllcallon. Typawrlto or wrllu loqll ~ l yl hINd. Up t o 20 graduate students j radiation measuring devices. Rooson lor Is u vil q : Medical School, Univ. ofC ali for nie Sari Frnncls co ..................................................................................................... Reoron lor leav ~ n p : Cyclotron program I Lac1 title 01 y o u r position: Salary or I.". mo . California, Berkeley, Tallf ................................................................................................
Page 3
oadnc).. mfo. a1 lacks. ulc.): m r and klnd of emplny*oi suporvied b y you: Namo and Ullu 01 Irnmedhle rulnrvlanr: .
Page 4
(dl Llrl Your Chid Undnrqraduaio Coilwe Subid1Lbt Your Phlol Gro duo lo Colloqe Sublect. b l Othur truln!nc). I.LI ~ I OP vocnuonol, bwinoo.. itudy oouraos given 1Iiro:t 11 tho Arrnal Fwcoa Ittslltule (ohow n o m s and IocaUon 01 19. hdl cato ynur knowlodge or himi Ilconro or ctartiriwto (yoor): 22. 91vit a n y opaclol quulilkatlon# not covered elsewhere In your uppllcatton i u c ai: (a) your morn Iinparlonl puhllcalloni (do NOT rubmll copier u n l w mque!led) (b) your pal snl i or lnvanllann (d) memhermhlp In pmlemlonal or nclenllflc ~ffleUer.qlo. !rho*. waa your knaX & Z ~ ro ign la ngua gaia c quid (bl If mu ho v nIra vald or resided In nny forelqn eounlrlor. Indicale. (I1 nnnioa nl counlrtni. (2) datoi and longth of IImn lpanl lhero ond (3) l ~ asot io rpumm (0. 0.. buitnrm. educallon. ncroat;on): p-aj Nl Member Sigma Xi)
Page 5
9. REFEEENCES.-LIUI llira perion8 Ilv:tig In tho Urillod Sloloa or Torrllorles 01 the Unlled Slalcr who a r e NOT relotod lo you and whu hu\e clollnlle knovrlodgnol y r BUSlNESS OR OCC UP A quullllcalluiia utid lilnors 1 , s - lliri pmlllon lrrr which you ore opplylnq. Do no1 l o p a l nwnoj 01 ruporvlairr Iiilnd under llorn IG IEXI'EKITNCEI. BUSINESS OR HOME ADDRESS FULL NAME (Glve cornplele addreia. lncludlng ilrwl and number) TION 4. May lnqulry ho mad. d your preranl oinployrr roq~ircllngyout chctrocbr. quullllccrnonr. elc.7 0 Yea 0 NO !7. Wilhln the pas! I 2 :nnathn, hnro yoii liolrilurilly u i c d Iriloxl. hnod. or Imprlrond. 01 I:laicCd .>!I protxitlon, or l.ilvo you war boon ordrrod to d e r a i l lail. 11,: tliu violation ul tiny luw. 01 which a hn. 01 $25 or less wus iinwd)?..- __.______._____ I I our answnr IS "Yes." 11s1 011 such cmos uiidvr llwn 30 Im. ow. d l v o In each c a w (I)lhe dulci: (21 Ihe niiluru 01 Iho ollorire 31. Ars you cro dllaal or nnipluyoc ul ciiiy :Ai!e. Tarrllory. caunly. 33. Hove you any phyalcal detect or dlaoblllly whoboavor?--. .___.._._ _ _ _I! your nnower I s "Yor." qIve Lwmplole dolaill In l t m i i i 30. 38. (0) Wuro you w o r In lha Uiillud Slolos Mililury or Naval In your dlschorqe or saporallon pulmra lo sl~uwdie l y p a Indlcatr "Ye," or "No" ~ n i w o rby plocltiq X In propor mlumn. paign nr arpeditlon atid rocuivu a cuiowiqrl hdqo or TIP, ~ n l u t ~ ~ l r ncon1aln.d In tho unaweri lo Quwllon 36 utore has b o 1 1 VI
Page 6
,ce of employment (oity a n d Statel: Solo ry or earnings: EXOCI title 01 your position: ; I Fodorul. name depariinunt. burouu or u=lablinhmont. and ........................................................................................................ Ason lor leaving: Salary or earnings: Exact tiUe 01 your position: ace 01 ernploynrent (city a n d State): Description your work: .......................................................................... ayency. nilq.'oI locks. uk.):