DECLARATION.
I declare upon my honour as follows:
1. My true and full name is (if female, please say whether
Mrs. or Miss)
2. Since my application was made I have been living at (give
all the places)
3. My post-office address in full is
4. If examined within twelve months for the civil service--for
any post-office, custom-house, or Department at Washington--state
the time, place, and result.
5. If you have ever been in the civil service, state where and
in what position, and when you left it and the reasons therefor.
6. Are you now under enlistment in the army or navy?
7. If you have been in the military or naval service of the
United States, state which, and whether you were honourably
discharged, when, and for what cause.
8. Since my application no change has occurred in my health
or physical capacity except the following:
9. I was born at ----, on the ---- day of ----, 188.
10. My present business or employment is
11. I swore to my application for this examination as near as
I can remember at (town or city of) ----, on the ---- day
of ----, 188.
All the above statements are true, to the best of my knowledge
and belief.
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