Difference between revisions of "The Fanzine Questionnaire"
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12 | 12 | ||
---- | ---- | ||
| − | 13 | + | 13. Profession ''If student so state'' |
| + | ---- | ||
| + | 14. Place of Emplyment if presently emplyed ''University or school if student'' | ||
| + | ---- | ||
| + | 15. Position | ||
| + | ---- | ||
| + | 16. Description of work | ||
| + | ---- | ||
| + | 17. FOREIGN TRAVEL<br> | ||
| + | Have you ever lived or traveled through any foreign city/states throughout the Continental United States? ''explain in detail)'' | ||
| + | ---- | ||
| + | 17. SPECIAL QUALIFICATIONS AND SKILLS<br> | ||
| + | A. Licenses or certificates | ||
| + | ---- | ||
| + | E. Special skills you possess and machines and equipment you can use | ||
| + | ---- | ||
| + | F. Special qualifications not covered in application ''(For example, your most important publications; your patents or inventions; membership in professional or scientific societies, etc.; honors and fellowships received.)'' | ||
| + | ---- | ||
| + | 21. EDUCATION | ||
| + | ---- | ||
| + | A. State major field of study at highest level of education | ||
| + | ---- | ||
| + | B. Most enlightening revelation brought about ''through'' highest level of education ''(in less than five words please)'' | ||
| + | ---- | ||
| + | C. Most enlightening regulation maintained by educational facility ''(use as many words as you please)'' | ||
| + | ---- | ||
| + | TRUE OR FALSE -- PLACE X IN PROPER COLUMN -- YES - NO | ||
| + | ---- | ||
| + | |||
[[Category:Articles by Zappa]] | [[Category:Articles by Zappa]] | ||
Revision as of 11:14, 19 January 2007
DATA FOR SENSITIVE OR CRITICAL-SENSITIVE POSITION
IMPORTANT: INSTRUCTIONS
This form must be completed in duplicate. Use dark legible pen or typewrite if possible. Make sure all questions have been answered to the fullest extent of your memory's capacity and/or imagination where applicable. Complete all items except No. 28. If an answer to any item is "no" or "none" so state. Any items that for personal reasons you wish to remain confidental leave blank.
Item 17A. pertains to type of licenses or certificates in possession.
After you have filled out this form in duplicate place one copy with your records in a safe place and send the other copy to United Mutations, Box 23315, Hollywood, California 90028 along with a suitable photograph or photographs and any other material which you feel may be necessary.
1. Photo
2. Social Name
3. Name at birth (First, middle, last)
4. Address of correspondence (Number, Street, State, and Zip code)
5. Home phone No.
6. Height
7. Weight
8. Sex
9. Marital status
10. Birthplace
11. Birth date
12
13. Profession If student so state
14. Place of Emplyment if presently emplyed University or school if student
15. Position
16. Description of work
17. FOREIGN TRAVEL
Have you ever lived or traveled through any foreign city/states throughout the Continental United States? explain in detail)
17. SPECIAL QUALIFICATIONS AND SKILLS
A. Licenses or certificates
E. Special skills you possess and machines and equipment you can use
F. Special qualifications not covered in application (For example, your most important publications; your patents or inventions; membership in professional or scientific societies, etc.; honors and fellowships received.)
21. EDUCATION
A. State major field of study at highest level of education
B. Most enlightening revelation brought about through highest level of education (in less than five words please)
C. Most enlightening regulation maintained by educational facility (use as many words as you please)
TRUE OR FALSE -- PLACE X IN PROPER COLUMN -- YES - NO
