APPOINTMENT AFFIDAVITS - ELLER, MYRTLE WHITTINGTON

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005382784
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 23, 2015
• Document Release Date: May 29, 2009
• Case Number: F-2009-00898
• Publication Date: February 25, 1953

STANDARD FORM 61 (REVISED AUGUST 1949)
MWMULGATERAL SRRVIC ANUISSION
FEDERAL PERSONNEL FYANUALAL
APPROVED FOR
RELEASED DATE:
28-May-2009
APPOINTMENT AFFIDAVITS
IMPORTANT. Before swearing to these appointment affidavits, you should read and understand the
attached information for appointee
CENTRAL INTELLIGENCE AGENCY WASHIN_(l QN,.-.D.- C------- ____________
------------
---------- -------- ---------
------------- (Departraent -
- or - agency) (Bureau or division) (Place of employment)
Myrtle W. Eller
If ----------- -- - -------- - do solemnly swear (or affirm)
A. OATH OF OFFICE
I will support and defend the Constitution of the United States against all enemies, foreign and
domestic; that I will bear true faith and allegiance to the same; that I take. this obligation freely
without any mental reservation or purpose of evasion; that I will well and faithfully discharge the
duties of the office on which I am about to enter, SO HELP ME GOD.
B. AFFIDAVIT AS TO SUBVERSIVE ACTIVITY AND AFFILIATION
I am not a Communist or Fascist. I do not advocate nor am I a member of any organization
that advocates the overthrow of the Government of the United States by force or violence or other
unconstitutional means or seeking by force or violence to deny other persons their rights under the
Constitution of the United States. I do further swear (or affirm) I will not so advocate, nor will
I become a member of such organization during the period that I am an employee of the Federal
C. AFFIDAVIT AS TO STRIKING AGAINST THE FEDERAL GOVERNMENT
I am not engaged in any strike against the Government of the United States and that I will not
so engage while an. employee of the Government of the United States; that I am not a member of
an organization of Government employees that asserts the right to strike against the Government
of the United States, and that I will not, while a Government employee, become a member of such
an organization.
D. AFFIDAVIT AS TO PURCHASE AND SALE OF OFFICE
I have not paid, or offered or promised to pay, any money or other thing of value to any person,
firm or corporation for the use of influence to procure my appointment.
E. AFFIDAVIT AS TO DECLARATION OF APPOINTEE
11 The answers given in the Declaration of Appointee on the reverse of this form are true and
correct.
Subject to satisfactory completion of physical examination and interview.
25 F --- 125a --- - f -- 4/~ --- -----
Subscribed and sworn. before me this ,?5tn--------- day of __Fabr_varlr __;-:-___ ---- --------- A. D. 19.53_,
washingtony D. C.
at--- -- ----------------------------- I-- - --
(Signature of officer)
L3 ---------------- ____---- __
NOTE.-If the oath is taken before a Notary Public the date: of. expiration of his commission should
be shown. - 16-5510W1
 DECLARATION OF APPOINTEE
This form is to be completed before entrance on duty. Answer all questions. Any false statement in this
declaration will be grounds for cancellation of application or dismissal after appointment, Impersonation is a
criminal offense and will be prosecuted accordingly.
1. PRESENT ADDRESS (street and number, city and State) '- -
-4-U 9- c~ ,
o
- - -
2 (A) DATE OF BIRT
(B) PLACE OF BIRTH (city or town and State
r, country),
3. py IN. CASE0F EMERGENCY. PLEASE NOTIFY
?i" ~ ~ 1~ f~.SJ
I
(B) RELATIONSHIP
A4f~.-GPI-.~.0
(C) STREET AND NUMBER,CITY AND STATE
~ X9/9 ~-?-~-.V 0.~ .i~ is~O.Gt_
(D) TELEPHONE N0:
o
4. DOES THE UNITED STATES GOVERNMENT EMPLOY, IN A CIVILIAN CAPACITY. ANY REIATIE OF YOURS (EIT BY BLOOD OR RRIAGIE) WITH WHOM YOU LIVE OR HA E LIVED WITHIN
THE PAST 24 MONTHS? [] YES ^ NO
If so. for each such relative fill in the blank. below. If additional space is necessary, complete under Item 10.
POST OFFICE ADDRESS
(I) POSITION (2) TEMPORARY OR NOT
'
RELATION-
MAR- (SINGLE
NAME
street number, if any)
(3) DEPARTMENT OR AGENCY IN
WHICH
SHIP
RIED
EMPLOYED
(Check one)
. ..: ,. ..
?. ..
2_________ _ ___-_ _ ___________
-------------------------- ----------------
------------- -----------
INDICATE "YES" OR"'NO" ANSWER BY PLACING "X?
10. SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS
1NPROPER COLUMN
YES
NO
ITEM
WRITE iN LEFTCOLUMNNUMBERS OF ITEMSTO WHICNOETAILED ANGWERSAPPLY
NO
S.AREYDUACITIZEN OF OR DO YOUOWEALLEGIANCE TO THEUNITEDSTATESY.
-
- ;. _-_
1 AREYOUAN OFFICIAL OR EMPLOYEE OF ANY STATE. TERRITORY. COUNTY, OR
------
------------------- - ---- ------ _-- ------____--
MUNICIPALITYL__._____
. ,.__-____ __ _.____..
-
? ...
..
ve detadeter
Ifycut answer is "Yea", give ils in Item 10. -
--
--
--------- --------- ------- ----- ----------'----
i. DO YOU RECEIVE ANY ANNUITY FROM THE UNITED STATES OR DISTRICT OF
-
-
------
----------------------------------------------------------------------------------
COLUMBIA GOVERNMENT UNDERANY RETIREMENT ACT OR: ANY PENSION OR
-
'^.
-'--"
- - ~~--- 77 --'- -- '-- ~-'
OTHER COMPENSATION FOR MILITARY OR NAVAL SERVICE? _ ._-__._..
___ __
"Yea
nltem lbreaao
n
ol
a
ifyour a a
s
o
v
unt
ge op
b
ry
di
that is, ago, optional W.a. Rif or by reason of of
untarp.
__
_____ _--,
____ _ __ ____ _ _
m
mount. of..
invdluntary separation after 5 years' seavfc; a o
Y
-
ret
retirement pay, and under what retirement act; and rating,
-
__
_________ _ _ ______ ____-_ _ _ ________ ________________-
if-retired from. military or naval service.
:. .! .
B. SINCE YOU FILED APPLICATION RESULTING IN THIS APPOINTMENT HAVE YOU
_________ _________ _L__.___
___
-
BEEN DISCHARGED, OR FORCED TO RESIGN, FOR MISCONDUCT OR UNSATIS
_
_
____
FACTORY SERVICEFROM ANY,' PDSITIONT_- ________ _________
Ifyouranswar fe "Yea", givein lfem lO ?fie nam.sud.ddram
t
and
in
d
h
'.
_
-- __ _ _-___ _ _ ___ _____ _ _ ______ ______
reason
case.
of employer,
a
e
eac
a HAVE YOU BEEN ARRESTED (NOT INCLUDING TRAFFIC VIOLATIONS FOR
-
--------- --------- - ---- ---~ _ ___ _-r--
~
WHICHYOUWEREFINEDRSORLESS, OR FORFEITED COLLATERAL OF 32S OR
_
-______ _ _____ ___ _-,._
_ _, ____
LESS) SINCE YOU FILED APPLICATIONRESULTING IN: THIS APPOINTMENT?_~
-- - ' --?
If your enawcr is "Yes", list all such case. under Item 10.
eachh case: (1)The data; (2) the nature of the offense
Give l
_
______
__________ _ _ ______ __ ______ _______- __. _ ___________
___ ____________________________________________________ ________
a
or violation; (3) the name and location of the court; (4) the
ppenalty imposed, if any, or other disposition of the" case..
IF appointed, your finge pried. will be taken.
_.
_ __
------
_____-__ _______- ____. ___? _- _ _
"
----------------------------------------------------------------------------------
PPOINTING OFFICER
INSTRUCTIONSJO ,A
The appointing officer before whom the foregoing certificate is made shell (2) Age.-ifdefinite age limit. have been established for the position, it should
determine to his own satisfaction that this appointment would be in conformance be determined that applicant is not outside the age range for appointment.
with the Civil Service Act, applicable Civil Service Rules end Regulations and Until such determination is made, the appointment may not be consummated.
acts o# Congress pertaining to appointment. (B) Citizenship.-The appointing officer is responsible for observing the
This form should be checked for holding of office, pension, suitability in con- citizenship provisions of (1) the Civil Service Rules snd (2) appropriation acts.
nection with any record of recent discharge or arrest, and particularly far, the roan. 61 constitutes, an. afdavit for both purposes and is acceptable proof of
following: - ` citizenship status in the absence of conflicting evidence, In doubtful cases the
(1) Identity of appointee:p-It is the duty of the ?appointing 'officer toappointment should not be consummated until clearance has been secured- from
guard against inpersonation and to determine beyond reasonable doubt that the the certifying office of the Civil Service Comm fission ' z " - , -
appointee is the same person whose appointment was authorized, The (4) Members of Family.-Section 9 of the Civil Service Act provides that
appointee's signature and handwriting are to be compared with the application whenever there are already two or more members of a family serving under
and/or other /pertinent papers. If the appointee qualified do-a written esami- - probational or permanent appointment in the competitive service, no other
nation, the signature on this form should be compared with the signature on member of such family is eligible for probational or permanent appointment in
the declaration sheet, which was signed in the examination room, His physical the competitive service. The appointments of persons entitled to veteran
appearance may be checked against the medical certificate. The appointee preference are not subject to this requirement. The members-of-family provision
may also be questioned on his personal history for agreement with his previous does not apply to temporary appointments. Doubtful cades may be referred to
statements. the appropriate office of the r'- q Service Commission for decision.
Sf .. s. OOls...i.T vmm~ae o1Pia6 16-661602