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.
(Signature in usual form.)——————