10. Are you related to the applicant? If so, what is the relationship?
11. Are you aware of any circumstances tending to disqualify the applicant for the public service?
12. Would you yourself trust the applicant with employment requiring undoubted honesty?
13. What is the name of the applicant for whom you furnish this certificate? First name, middle initial, or initials, if there be any, and last name, should be correctly given.
The above questions are answered to the best of my knowledge and belief.
(Signature of voucher) ......................
(P. O. address) .........................
Date, ............... 190 .
(Applicant will NOT fill the following blank.)