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23. (a) Were you ever discharged on account of delinquency or misconduct from any position in which you were employed? Answer “Yes” or “No.”

(b) If so, state when, from what position, and by whom were you discharged.

24. Are each and all of the answers to the foregoing questions in your own handwriting? Answer “Yes” or “No.”

I hereby certify that the answers to the foregoing questions are true in every particular.

(Signature of Applicant) ............

(P. O. address) ..............

(The following oath must be taken before a Notary Public, or other officer authorized to administer oaths for general purposes, and the officer’s signature must be authenticated by official seal. If the oath be taken before a Justice of the Peace or other officer who has no official seal, his character must be certified by the Clerk of Court, Secretary of State, or other proper officer, under official seal.)

The Notary is requested to see that all the foregoing questions are answered in full before executing the jurat.