Official Text of Draft Questionnaire (10-12-40)

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The Pittsburgh Press (October 12, 1940)

OFFICIAL TEXT OF DRAFT QUESTIONNAIRE PUBLISHED

The complete official text of the questionnaire which all draft eligibles eventually must fill out is published by The Pittsburgh Press today.

The questionnaire is important to all men of registration age, from 21 to 36. While they will not be required to fill it out until their numbers are drawn at Washington, the printing of the text will give them an opportunity to study the required information so that when the time comes they can answer the questions properly.

Upon the answers to the questions will depend the decision on whether a man is called to service or deferred. In other words, the evidence submitted in the questionnaire will determine the registration’s eventual classification under the Conscription Act.

Last Sept. 19, The Press published a facsimile of a questionnaire prepared as part of a general mobilization plan long in advance of the present emergency.

The questionnaire published today, however, is the complete and official form for the peacetime conscription authorized by this session of Congress.

Readers should remember that the questionnaire will not be mailed to draft eligibles until sometime after registration day, set for next Wednesday.

After registration day, each registrant will be assigned a serial number. The serial numbers will be drawn by lot at Washington to determine the order of consideration for each registrant.

When a registrant’s number is drawn, he will be mailed the questionnaire and instructed to fill it out within a prescribed time and return it to his local draft board.

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SELECTIVE SERVICE QUESTIONNAIRE

Order no.: __
Date of mailing: __

(Stamp of Local Board)

Name:
(First) __
(Middle) __
(Last) __.

Address:
(Number and street or RFD route) __,
(Town–City, town or village) __,
(County) __,
(State) __.

NOTICE TO REGISTRANT

You are required by the Selective Training and Service Act of 1940 to fill out this Questionnaire truthfully and to return to this local board on or before the date shown below. Willful failure to do so is punishable by fine and imprisonment.

This questionnaire must be returned on or before __.

(To be signed by a member of the local board)

The above items are to be filled in by the local board before the questionnaire is mailed to the registrant.

INSTRUCTIONS

This questionnaire is intended to furnish the local board with information to enable it to classify you in one of the following Selective Service classes:

  • Class I includes men who are available for induction into the armed forces of the United States.

  • Class II includes those whose induction is deferred because of the importance to the nation of the service they are rendering in their civilian activities.

  • Class III includes those whose induction is deferred because they have persons dependent upon them for support.

  • Class IV includes those whose induction is deferred by law and those unfit for military service.

You will receive notice from your local board of your classification.

Oaths required in the questionnaire may be administered by:

  1. a member or chief clerk of a local board or board of appeal, member or associate member of an advisory board for registrants, or a government appeal agent;

  2. any postmaster, notary public, or any federal, state, county, or municipal officer authorized by law to administer oaths generally or for military purposes.

No fee should be charged for this service.

Advisory boards for registrants are organized to assist registrants in completing their questionnaires. No charge will be made for this service. If there is no advisory board available, you must nevertheless complete your questionnaire.

If the registrant is an inmate of an institution and is unable to complete the questionnaire, the executive head of the institution shall communicate these facts immediately to the local board.

  1. Make no alterations in the printed matter in this questionnaire.

  2. Write the applicable words in the spaces provided in the questionnaire.

  3. If you furnish additional information or affidavits with your questionnaire, attach the same securely to it.

  4. If you are already in the active military or naval service, obtain a certificate to that effect from your commanding officer and attach same to your questionnaire.

  5. After this questionnaire has been returned, report to your local board at once any change of address or any new fact which may affect your classification.

…

WHEN A NOTICE AFFECTING YOU IS POSTED AT THE OFFICE OF YOUR LOCAL BOARD, YOU ARE BOUND TO PERFORM THE DUTY REQUIRED EVEN IF NO NOTICE REACHES YOU BY MAIL.

Any statements in this questionnaire marked (Confidential) are for information only of the officials duly authorized under the regulations to examine them.

DSS Form 40

STATEMENT OF THE REGISTRANT

Series I. – IDENTIFICATION

INSTRUCTIONS – Every registrant shall fill in all statements in this series.

  1. My name is…
    (First) __
    (Middle) __
    (Last) __.

  2. In addition to the name given above, I have also been known by the name or names of __.

  3. My residence is:
    (Number and street or RFD route) __,
    (Town–City, town or village) __,
    (County) __,
    (State) __.

  4. My telephone number is… (If you have no phone, write “None”)
    (Town) __
    (Exchange) __
    (Number) __.

  5. My Social Security number is __. (If none, write “None.”)

Series II. – PHYSICAL CONDITION (Confidential)

INSTRUCTIONS – Every registrant shall fill in all statements in this series.

  1. To the best of my knowledge, I (have/have no) __ physical or mental defects. If so, they are (list defects or diseases here) __.

  2. I (am/am not) __ an inmate of an institution. If so, its name is (Name of hospital, prison, or other institution) __ and it is located at (address) __.

Series III. – EDUCATION

INSTRUCTIONS – Every registrant shall fill in all statements in this series.

  1. I have completed __ years of elementary school and __ years of high school.

  2. I have had the following schooling other than elementary and high school (if none, write “None.”):

Name of vocational school, college or university Course of study Length of time attended
__ __ __
__ __ __
__ __ __

Series IV. – OCCUPATION OR ACTIVITY

INSTRUCTIONS – All registrants shall fill in statement No. 1 in this series. Every registrant who is now working shall fill in all statements in this series except No. 9. Every registrant who is now prevented from working merely because of some seasonal or temporary interruption shall fill in all statements except statements numbered 2 through 8 in this series.

As used in this series, words such as occupation, work, and job apply to services rendered in any endeavor and to training or preparation for any endeavor.

  1. I (am/am not) __ working at present.

  2. The job I am working at now is (give full title): __.

  3. I do the following work in my present job (be specific - give a brief statement of your duties) __.

  4. I have done this kind of work for (length of time) __.

  5. My average weekly earnings in this job are $__ (Confidential).

  6. In this job, I am… (Put an X in one box)
    __ an employee, working for salary, wages, commission, or other compensation.
    __ an independent worker, working on my own account, not hired by anyone, and not hiring any help.
    __ working for my father or for the head of my family, but receiving no pay.
    __ an employer or proprietor hiring __ paid workers.
    __ a student preparing for __.

  7. My employer is…
    (Name or organization or proprietor, not foreman or supervisor) __, (Address of employment – street or RFD route, city and state) __ …whose business is __.

  8. Other business or work in which I am now engaged is (If none, write “none”) __.

  9. If you are now working because of some seasonal or temporary interruption, attach to this page a statement (a) explaining what the interruption is, when it began, and when you expect to be able to resume your work, and (b) supplying substantially the same information regarding your last job as is required in the above items in this series.

  10. I (am/am not) __ licensed in a trade or profession. If so, I am licensed as __.

  11. I (am/am not) __ at present an apprentice under a written or oral agreement with my employer.

  12. Other facts which I consider necessary to present fairly the occupation which I have described, or my connection with it, as a ground for classification are (if none, write “none”) __.

You may attach to this page any statement from your employer which you think the local board should consider in determining your classification. Such statements will then become a part of this questionnaire.

Series V. – OTHER OCCUPATIONAL EXPERIENCE

INSTRUCTIONS – Every registrant shall fill in this statement. Include any formal apprenticeship served.

  1. I have also worked at the following occupations other than my present job, during the last 5 years: (If none, write “none”)
Occupation Kind of work done From To
__ __ __ __
__ __ __ __

Series VI. – AGRICULTURAL OCCUPATIONS

INSTRUCTIONS – Every registrant who works on a farm shall fill in this series, in addition to filling out Series IV and V above.

  1. I work on or operate a farm as… (Put an X in the correct box)
    __ sole owner of the farm.
    __ joint owner with (name) __, (address) __.
    __ hired manager.
    __ cash tenant or renter.
    __ standing share tenant.
    __ share cropper.
    __ share tenant.
    (My agreement (if any) expires __.)
    __ wage hand (hired man).
    __ unpaid family worker.

  2. I have farmed for __ years.

  3. I (do/do not) __ live on the farm with which I am connected.

  4. I (am/am not) __ actually and personally responsible for the operation of the farm on which I work.

  5. The principal crops and livestock of the farm I operate or work on are:

Names of crops Acres devoted to each Kinds of livestock Number of each now on farm
__ __ __ __
__ __ __ __
__ __ __ __

  1. The number of hands employed on this farm is __.

  2. Other facts which I consider necessary to present fairly the agricultural enterprise I have described and my connection with it as a ground for classification are: (If none, write “none”) __.

Series VII. – DEPENDENCY (Confidential except as to names and addresses or claimed dependents)

INSTRUCTIONS – Every registrant shall fill in the statements numbered 1, 2, and 3 in this series.

  1. (a.) I am… (Put an X in one box)
    __ single.
    __ married.
    __ a widower.
    __ divorced.

  2. (b.) If married, I married my present wife at (city and state) __ on (month, day, year) __.

  3. (c.) I (do/do not) __ live with her. If not, her address is __.

  4. I have (number of children; if none, write “no”) __ children who are under 18 years of age or are physically or mentally handicapped, and who live with me.

“DEPENDENT”, AS USED IN THIS SERIES DEFINED

The word “dependent,” as used in this series, means any person to whose support the registrant contributes more than merely a small part of such person’s support (or to whose support the registrant would contribute were he not temporarily prevented from so doing by the registrant’s physical or economic situation) who is either (a.) the registrant’s wife, divorced wife, parent, foster parent, or grandparent, or (b.) the registrant’s child, unborn child, brother, half-brother, sister, or half-sister, who is under 18 years of age or is physically or mentally handicapped, or (c.) a person whose support the registrant has assumed in good faith, who is either under 18 years of age or is physically or mentally handicapped.

Only a person who is a United States citizen or who lives in the United States or its territories or possessions may be regarded as a dependent.

Based on the information contained in this questionnaire and on other information which the local board may receive, the local board will determine whether the “dependent” is an individual who is dependent in fact for support in a reasonable manner in view of such individual’s circumstances on income earned by the registrant by his work in a business, occupation, or employment.

Only those registrants who believe that one or more persons are dependent for support on the registrant’s earnings from his work are required to fill in the statements numbered 3 through 12 in this series.

  1. The following persons live with me in a home maintained by me and are entirely or partly dependent on my earnings from my work in my business, occupation, or employment, and have no other sources of income except as stated below:
Name Sex Age at last birthday Relationship to registrant Date when support began
__ __ __ __ __
__ __ __ __ __
__ __ __ __ __
__ __ __ __ __

|Dependent’s income, last 12 months other than board and lodging provided by the registrant in his home|

Contributed by the registrant Earned by the dependent Received from other sources
__ __ __
__ __ __
__ __ __
__ __ __

The net cost to me of maintaining my home during the last 12 months, after deducting $__, contributed by others than myself for the support of such dependents was $ __.

  1. The following persons do not live with me in a home maintained by me, but are entirely or partly dependent on my earnings from my work in my business, occupation, or employment, and have no other sources of income except as stated below:
Name and address Sex Age at last birthday Relationship to registrant Date when support began
__ __ __ __ __
__ __ __ __ __
__ __ __ __ __
__ __ __ __ __

|Dependent’s income, last 12 months|

Contributed by the registrant Earned by the dependent Received from other sources
__ __ __
__ __ __
__ __ __
__ __ __

  1. The cause of the dependency of any persons over 18 years of age (excluding my wife) listed above is as follows: (Give the name and a full statement of cause for dependency in each case) __.

  2. Of my dependents, only the following are receiving a part of their support from person s other than myself. (Give name of dependent, name and address of other person or agency contributing to his support, and amount so contributed in cash or other things of value by such other person or agency during the last 12 months) __.

  3. Of the amounts contributed by me to dependents listed above, only (if none, write “none”) $__, contributed to (name of dependent) __, was in payment for my own board and/or lodging.

  4. The income I earned from my work in my business, occupation, or employment during the past 12 months was $__.

  5. My income from all other sources during the past 12 months was $__.

  6. The following is a list of all property owned by (or held in trust for) either me or my dependents, the value of such property, and the net income received by either me or my dependents from such property during the last 12 months: (List this information separately as to the registrant and each dependent. Do not include clothing, personal effects, or household furnishings; or cash less than $500. Indicate which of such property is your home)

Name of person Type of property Value after deducting encumbrances Net income from such property
__ __ __ __
__ __ __ __
__ __ __ __

  1. I (do/do not) __ rent the house in which I live. If so, the monthly rent is $__, and the name and address of my landlord is __.

  2. Other facts which I consider necessary to present fairly my own status and that of my dependents as a basis for my proper classification are: (If none, write “none”) __.

With respect to any dependent (other than the registrant’s own wife, child, parent, or grandparent) whose support the registrant has assumed, attach to this page a statement explaining why and under what circumstances the registrant assumed such person’s support. Such statements will then become a part of this questionnaire.

SUPPORTING AFFIDAVIT OF DEPENDENTS OVER 18 YEARS OF AGE

INSTRUCTIONS – If convenient, each dependent over 18 years of age except the registrant’s wife shall swear to (or affirm) the following affidavit. The registrant shall furnish the local board a separate affidavit from each such dependent who does not sign the affidavit below. Blanks for this purpose will be supplied by the local board on request.

STATE OF __, COUNTY OF __.

We the undersigned do solemnly swear (or affirm) each for himself and herself individually, that we have read or had read to us the foregoing statements under the heading “DEPENDENCY” that we understand the same that we are named as dependents, that the statements contained therein as to the name, age, residence, relationship, and dependency of each of us toward said registrant, and the statements of his contributions and the contributions by other persons to the support of each of us and the statements of the financial and material condition of each of us, and of the income of each of us from all sources, are true.

(Signature[s] of dependent[s])

Subscribed and sworn to before me this __ day of __, 19 __.

(Signature of officer)
(Designation of officer)

Series VIII. – MINISTER, OR STUDENT PREPARING FOR THE MINISTRY

INSTRUCTIONS – Every registrant who is a minister or student preparing for the ministry shall fill in the statements in this series that apply to him.

  1. (a.) I (am/am not) __ a minister of religion.

  2. (b.) I (do/do not) __ customarily serve as a minister.

  3. (c.) I have been a minister of the (Name of sect or denomination) __ since (month, day, year) __.

  4. I (have/have not) __ been formally ordained. If so, my ordination was performed on (month, day, year) __ by (Ecclesiastical official performing the ordination) __ at (City and state) __.

  5. I (am/am not) __ a student preparing for the ministry in a theological or divinity school.

  6. I am attending the (Name of theological or divinity school) __, which was established (before/after) __ September 16, 1939, and is located at __.

Series IX. – CITIZENSHIP

INSTRUCTIONS – Every registrant shall fill in the statements numbered 1, 2, 3 and 4 in this series.

  1. I was born at…
    (Town) __
    (State) __
    (Country) __.

  2. I was born on
    (Month) __
    (Day) __,
    (Year) __.

  3. My race is…
    __ White.
    __ Negro.
    __ Oriental.
    __ Indian.
    __Filipino.
    __ Other (specify) __.

  4. I (am/am not) __ a citizen of the United States.

INSTRUCTIONS – Every registrant who is not a citizen of the United States shall fill in the statements numbered 5, 6, 7, 8 and 9.

  1. I (am/was last) __ a citizen or subject of (Name of country) __.

  2. My permanent residence has been in the United States since…
    (Month) __
    (Day) __,
    (Year) __.

  3. I (have/have not) __ filed a declaration of intention to become a citizen of the United States (first papers). Declaration filed at __ on __.

  4. I (have/have not) __ filed a petition for naturalization (second papers). Petition filed at __ on __.

  5. I (have/have not) __ registered with the Alien Registration Division, United States Department of Justice, under the Alien Registration Act of 1940. Registration receipt card number, if received: __.

Series X. – CONSCIENTIOUS OBJECTION TO WAR

INSTRUCTIONS – Only registrants who are conscientiously opposed to combatant or noncombatant military service by reason of their religious training and belief shall fill in this series, and shall obtain from the local board a special form on which to give substantiating evidence of conscientious objection. The local board will determine whether the registrant shall be classed as a conscientious objector on the basis of the claim made and the information contained in the special form.

I claim the exemption provided by the Selective Training and Service Act of 1940 for conscientious objectors because I am conscientiously opposed, by reason of my religious training and belief, to the types of service checked below: (Put an X in the correct box)
__ Combatant military service
__ Noncombatant military service

Series XI. – COURT RECORD (Confidential)

INSTRUCTIONS – Every registrant shall fill in statement Number 1.

  1. I (have/have not) __ been convicted of treason or a felony.

Every registrant who has ever been convicted of such an offense shall fill in the statements numbered 2, 3, and 4.

  1. The offense was __.

  2. The approximate date of conviction was ___.

  3. The name and location of the court was __.

Series XII. – MILITARY SERVICE (Confidential)

INSTRUCTIONS – Every registrant who now is or has been a member of the armed forces of the United States shall fill in the statements in this series (Use a separate line for each term of service)

My military service has been as follows:

Arm of service Date of entry into service Still in service (Yes/no) Date of discharge Type of discharge (Honorable/dishonorable/bad conduct/not honorable/undesirable/other)
__ __ __ __ __
__ __ __ __ __
__ __ __ __ __

Series XIII. – STUDENTS, PRESENT MEMBERS OF ARMED FORCES, CERTAIN OFFICIALS, ETC.

INSTRUCTIONS – Every registrant ho is a member of one or more og the groups named in this series shall check the appropriate item or items, and shall supply any further information called for under the item or items checked.

I am at present:
__ A college or university student, having entered upon attendance for the academic year 1940-1941 at __ on __, 1940. This college or university is located at __. I am pursuing a course of study involving __ hours attendance per week leading to the __. I (do/do not) __ request that if I am selected for training and service, my induction be postponed until the end of the present academic year, which ends on __, 1941.

__ A commissioned officer, warrant officer, pay clerk, or enlisted man of the Regular Army, the Navy, the Marine Corps, the Coast Guard, the Coast and Geodetic Survey, the Public Health Service, the federally recognized active National Guard, the Officers’ Reserve Corps, the Regular Army Reserve, the Enlisted Reserve Corps, the Naval Reserve, or the Marine Corps Reserve; my rank or commission is __ in the __.

__ A cadet, United States Military Academy; midshipman, United States Naval Academy; cadet, United States Coast Guard Academy; man who has been accepted for admittance (commencing with the academic year next succeeding such acceptance) to the United States Military Academy as cadet, to the United States Naval Academy as midshipman, or to the United States Coast Guard Academy as cadet, and whose acceptance is still in effect; cadet of the advanced course, senior division, Reserve Officers’ Training Corps or Naval Reserve Officers’ Training Corps; I am __ in __.

__ The Governor of a state or territory, a member of a legislative body of the United States or of a state or territory, a judge of a court or record of the United States or of state or territory or the District of Columbia; my office is __.

REGISTRANT’S AFFIDAVIT

INSTRUCTIONS –
1. Every registrant shall make the registrant’s affidavit.

2. If the registrant cannot read, the questions and his answers therein shall be read to him by the officer who administers the oath.

STATE OF __, COUNTY OF __.

I, __, do solemnly swear 9or affirm) that I am the registrant named and described in the foregoing statements in this questionnaire, that I have read (or have had read to me) the statements made by and about me, and that each and every such statement is true and complete to the best of my knowledge, information and belief.

(Registrant sign here)

Subscribed and sworn to before me this __ day of __, 19 __.

(Signature of officer)

(Designation of officer)

If the registrant has received assistance from an advisor, the latter will sign the following statement:

I have assisted the registrant herein named in the preparation of this questionnaire.

(Signature of advisor)

INSTRUCTIONS – Registrant shall write nothing below this line when filling out the questionnaire

MINUTE OF ACTION ON REQUEST FOR EXTENSION OF TIME FOR FILING CLAIM OR PROOF

The application of __ to have time for filing claim or proof extended to __, 19 __ is (granted/refused) __ for the reason that __.

(Date)

(Signature of member)

MINUTE OF ACTION BY LOCAL BOARD

The local board classifies the registrant in Class __, Subdivision __, by the following vote:
Ayes __, Nays __,

(Date)

(Signature of member)

APPEAL TO BOARD OF APPEAL

I hereby appeal from the classification by the local board in Class __, Subdivision __.

(Date)

(Signature of person appealing)

You must also attach here a written statement specifying the class or classes in which you think you should be placed. If you wish the appeal board to review a determination regarding your physical or mental fitness, you must fill out and sign the form for appeal on the Report of Physical Examination (Form 200) and you must attach to that form a statement specifying the class or classes in which you think you should be placed.

MINUTE OF ACTION BY BOARD OF APPEAL

The board of appeal classifies the registrant in Class __, Subdivision __, by the following vote:
Ayes __, Nays __,

(Date)

(Signature of member)

Date Minutes of Other Actions
__ __
__ __
__ __
__ __
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