HomeMy WebLinkAboutBrazos County Civil Defense Office Application for Civil Defense AppointmentName Moen
Birthdate
Sex Male
(Last)
11/20/26
BRAZOS COUNTY CIVIL DEFENSE OFFICE
APPLICATION FOR CIVIL DEFENSE APPOINTMENT
(Please print or type all answers)
Civil Defense AppointmentC.A.P. Liaison Officer
(civil Air Patrol)
Eugene
(First)
Address 3814 Windridge Dr. Bryan, Texas 77801
Occupation Individual Income Tax Preparer
Employer H & R Block Inc. Address2424 Rice Blvd.Houston,Tx.77005
Telephone No. Marital Status Married
Race
White
Height 5'81"
Blood type O
I.D.253 -32 -1349
Date 3/1/80
Donnell
(Middle)
Telephone846 -8695
Working Hours 10 -7 M -F
Age 53
Weight 195
Education Bach of Aero Administration - Auburn Univ. 4 yr.Acct.at TAMU
Do you have any physical defects: serious overweight, amputations, eplilepsy,
Etc?
Explain mild diabetes (no insulin) 15 lbs. overweight
Color of hair Brown Eyes Blue Military Service: Yesx No
Branch USAF gixERNIccifiVex Date 9/1/71
Retirement
Present Military Reserve affiliation, if any
In case of emergency notify Mrs.Eugene D.Moen 3814 Windridge Dr.Bryan,Texas
Have you ever been convicted of a felony? No
OATH
"I, , do solemly swear (or affirm)
that I win support and defend the Constitution of the United States and the
Constitution of the State of Texas, 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;
and that I will well and faithfully discharge the duties upon which I am
about to enter. And I do further swear(or affirm) that I do not advocate,
nor am I a member or an affiliate of any political party or organization,
group or combination of persons that advocates the overthrow of the Govern-
ment of the United States or of this State by force or violence; and that
during such time as I am a member of the County Civil Defense and Disaster
Relief Committee of the County of Brazos I will not advocate nor become a
member or an affiliate of any organization, group, or combination of persons
or of any political party that advocates the overthrow of the Government of
the United States or of this State by force or violence."
Approved: Signature
Retired
Eugene D. Moen
(Note: on reverse side, list skills and training).
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