|Hours|During| |D l p y|During |+ Church
Members. |present|Weekly| per | past |Weekly|a o a e|entire | affiliations.
| time. | Pay. | day.| year.| Pay. |y s s a|time |B = Baptist.
| | | | | |s t t r|in N.Y.|M = Methodist.
| | | | | | .|City. |E = Episcopal
------------+-------+------+-----+------+------+-------+-------+P = Presbyterian.
1. Man | | | | | | | |C = Catholic.
2. Woman | | | | | | | |MN = Moravian.
(Sex) | | | | | | | +----------------------
3. | | | | | | | |X Political
4. | | | | | | | | affiliations.
5. | | | | | | | |R = Republican.
6.(Lodgers) | | | | | | | |D = Democrat.
7. | | | | | | | |S = Socialist.
8. | | | | | | | |PB = Prohibition.
9. | | | | | | | +----------------------
10. | | | | | | | | *See space for
11. | | | | | | | |remarks on other
| | | | | | | |side (3) (4).
--------------------------------------------------------------------------------------

FAMILY SCHEDULE (REVERSE SIDE)

UNSUCCESSFUL APPLICATIONS | |TRADE UNION, SECRET
FOR WORK.* (1) | REASON FOR REFUSAL.* (1) | SOCIETIES.* (2)
------------+------------------------------------------------------------------------
Family |Date|Place: Name |Kind of|Place |Lack of| | |Name of |Why not
Members | | and Address| Work |Filled| Skill |Color|Other|Organiz-| member?
| | | | | | | | ation |Did you
| | | | | | | | | apply?
------------+----+------------+-------+------+-------+-----+-----+--------+----------
1. Man | | | | | | | | |
2. Woman | | | | | | | | |
(Sex.) | | |