Confidential
1. | How long have you known the candidate? |
2. | Are you related to the candidate? If so, please describe the relationship. |
3. | Have you known the candidate as:
(a) | a friend? |
(b) | an aquaintance? |
(c) | an employee? |
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4. | If as an employee -
(a) | over what period was the candidate employed by you? |
(b) | why did the candidate leave your employ? |
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5. | As far as you know is the candidate -
(a) | Reliable? |
(b) | Sober? |
(c) | Conscientious? |
(d) | Of good character? |
(e) | Discreet? |
(f) | Free from any significant history of mental or physical disability? |
(g) | Free from undue financial pressure? |
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6. | As far as you know -
(a) | Is the candidate associated in any way with a Communist Party or with any body that is looked upon with favour by Communist Parties, e.g. in New Zealand, the New Zealand Peace Council, the NZ-USSR Society, the Chinese Cultural Association, the New Zealand China Society (or The China Friendship Society)? |
(b) | Is the candidate associated in any way with a Fascist organisation? |
(c) | Has the candidate had association in the past with any of the parties or societies named in (a) and (b) |
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7. | If there are any other comments you would like to make, bearing on the candidate's character and reliability, please make them here or on a separate, sheet. |
8. | Can you give me the name and address of another person who can assist in this enquiry? |
9. | Would you prefer that a member of this Service should call and discuss this matter with you? |
Signature: ...................
Date: ...................
20,000/10/64—94145 W