PERS 
. CLASSIFICATION BOARD FORM NO. 14— FIELD QUESTIONNAIRE 
be filled out in accordance with the instructions given in 
P. C. B. Forms Nos. 15 and 16) 
Bureau No ... Sheet No.. 
m* 
1. 
(Surname) 
(Given name) 
(Initial) 
Space reserved for the use of the Board 
2. Department . 
3. Bureau 
4. Field service. 
6. Pay roll title 
— — . 7 . Customary office title 
8. Present administrative allocation 
5. (a) Field station 9 . Present gross rate of pay $. 
(&) Subdivision 10. Deduction for allowances.. $. 
(c) City or town ... — State 11. Net rate paid in cash $. 
12. Indicate by an £i X” in the proper box or boxes the kind of allowances, if any, received by the employee: 
I I Furnished Q Heat Q Fuel Q Uniform Meals per day: jHj 1 Q 2 | 1 3 
| [ Unfurnished j [ Light ( j Laundry j j Subsistence or rations in kind 
□ House Q Room 
13. Describe any other allowance, privilege, or perquisite of value 
14. If any special equipment or a bond is required by law or regulation to be furnished at the employee’s expense, state kind and annual cost 
.m. ( b ) How many hours per week excluding unusual or irregular overtime work? 
(c) If not a full time and all-the-year-round position, state number of hours per day 
15. (a) Regular hours of work: From to -A 
Summer Winter 
[ week 1 
number of days per -I month > (d) If certain hours of availability for duty, outside of regular working hours, are required, state hours and 
l year J 
type of such duty 
16. (a) Rate of pay for overtime (&) Amount of overtime pay in last 12 months 
17. (a) Does the employee in any way direct or supervise other employees? 
(5) If so, in what way? (See Form 16 before answering). 
— (c) How many? 
18. If the employee supervises other persons through immediate contact, give the name and the sheet numbers of such persons. (For such of these as may not be 
covered by questionnaires, give number and kinds by occupations.) If the employee exercises supervision through section or division heads, give the title of 
such sections or divisions and the names and sheet numbers of their heads. 
19. 
the employee in any way directed, supervised, or instructed, or his work reviewed ? . (b) If so, in what way ? (See Form 16 before answering.) 
20. What is the^name, official position, and sheet number of the employee’s immediate superior 
/" 
21. Employee’s education: Strike an “ X ” over the number representing the highest grade or year completed in each type of school: 
Elementary 
^ i8h 
Normal 
College W 
Postgraduate or professional 
1 
2 
3 
4 
5 
6 
7 
8 
1 
2 
3 
4 
1 
2 
3 
4 
1 
2 
3 
4 
1 
2 
3 
4 
(Kind) 
Other education (describe): 
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i. 1 . • • 1 11 1 •• 1 • w • a ■ . a • ■ • 1 • 1 I I* a ■ 
22. What length and kind of exper ienc e or other.training did the employee possess upon original entrance into this position which was most qualifying or.pertfnent? 
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