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City of New York..

To the Municipal Civil Service Commissoners of

The City of New York:

.190.

The undersigned states that he is......years of age, respectfully asks appointment as........in the........Department, City of New York, and refers you to the following testimonials:

Signed.....

Each of the undersigned respectfully represents to the Commissioners of...... .. City of New York, that he can and does hereby testify that he knows the above applicant personally, and that he is a man of good moral character, of sober and industrious habits, that he has never known him to be guilty or convicted of any criminal act or disorderly conduct, and each of the undersigned further says that he is not a keeper of a liquor saloon; that he consents that this certificate may be made public, and is willing to furnish any other information respecting the applicant which he may possess. Name....

Residence....

The second, which must be filled out and signed in the presence of the Secretary or of a Clerk of the Municipal Civil Service Commission, who shall also sign as witness, shall be as follows:

(N. B.-This statement of applicant must be filled out and signed in the presence of the Secretary or of a Clerk of the Civil Service Commission, who shall also sign as witness.)

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Where do you live? (street and number).

How long have you lived in New York City?.

If not born in the United States, have you been naturalized?....

When?....

Where?.....

.or single?........or widower?.

Are you married?........or single?.

What family have you?....

Have you been complained of, indicted for or convicted of any criminal offense?.....

What is your regular occupation?....

.Where?.

What has been the nature of your occupation for the last five years?.....

Have you ever been a policeman (or fireman, as the case may be)? and when?......

If so, where?....

Have you paid or promised to pay, or given any money or other consideration to any person, directly or indirectly, for any aid or influence toward procuring your appointment?.

*Have you ever been in the Army or Navy of the United States? .If so, when?..... In what capacity?.....

Witness.

Signature of Applicant.

Sworn to before me, this

....day of...........190...

Signature of officer administering oath.

*If the applicant has been in the military or naval service of the United States he should furnish the name and address of one or more of his surviving officers if practicable. In any case he shall give satisfactory evidence of honorable discharge.

Rule 49.

Every applicant for position in Schedule C, except for Matron and Doorman in the Police Department, shall present to the Examining Board a statement in reference to his physical qualifications, in which he shall answer in writing the following questions:

Name

Date of birth..

Occupation

...

APPLICANT'S STATEMENT.

Have you any disease now?.

What diseases have you had during the last seven years?.

Do you know of any hereditary disease in your family?.

If your parents, brothers or sisters, or any of them, are dead, of what disease did they die?.

Have you ever had fits?....

Have you ever had any fracture or dislocation?....

Have you ever received any injury in the head or spine?.

Are you subject to piles?....

Have you ever been vaccinated?..

Have you ever had rheumatism?..

.Applicant.

The medical and physical examiners of the Civil Service Boards. shall examine the applicant in reference to the matters designated in the following schedule, and fill up and certify the same in accordance with the results of such examination.

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HAS THE APPLICANT ever been examined by the Medical Officer of the Department, and if so, state the result?

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WEIGHT.

HEIGHT.

C+

* STATE THE EXACT Weight, A; Height, B; Circumference of Chest, C.

A.

B. Feet.

Inches.

At forced Expiration.

inches

On full Inspiration

inches

A. IS THE RESPIRING MURMUR clear and distinct over both lungs?

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Is the character of the Respiration Full, Easy, and Regular? Are there any indications of Disease of the Organs of Respiration or their Appendages?

C.

A. IS THE CHARACTER of the Heart's action Uniform, Free, and A. Steady?

B. Are its Sounds and Rhythm Regular and Normal?

B.

C. Are there any indications of Disease of this Organ or of the Blood
Vessels?

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IS THE APPLICANT SUBJECT TO COUGH, Expectoration, Difficulty of Breathing, or Palpitation?

A. ARE THE FUNCTIONS of the Brain and Nervous System in a Healthy State?

A.

B.

Has the Brain or Spinal Cord ever been Diseased?

B.

IF THE APPLICANT has had any serious illness or injury, state
expressly what effect, if any, is perceptible in the heart, lungs, kidneys
or abdominal organs, or the skin, eyes, ears, limbs, etc.

HAS THE APPLICANT any predisposition, either hereditary or ac-
quired, to any constitutional disease, as phthisis, scrofula, rheumatism?)

‡ DOES THE APPLICANT display any evidence of having or having had syphilis?

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(a) In examining the sense of sight, not only shall the general condition of the organs be ascertained, but weight shall be given to quickness and accuracy in discriminating colors and distances. The hearing shall be tested also as to keenness and correctness in distinguishing degrees and kinds of sounds and the direction from which they come.

(b) In the case of Patrolmen in the Police Department the minimum height required is 5 feet 736 inches and the weight is 138 pounds. (c) In the case of Firemen in the Fire Department, the stature shall not be below 5 feet 6

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those marked as the minimum in the subjoined table:

inches, nor the chest measurement and weight below

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Affidavit to be signed and sworn to by applicant.

City and County of New York, ss.:

I......

.being duly sworn, depose and say, that I have returned true answers to the inquiries of...... touching my personal and family health, history, habits and antecedents, and that I am the person described in the above record of examination.

Sworn to before me this

...day of........190..

Notary Public (or Commissioner of Deeds).

CERTIFICATE OF MEDICAL AND PHYSICAL EXAMINERS. We hereby certify that we have this day carefully and thoroughly examined, in accordance with the above instructions..... ....and find that he is...... sound in limb and body, is...... able-bodied......of a robust constitution, has......good eyesight, and......good hearing, and in our opinion is......physically.......qualified to sustain the labors and exposures, and perform the duties of a......and that the above is a truthful record of the examination.

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