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Page 38
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Est.
Provide the country(ies) of citizenship for your former spouse.
Country #1
Country #2
Provide the date you married your 
former spouse.
(Month/Day/Year)
Est.
YES
NO 
(If NO, complete (a))
I don't know
Is this former spouse deceased?
Provide City and Country if outside the United 
States; otherwise, provide City, State and Zip Code)
Street 
City
State
Country
Zip Code
I don't know
(a)
Middle name
Provide the date of birth of your 
former spouse. 
(Month/Day/Year)
Suffix
Last name
First name
Est.
Provide the full name of your former spouse.
Entry #2
Provide the place of birth for your former spouse. 
City
State
Country 
(Required)
Zip Code
17.2  Complete the following if you selected 'Divorced', 'Annulled', 'Widowed', or 'Other Former Spouses'.
Provide the place married. (
Provide City and Country if outside the United States; otherwise, provide City, State and Country.)
City
State
Country
Section 17 - Marital Status - (Continued)
Annulled
Widowed
Divorced
Provide the status of this marriage.
(
Provide City and Country if outside the United States; otherwise, provide City, State and Zip 
Code)
City
State
Country
Zip Code
Provide the date divorced, annulled or widowed. 
(Month/Day/Year)
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Page 39
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
NO 
(If NO, proceed to Section 18)
YES
Do you presently reside with a cohabitant?    
(Month/Day/Year)
17.3
outside the U.S., provide citizenship information.
Complete the following if you presently reside with a cohabitant.
Middle name
First name
Last name
#1
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Country #1
Provide date cohabitation began. 
(Month/Day/Year)
Country #2
Provide your cohabitant's country(ies) of citizenship.
Entry #1
Middle name
Provide the cohabitant date of birth.
Suffix
Last name
First name
Est.
Provide the cohabitant full name.
Date
Provide the cohabitant place of birth.
City
State
Country 
(Required)
Section 17 - Marital Status - (Continued)
DS 1350
U.S. Passport (current or most recent)
U.S. Naturalization certificate
Alien registration
U.S. Citizenship certificate
FS 240 or 545
None (Provide explanation)
Other (Provide explanation)
Provide your cohabitant's U.S. Social Security Number.
Not applicable
Explanation
Not applicable
name was used).
Provide document number.
Middle name
First name
Last name
#3
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
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Page 40
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
(Month/Day/Year)
Complete the following if you presently reside with a cohabitant.
Middle name
First name
Last name
#1
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Entry #2
Middle name
Provide the cohabitant date of birth.
Suffix
Last name
First name
Est.
Provide the cohabitant full name.
Date
Provide the cohabitant place of birth.
City
State
Country 
(Required)
DS 1350
U.S. Passport (current or most recent)
U.S. Naturalization certificate
Alien registration
U.S. Citizenship certificate
FS 240 or 545
None (Provide explanation)
Other (Provide explanation)
Provide your cohabitant's U.S. Social Security Number.
Not applicable
Explanation
Not applicable
name was used).
Provide document number.
Section 17 - Marital Status - (Continued)
Country #1
Provide date cohabitation began. 
(Month/Day/Year)
Country #2
Provide your cohabitant's country(ies) of citizenship.
Middle name
First name
Last name
#3
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
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Page 41
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Has this relative used any other names?
NO
YES
Not applicable
name, alias, or nickname).
City
State
Country 
(Required)
Provide your relative's place of birth.
Middle name
Last name
Provide your relative's full name.
Suffix
First name
Suffix
Middle name
Last name
First name
If mother, provide your mother's maiden name.
Same as listed
18.1  Complete the following if the relative listed is your 
Sister, Stepbrother, Stepsister, Half-brother, Half-sister. 
I don't know
Middle name
First name
Last name
#1
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#3
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide relative type.
Country #1
Country #2
Provide your relative's country(ies) of citizenship.
Provide your relative's date of birth.
Est.
Date 
(Month/Day/Year)
Father
Child (including adopted/foster)
Stepchild
Foster parent
Stepmother
Mother
Check all that apply.
Section 18 - Relatives 
Stepfather
Brother
Sister
Stepbrother
Stepsister
Half-brother
Father-in-law
Half-sister
Mother-in-law
Guardian
Entry #1
Entry #1 
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Page 42
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
DS 1350
U.S. Passport
U.S. Naturalization certificate
U.S. Citizenship certificate
FS 240 or 545
None
Other
Provide document number.
(Provide explanation)
State
City
Street
Zip Code
(Provide explanation)
Provide your relative's current address. (
Provide City and Country if outside the United States; otherwise, provide City, State and Zip Code)
Provide your relative's APO/FPO address. 
YES 
NO
I don't know
Is your relative deceased?    
YES
(If YES, proceed to 18.3)
NO
Zip Code
Does this relative have an APO/FPO address?
Address
APO or FPO
APO/FPO State Code
Street 
City
State
Country
Zip Code
Complete the following if the relative listed is your 
Sister, Stepbrother, Stepsister, Half-brother, Half-sister and is a U.S. Citizen, foreign born and is deceased. 
OR 
Complete the following if the relative listed is your 
and is a U.S. Citizen, 
foreign born and has a U.S. or APO/FPO address.
18.3  
18.2  Complete the following if the relative listed is your 
and is not deceased.
Entry #1 
Entry #1 
Page 43
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
(Provide explanation)
Provide document number
Other 
U.S. Visa
U.S. Alien registration
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other 
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other 
Quarterly
Employer name
I don't know
(Provide City 
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
Complete the following if the relative listed is your 
and is not a U.S. Citizen, 
has a U.S. address and is not deceased. 
18.4  
18.5  Complete the following if the relative listed is your 
and is not a U.S. Citizen,  
has a foreign address and is not deceased. 
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.  
(Month/Year)
Present
Est.
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other 
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other 
Quarterly
Employer name
I don't know
(Provide City 
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.  
(Month/Year)
Present
Est.
Entry #1 
Entry #1 
Page 44
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Has this relative used any other names?
NO
YES
Not applicable
name, alias, or nickname).
City
State
Country 
(Required)
Provide your relative's place of birth.
Middle name
Last name
Provide your relative's full name.
Suffix
First name
Suffix
Middle name
Last name
First name
If mother, provide your mother's maiden name.
Same as listed
18.1  Complete the following if the relative listed is your 
Sister, Stepbrother, Stepsister, Half-brother, Half-sister. 
I don't know
Middle name
First name
Last name
#1
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#3
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide relative type.
Country #1
Country #2
Provide your relative's country(ies) of citizenship.
Provide your relative's date of birth.
Est.
Date 
(Month/Day/Year)
Section 18 - Relatives - (Continued) 
Entry #2
Entry #2 
Page 45
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
DS 1350
U.S. Passport
U.S. Naturalization certificate
U.S. Citizenship certificate
FS 240 or 545
None
Other
Provide document number.
(Provide explanation)
State
City
Street
Zip Code
(Provide explanation)
Provide your relative's current address. (
Provide City and Country if outside the United States; otherwise, provide City, State and Zip Code)
Provide your relative's APO/FPO address. 
YES 
NO
I don't know
Is your relative deceased?    
YES
(If YES, proceed to 18.3)
NO
Zip Code
Does this relative have an APO/FPO address?
Address
APO or FPO
APO/FPO State Code
Street 
City
State
Country
Zip Code
Complete the following if the relative listed is your 
Sister, Stepbrother, Stepsister, Half-brother, Half-sister and is a U.S. Citizen, foreign born and is deceased. 
OR 
Complete the following if the relative listed is your 
and is a U.S. Citizen, 
foreign born and has a U.S. or APO/FPO address.
18.3  
18.2  Complete the following if the relative listed is your 
and is not deceased.
Entry #2 
Entry #2 
Page 46
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
(Provide explanation)
Provide document number
Other 
U.S. Visa
U.S. Alien registration
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other 
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other 
Quarterly
Employer name
I don't know
(Provide City 
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
Complete the following if the relative listed is your 
and is not a U.S. Citizen, 
has a U.S. address and is not deceased. 
18.4  
18.5  Complete the following if the relative listed is your 
and is not a U.S. Citizen,  
has a foreign address and is not deceased. 
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.  
(Month/Year)
Present
Est.
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other 
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other 
Quarterly
Employer name
I don't know
(Provide City 
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.  
(Month/Year)
Present
Est.
Entry #2 
Entry #2 
Page 47
Form approved: 
OMB No. 3206 0005 
QUESTIONNAIRE FOR 
NATIONAL SECURITY POSITIONS
Standard Form 86 
Revised December 2010 
U.S. Office of Personnel Management 
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Has this relative used any other names?
NO
YES
Not applicable
name, alias, or nickname).
City
State
Country 
(Required)
Provide your relative's place of birth.
Middle name
Last name
Provide your relative's full name.
Suffix
First name
Suffix
Middle name
Last name
First name
If mother, provide your mother's maiden name.
Same as listed
18.1  Complete the following if the relative listed is your 
Sister, Stepbrother, Stepsister, Half-brother, Half-sister. 
I don't know
Middle name
First name
Last name
#1
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#3
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From 
(Month/Year)
To 
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide relative type.
Country #1
Country #2
Provide your relative's country(ies) of citizenship.
Provide your relative's date of birth.
Est.
Date 
(Month/Day/Year)
Section 18 - Relatives - (Continued) 
Entry #3 
Entry #3 
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