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Document DOJ-OGR-00023877

AI Analysis

Summary: The document is a questionnaire asking for personal details including current and past residential addresses, employment history with current employer listed as Law Office of Marc Fernich, and educational background. The respondent has been employed at the Law Office of Marc Fernich since July 2019. The form is likely used for official or administrative purposes.
Significance: This document appears to be a personal history form, potentially used for background checks or security clearances, providing detailed information about an individual's residence, employment, and education history.
Key Topics: Residential History Employment History Educational Background
Key People:
  • Marc Fernich - Employer
  • Marsha Fernich - Supervisor
  • Jonathan Savella - Supervisor
Document Type
Form
Date
2/01/08
Pages
1
Folder
IMAGES009
Has Handwriting
Yes

Full Text

3. A. Present Residential Address: ____________________________________________________ B. Length of time at this address: ________________________ 11 months C. Home telephone number: _____________________________________________________ D. List all residential addresses (including street and number, city and state) for the last five (5) years and dates you resided at each address: Addresses Dates ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 4. A. Present Place of Employment: Law Office of Marc Fernich I. Name of immediate supervisor: Marsha Fernich / Jonathan Savella II. Employer's business address: 810 Seventh Avenue, Ste 620 New York, NY 10019 III. Employer's telephone number: 212-446-___________ IIII. Dates of Employment: 7/2019 - Present B. List all previous employers for the past five (5) years, including employers' addresses and dates of your employment with each employer: EMPLOYER ADDRESS DATES OF EMPLOYMENT ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ 5. A. List all schools, universities, or other educational institutions attended from grade Page 4 of 10 Revised 2/01/08 DOJ-OGR-00023877