Northern Virginia Doctors Hospital termination form for Jack Coffelt, orderly
Document date 19 October 1972
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Id: Cooper-Part-86:031-031
Subject: Cooper Files: Cooper-Part-86:031-031 Document: Northern Virginia Doctors Hospital termination form for Jack Coffelt, orderly Id: Cooper-Part-86:031-031 Page: https://cooper.theunsolved.net/documents/Cooper-Part-86%3A031-031 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
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FBI 164-81, Vault Part 86 p. 31, Form, dated 19 Oct 1972 — cooper.theunsolved.net/documents/Cooper-Part-86%3A031-031
TERMINATION Date: 10/19/72
Employee's Name: Tack Coffit [guess: COFFIT] First Middle Last
Department: OC Position: Orderly
Reason for Termination: (Check One) Remarks: (Briefly indicate nature of action.) Voluntary Resignation ______ End Temp. Assignment ______ Discharge [checked] Excessive LWOP Other ______
Employee's Rating: Excellent Very Good Good Satisfactory Unsatisfactory Performance [checked] Attendance Until recently Attitude [checked] Appearance [checked] Personality [checked]
Remarks: Mr. Coffit has been [guess: resigned] [guess: several] mo. ago due to extended business concerning family. Death lines [guess: ephiendaire] to the Vacant Position. He has been off again for 3wk LWOP on personal business. I talked with him by phone 10/12/72. He [guess: Permission] he would be to work. [guess: regular] 10/13/72. He has not worked since. It to10 him to report for work 10/13 Last Day Actually Worked: FRI 9/29 , 19 72 Day Date
Would you rehire? [checked] No Subject To: See above - would [guess: George] Yes [guess: more] Re D.B./[guess: Lem].
Supervisor b6 b7C
NOTED AND APPROVED: Northern Virginia Doctors Hospital Termination record received: Administrator (Date) REMARKS: Earnings record file: [checked] Leave slip filed: [checked] Time card filed: [checked] Record card filed: [checked] NVDH Form # 126 Hospitalization cancelled: [checked] Switchboard: [checked] Temp. W. Comp # S.W.