Northern Virginia Doctors Hospital application for appointment, Jack Coffelt
Document date 6 December 1971
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Id: Cooper-Part-86:065-066
Subject: Cooper Files: Cooper-Part-86:065-066 Document: Northern Virginia Doctors Hospital application for appointment, Jack Coffelt Id: Cooper-Part-86:065-066 Page: https://cooper.theunsolved.net/documents/Cooper-Part-86%3A065-066 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
A person reads every report. Corrections are made by hand, to the data — titles, dates, names, which pages belong together — never to the scans, and they can take a while to appear.
FBI 164-81, Vault Part 86 pp. 65–66 (DB Cooper-37909–37910), Form, dated 6 Dec 1971, serial 513-26-7420 (as read from the transcript) — cooper.theunsolved.net/documents/Cooper-Part-86%3A065-066
Social Secu( Number 513-26-7420
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NORTHERN VIRGINIA DOCTORS HOSPITAL CORP. 601 S. CARLYN SPRINGS ROAD ARLINGTON, VIRGINIA
APPLICATION FOR APPOINTMENT
Date: February 6, 19.71 NAME: (Miss, Mrs., Mr.) [guess: Jock R. Cobliett] ............. Telephone: 521-4665 ADDRESS: (Permanent) 4208 S.O. [guess: 4th St] Rd (Local) c/o [guess: Arlington, Va] Date of Birth: 1.9.24 Height: 6.2 Weight: 195 Date of last Physical Examination: [guess: December] 19.70 Date and diagnosis of any recent illness: [guess: None] ............ Marital Status - M..... S. [checkmark] Other...... No. of Dependents.. 0 Position for which Application is made: O.n.R. ......[guess: Orderly] Date Available: [illegible] Minimum Salary Expected: ...............
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REGISTRATION: By examination in which State: ........................ Year: .................. Certificate Number: .................. Virginia: ............................. Year: .................. Certificate Number: .................. Other States: .......................................................
MEMBERSHIP: Alumnae .............. A.N.A. .............. L.N.E. .............. A.R.C. .............. Other ..................
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ACADEMIC AND PROFESSIONAL QUALIFICATIONS: Name City and State Dates Diploma Degree Credits Course
High School: [guess: grad]
School of Nursing: [guess: grad]
College or University: [guess: University of] [illegible] [guess: Kansas] ............. [guess: 3 years]
Clinical Post-grad. Courses: .............
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EMPLOYMENT EXPERIENCE: Position title: Institution or Agency: Address: Dates: (Duties describe briefly)
[guess: Doctor Hospital] b6 [illegible] [guess: Dr. Fle[illegible]] [illegible] [guess: Lancaster, California] b7C
[illegible] [guess: 1954] [guess: 4947/8th St. N.W. Washington D.C. 20007] [illegible] [guess: Kansas] [illegible] [guess: 1924 - 19[illegible]]
[guess: OB] [guess: Washington Troy, Va] .......... [guess: CO 5-7300 (3 mos)] [guess: CO 5-5416]
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PROFESSIONAL REFERENCES: [guess: college 6 J.J. + sciences] Name Position Address 1. [illegible] .................... [illegible] .............. [guess: Lancaster [illegible]] 2. ............................ [guess: 10/6/[illegible]] [guess: Kansas]
Date: .................. Signature: [guess: Joel R. [illegible]]
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N.V.D.H. #54 REV. 10/63
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DB Cooper-37909
Please Attach Recent Photograph
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(Please use this space for additional information regarding eductation, experience, etc.)
........................................................... ........................................................... ........................................................... ...........................................................
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In case of emergency Person to be notified .......................... Relationship
Address [guess: Goldendale] [guess: Wa.] Phone. (Please do not write below this line) b6 b7C Date application received:................................... References received:......................................
Date of employment:........................................... Position title:................................................
Initial Salary:.....................................................................................................................
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CHANGES IN POSITION STATUS | SALARY INCREASE
Date: Change: | Date: New Salary: ......................................|.......................................... ......................................|.......................................... ......................................|..........................................
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RESIGNATION: Date:................................... Letter of notification received:..............................
Summary of Professional progress submitted:...................
DISMISSAL FROM HOSPITAL EMPLOYMENT:
Date:.................................
Remarks:...........................................................................................
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..........................................................................................................
Signed:.............................................
Title:................................................
Date:................................................
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DB Cooper-37910
Serials: 513-26-7420