Part 104, page 378

Transcript

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Apprentice, Special Training and Extension Courses and Dates, Machines Operated, Languages You Write and Speak Fluently. [guess: Goblin] Avon + Gyros [guess: Gunnery] [guess: Physics] Courses / Various Royal Air Force Courses UNIVERSITY OF WASHINGTON, M.B.A candidate, 1965/7 (35 CREDITS) Do You Own Tools of Your Trade? YES □ NO □

OCCUPATIONAL LICENSES AND CERTIFICATES TYPE AND NO.: PRIVATE PILOT LICENSE EXPIRATION DAT[E]: 1969

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LIST BELOW WHERE YOU HAVE LIVED DURING THE PAST 5 YEARS (Longer if Information is available) FROM MO./YR. | TO MO./YR. | TIME IN MOS. | NUMBER AND STREET | CITY | STATE [illegible] | [illegible] | [illegible] | 1410 Richmond Beach Road | Seattle | Wash. [illegible] | [illegible] | [illegible] | 1608 11th Street South | Seattle | Wash. [illegible] | [illegible] | [illegible] | 640 No Williams St | Renton | Wash. [illegible] | [illegible] | [illegible] | 511 Bourbon St | New Orleans | La. [illegible] | [illegible] | [illegible] | 2715 72nd Avenue | Mercer Island | Wash.

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List all organizations or associations to which you belong, excluding trade unions and others the names or character of which is cato the race, religious creed, color, nat[ional] origin or ancestry of its members.

American Institute of Aero[nautics] Royal Aeronautical Soci[ety] Inst. of Production Engi[neers] Royal Aero Club

Spouse/Deceased YES □ NO □

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Husband's or Wife's Full Name: LAST: NIL FIRST: [blank] MIDDLE: [blank]

Spouse's Present Address: NUMBER AND STREET: Nil CITY: [blank] STATE: [blank]

Name and Address of Spouse's Employer: NIL

SPOUSE'S OCCUPATION (IF EMPLOYED): [blank]

In Case of Emergency Notify: [blank] TELEPHONE NO.: [redacted b6, b7C]

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Have You Worked For Any Lockheed Company Under a Different Name? YES □ NO ☒

Have You Ever Been Convicted of a Crime Under a Different Name? YES □ NO ☒ IF YES, GIVE THE NAME: [blank]

Have You Ever Been Arrested For Any Offense Other Than Minor Traffic Violations? YES □ NO ☒ IF YES, EXPLAIN, USE SEPARATE SHEET IF NECESSARY

Have You Ever Had Security Clearance? YES ☒ NO □ IF YES, WHERE GRANTED: AIR FORCE BY WHOM: [blank] LEVEL OF CLEARANCE: SECRET DATE: 1957

Have You Ever Been Denied a Security Clearance? YES □ NO ☒

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GIVE THREE REFERENCES, NOT RELATIVES OR FORMER EMPLOYERS, WHOM YOU HAVE KNOWN FOR AT LEAST THREE YEARS [Table headers: NAME | ADDRESS | Telephone No. | YEARS KNOWN | OCCUPATION] [All rows blank]

Do You Have Any Relatives or Acquaintances Employed by Lockheed? YES □ NO □ IF YES, GIVE NAME | POSITION | DEPARTMENT | RELATIONSHIP [blank]

DB COOPER-47345

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Are you, or have you ever been member of any communist organization or political party or organization which advocates or advocated the overthrow of our constitutional form of govern- ment in the United States, or do you have or have you had membership in or affiliation with any group, association or organization which advocated or advocates or lent or lends support- to any organization or movement advocating the overthrow of our constitutional form of government in the United States.

I hereby certify that the answers given by me to the foregoing questions and statements made are true and correct wit[hout] consequential omissions of any kind whatsoever. I agree that the companies shall not be liable in any respect if my a[ny] ment is terminated because of the falsity of statements, answers or omissions made by me in this questionnaire. I agr[ee to] submit to physical examination. If employment is obtained under this application I will comply with all orders, rules and[...] lations of this Company. I also authorize the companies, schools or persons named above to give any information regardi[ng] employment, together with any information they may have regarding me whether or not it is on their records. I hereby re[lease] said companies, schools or persons from all liability for any damage whatsoever for issuing this information.