Part 113, page 133

Transcript

The scan is the source; the transcript is machine-generated from it.

TALENT PLUS INC. 905 DEXTER N. SEATTLE, WA 98109 AT. 4-0140

---

[guess: Suw] 4'7'1 a ) 6 1

---

APPLICATION FOR MEMBERSHIP

TALENT PLUS 232-White - Henry - Stewart - Bldg. 1348 4th Ave. - Seattle, Washington 98101- (206) MA2-5060 Ext. 16, 17, 18 - MU2-0702

date issued ___________ interviewer ___________

NAME ___________ PHONE ( ) LAST FIRST MIDDLE NICKNAME AREA NUMBER

ADDRESS ___________ Number and Street City State Zip

BIRTHPLACE ___________ BIRTHDATE ___________ AGE ___ S/S NO ___________

U.S. CITIZEN ___ MARITAL STATUS ___ NO of DEPEDENTS ___ AGES ___________

EDUCATION (COLLEGE OR UNIVERSITY) YEARS DEGREE & DATE NAME & LOCATION NAME & LOCATION NAME & LOCATION

HIGHEST ANNUAL EARNINGS ___________ AVER PAST 10 yrs ___________ PAST 5 yrs ___________

Two personal references other than relatives or former employers who have known you for at least five years. NAME & PHONE ADDRESS NO. ( ) NAME & PHONE ADDRESS NO. ( )

At least 1 credit ref or acct (Banker, CPA, Broker, etc) not a cr-od NAME & PHONE ADDRESS NO. ( ) NAME & PHONE ADDRESS NO. ( )

Previous employers or major positions within 1 company Company name & address Incl. dates Title Salary

1. 2. 3. 4. 5. 6.

TYPE OF POSITION DESIRED SALARY MINIMUM NEGOTIABLE? WOULD YOU ANYWHERE IN DESIRED SALARY YES ( ) NO ( ) RELOCATE? U.S. OVERSEAS WOULD YOU LIMITATIONS TRAVEL? over

---

DB COOPER-51632