Part 118, page 180

Transcript

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

CHEMETRON CORPORATION APPLICATION FOR TRUCK DRIVER EMPLOYMENT BOTH SIDES MUST BE COMPLETED BEFORE ACCEPTANCE Birth Date: May 17, 1928

NAME OF COMPANY MAKING APPLICATION: Chem Trom Corp. - Orem Utah Sub 755 NAME (FIRST, MIDDLE, LAST): Howard Eugene Shirley PRESENT ADDRESS: Roberts Hotel, Provo, Room 77 Phone 373-3400 COUNTY: [blank] OWN: X PREVIOUS ADDRESS: 4843 Thunderbird, Eugene-Ore. COUNTY: Lane OWN: X PREVIOUS ADDRESS: 81820 N. Melody Ln. Creswell, Ore. COUNTY: Lane OWN: X SEX: [X] MALE [ ] FEMALE WEIGHT: 220 HEIGHT: 5'10" ARE YOU AT LEAST 21 YEARS OLD: [X] YES [ ] NO CAN YOU READ AND SPEAK THE ENGLISH LANGUAGE: [X] YES [ ] NO MARITAL STATUS: [ ] SINGLE [X] MARRIED [ ] DIVORCED [ ] SEPARATED [ ] REMARRIED NO OF DEP.: 6 AGES OF CHILDREN: 16-16-14-12-9 ARE YOU A U.S. CITIZEN: [X] YES [ ] NO IF YOU ARE NOT A U.S. CITIZEN, HAVE YOU THE LEGAL RIGHT TO REMAIN PERMANENTLY IN THIS COUNTRY: [ ] YES [ ] NO DO YOU NOW HAVE A VALID DRIVER'S OR CHAUFFEUR'S LICENSE: Yes IF SO, WHAT IS THE EXPIRATION DATE: May 17, 1974 STATE OF ISSUE: Oregon GIVE LICENSE NUMBER: 1485393 [partially legible] IN WHAT OTHER STATES HAVE YOU HELD A CHAUFFEUR, OPERATOR'S LICENSE: None NUMBER (IF KNOWN): [blank] NO. TIMES CHAUFFEUR OR OPERATOR'S LICENSE HAS BEEN REVOKED OR SUSPENDED: None WHY? (IN EACH CASE): [blank] JOB APPLYING FOR: Line haul driver YEARS EXPERIENCE: 18 1/2 WAREHOUSE DOCK: 2 ALL TYPES VEHICLES YEARS EXPERIENCE: 18 1/2 CITY VAN YR. EXP.: 2 TRACTOR TRAILER YR. EXP.: 16 1/2 DIESEL YR. EXP.: 16 1/2 [guess: 16 1/2] DUMP TRUCK YR. EXP.: [blank] NUMBER OF VEHICLE ACCIDENTS: 2 ARE YOU NOW EMPLOYED: No IF SO - WHY DO YOU WANT TO CHANGE?: [blank] HAVE YOU PREVIOUSLY BEEN EMPLOYED BY THIS COMPANY: [ ] Yes [X] No IF SO, PLEASE GIVE DATES: FROM [blank] TO [blank] NAME OF WIFE (OR HUSBAND): Carla T. Shirley OCCUPATION: Housewife COMPANY: [blank]

SCHOOLING TABLE: GRAMMAR OR HIGH SCHOOL: YEARS COMPLETED: 12 DEGREE REC'D & MAJOR SUB.: General NAME OF SCHOOL: Klamath Union High School LOCATION: Klamath Falls, Ore. DATE OF GRADUATION: 17 May 46 TRADE, BUS. OR CORRESPONDENCE: [blank] COLLEGE: [blank]

MILITARY RECORD: PRESENT DRAFT STATUS: P MEMBER OF RESERVE: [ ] YES [X] NO [ ] ACTIVE [ ] INACTIVE TYPE OF DISCHARGE: Honorable

LIST ALL VEHICLE ACCIDENTS INVOLVED IN DURING THE PAST THREE YEARS: Nature of accident: None Date: [blank] Any injury or fatalities: [blank] (annotation at right: "Sub 755") [second row] Nature of accident: [blank] Date: 164-816479 [guess: reference/case number, partially legible] Any injury or fatalities: [blank]

LIST ALL VIOLATIONS OF MOTOR VEHICLE LAWS OR ORDINANCES (OTHER THAN PARKING) LAST THREE YEARS: None

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SEARCHED ___ INDEXED ___ SERIALIZED ___ FILED ___ FEB 24 1975 FBI SEATTLE

DB COOPER-54266