Part 26, page 40
Document date 17 December 1970
FBI 164-81, Vault Part 26 p. 40 (DB Cooper-7193), Form, dated 17 Dec 1970 — cooper.theunsolved.net/parts/Cooper-Part-26/pages/40
Transcript
The scan is the source; the transcript is machine-generated from it.
14. HAVE YOU EVER BEEN DISCHARGED FROM [redacted] ED FORCES UNDER OTHER THAN HONORABLE CONDI[TIONS] . ☐YES ☒NO. (If answer is "Yes," give details in item [redacted])
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15. EMPLOYMENT. (List ALL employment dates starting with your present employment. Give both month and year for all dates. Show ALL dates and addresses when unemployed. Give name under which employed if different from name now used.)
FROM TO NAME OF EMPLOYER (Firm or agency) ADDRESS TYPE OF WORK REASON FOR LEAVING AND SUPERVISOR (Full name, if known) (Where employed) 11/01/70 Present Unemployed b6 Per BOC
[remainder of employment table is blank]
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15. HAVE YOU EVER BEEN DISCHARGED (FIRED) FROM EMPLOYMENT FOR ANY REASON? ☐YES ☒NO.
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17. HAVE YOU EVER RESIGNED (QUIT) AFTER BEING INFORMED THAT YOUR EMPLOYER INTENDED TO DISCHARGE (FIRE) YOU FOR ANY REASON? ☐YES ☒NO. (If your answer to 16 or 17 above is "Yes" give details in item 23. Show the name and address of employer, approximate date, and reasons in each case. This information should agree with the statements made in item 15--EMPLOYMENT.)
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18. HAVE YOU EVER BEEN ARRESTED, TAKEN INTO CUSTODY, HELD FOR INVESTIGATION OR QUESTIONING, OR CHARGED BY ANY LAW ENFORCEMENT AUTHORITY? (You may omit: (1) Traffic violations for which you paid a fine of $30 or less; and (2) anything that happened before your 16th birthday. All other incidents must be included, even though they were dismissed or you merely forfeited collateral.) ☐YES ☒NO.
IF YOUR ANSWER IS "YES," GIVE FULL DETAILS BELOW:
DATE CHARGE PLACE LAW ENFORCEMENT AUTHORITY ACTION TAKEN
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(SIGNATURE AND TITLE OF AUTHORIZED AGENCY OFFICIAL) [redacted] U.S. GOVERNMENT PRINTING OFFICE: 1964-O-755-147 /19-C DB Cooper-7193