FormNorthern Virginia Doctors Hospital termination form for Jack Coffelt, orderly19 October 19721 page
fbi_formLegibility: medium

Part 86, page 31

Document date 19 October 1972

Open in FBI Vault (Part 86, page 31 of the PDF)

FBI 164-81, Vault Part 86 p. 31, Form, dated 19 Oct 1972 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/31

Transcript

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

TERMINATION Date: 10/19/72

Employee's Name: Tack Coffit [guess: COFFIT] First Middle Last

Department: OC Position: Orderly

Reason for Termination: (Check One) Remarks: (Briefly indicate nature of action.) Voluntary Resignation ______ End Temp. Assignment ______ Discharge [checked] Excessive LWOP Other ______

Employee's Rating: Excellent Very Good Good Satisfactory Unsatisfactory Performance [checked] Attendance Until recently Attitude [checked] Appearance [checked] Personality [checked]

Remarks: Mr. Coffit has been [guess: resigned] [guess: several] mo. ago due to extended business concerning family. Death lines [guess: ephiendaire] to the Vacant Position. He has been off again for 3wk LWOP on personal business. I talked with him by phone 10/12/72. He [guess: Permission] he would be to work. [guess: regular] 10/13/72. He has not worked since. It to10 him to report for work 10/13 Last Day Actually Worked: FRI 9/29 , 19 72 Day Date

Would you rehire? [checked] No Subject To: See above - would [guess: George] Yes [guess: more] Re D.B./[guess: Lem].

Supervisor b6 b7C

NOTED AND APPROVED: Northern Virginia Doctors Hospital Termination record received: Administrator (Date) REMARKS: Earnings record file: [checked] Leave slip filed: [checked] Time card filed: [checked] Record card filed: [checked] NVDH Form # 126 Hospitalization cancelled: [checked] Switchboard: [checked] Temp. W. Comp # S.W.