Part 86, page 57
Document date 6 December 1971
FBI 164-81, Vault Part 86 p. 57, Form, dated 6 Dec 1971 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/57
Transcript
The scan is the source; the transcript is machine-generated from it.
NORTHERN VIRGINIA DOCTORS HOSPITAL Pre-Employment Interview
NAME Coffelt, Tack DATE 12/6/71 POSITION APPLIED FOR Orderly Type of work: Full Time✓ Part Time No. Days per Week 5 FOR NURSING PERSONNEL: Shift: 8-4 [struck through: 4-12] 12-8 What days Mon-Fri Weekends Rotating Other O.T.
DATE AVAILABLE _NMN_ TRANSPORTATION [guess: PROVIDED] HOW REFERRED N. [guess: IL.] S [guess: BN] PHYSICAL IMPAIRMENTS None. LAST EMPLOYMENT (TYPE OF WORK AND DATE) Private Duty FAMILY: Husband's (or Wife's) Occupation ________ Children ________ Their ages ________ Care Provided ________
IMPRESSIONS: EXCELLENT GOOD FAIR POOR Appearance ✓ Personality ✓ Health ✓ Qualifications ✓ Knowledge of skills ✓ Interest ✓
RECOMMEND FOR EMPLOYMENT yes going NVCC for Nursing Degree - his [guess: SCRUBBED] on surg. + assisted REMARKS: much experience in hospitals - very talkative - good [guess: SOMEONE] 2ND choice
Employment to Commence 12/8/71 Department O. R. Shift [guess: 9] 3d (FT) PT SALARY $ 4/0 b6 APPROVAL DIFF. + O.T. b7C Administrator
NVDH Form #123