Part 86, page 65
DB Cooper-37909Serials 513-26-7420
Document date 6 December 1971
FBI 164-81, Vault Part 86 p. 65 (DB Cooper-37909), Form, dated 6 Dec 1971, serial 513-26-7420 (as read from the transcript) — cooper.theunsolved.net/parts/Cooper-Part-86/pages/65
Transcript
The scan is the source; the transcript is machine-generated from it.
Social Secu( Number 513-26-7420
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NORTHERN VIRGINIA DOCTORS HOSPITAL CORP. 601 S. CARLYN SPRINGS ROAD ARLINGTON, VIRGINIA
APPLICATION FOR APPOINTMENT
Date: February 6, 19.71 NAME: (Miss, Mrs., Mr.) [guess: Jock R. Cobliett] ............. Telephone: 521-4665 ADDRESS: (Permanent) 4208 S.O. [guess: 4th St] Rd (Local) c/o [guess: Arlington, Va] Date of Birth: 1.9.24 Height: 6.2 Weight: 195 Date of last Physical Examination: [guess: December] 19.70 Date and diagnosis of any recent illness: [guess: None] ............ Marital Status - M..... S. [checkmark] Other...... No. of Dependents.. 0 Position for which Application is made: O.n.R. ......[guess: Orderly] Date Available: [illegible] Minimum Salary Expected: ...............
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REGISTRATION: By examination in which State: ........................ Year: .................. Certificate Number: .................. Virginia: ............................. Year: .................. Certificate Number: .................. Other States: .......................................................
MEMBERSHIP: Alumnae .............. A.N.A. .............. L.N.E. .............. A.R.C. .............. Other ..................
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ACADEMIC AND PROFESSIONAL QUALIFICATIONS: Name City and State Dates Diploma Degree Credits Course
High School: [guess: grad]
School of Nursing: [guess: grad]
College or University: [guess: University of] [illegible] [guess: Kansas] ............. [guess: 3 years]
Clinical Post-grad. Courses: .............
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EMPLOYMENT EXPERIENCE: Position title: Institution or Agency: Address: Dates: (Duties describe briefly)
[guess: Doctor Hospital] b6 [illegible] [guess: Dr. Fle[illegible]] [illegible] [guess: Lancaster, California] b7C
[illegible] [guess: 1954] [guess: 4947/8th St. N.W. Washington D.C. 20007] [illegible] [guess: Kansas] [illegible] [guess: 1924 - 19[illegible]]
[guess: OB] [guess: Washington Troy, Va] .......... [guess: CO 5-7300 (3 mos)] [guess: CO 5-5416]
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PROFESSIONAL REFERENCES: [guess: college 6 J.J. + sciences] Name Position Address 1. [illegible] .................... [illegible] .............. [guess: Lancaster [illegible]] 2. ............................ [guess: 10/6/[illegible]] [guess: Kansas]
Date: .................. Signature: [guess: Joel R. [illegible]]
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N.V.D.H. #54 REV. 10/63
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DB Cooper-37909