Part 86, page 66
Document date 6 December 1971
FBI 164-81, Vault Part 86 p. 66 (DB Cooper-37910), Form, dated 6 Dec 1971, serial 513-26-7420 (as read from the transcript) — cooper.theunsolved.net/parts/Cooper-Part-86/pages/66
Transcript
The scan is the source; the transcript is machine-generated from it.
Please Attach Recent Photograph
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(Please use this space for additional information regarding eductation, experience, etc.)
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In case of emergency Person to be notified .......................... Relationship
Address [guess: Goldendale] [guess: Wa.] Phone. (Please do not write below this line) b6 b7C Date application received:................................... References received:......................................
Date of employment:........................................... Position title:................................................
Initial Salary:.....................................................................................................................
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CHANGES IN POSITION STATUS | SALARY INCREASE
Date: Change: | Date: New Salary: ......................................|.......................................... ......................................|.......................................... ......................................|..........................................
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RESIGNATION: Date:................................... Letter of notification received:..............................
Summary of Professional progress submitted:...................
DISMISSAL FROM HOSPITAL EMPLOYMENT:
Date:.................................
Remarks:...........................................................................................
..........................................................................................................
..........................................................................................................
Signed:.............................................
Title:................................................
Date:................................................
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DB Cooper-37910