Part 96, page 24

Transcript

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

1. Retail exact Cutting 2. [guess: Informing] outside [guess: jobs] [guess: Industrial] [illegible] & [guess: route] [illegible] 3. Hay Feed, Grain & Cattle Operation 4. Retail Sales - Store [guess: Mce.] [illegible] Sales - Outside [guess: Tech] Rep.

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[s]cribe the type of work you have been doing? [see annotations above]

[Na]me of supervisor at last two jobs? 1. __________ 2. Self [Te]lephone number of last two jobs 1. __________ 2. __________

EDUCATION [Hig]h School: ARCADIA HIGH SCHOOL From 19 51 to 19 55 Give name and location of school [Co]llege: LAVERNE COLLEGE From 19 55 to 19 58 UCLA, [guess: GOAL] POLY - MERRIT COLLEGE [Ot]her education or degree: In [guess: SUPPORT] of PRINT STORE, [guess: CATTLE RANCH] & [guess: MGMT] [guess: CUTTING] [Mi]litary experience? 8 YES Branch of Service? USN-R-R Type of discharge? Honorable

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REFERENCES.

__________ Allen Bradley Co. Phone No. What does he do? LA- [illegible] Los Angeles CAL Years acquainted? 29 City & State Superior Court Los Angeles Phone No. Name [illegible] Supporter Court What does he do? Los Angeles Years acquainted? 20 City & State __________ Life Ins. Phone No. What does he do? [illegible] Portland Years Acquainted? 1 City & State

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[Do] you feel you can pass a complete physical examination? Yes Date last examined 11/28/73

[I a]ffirm that the above answers are correct to the best of my knowledge. Any misrepresentation [of] information given is considered sufficient reason for discharge after employment.

[Dat]e 11/30/73 Signature [illegible signature]

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DO NOT WRITE BELOW THIS LINE

[Nea]tness __________ Character __________ [Per]sonality __________ Ability __________ [Ot]her comments: __________

[Da]te hired __________ Rate of Pay __________ Approved __________

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DB Cooper-42922

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b6 b7C