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40.  QUALIFICATION IN ARMS
WEAPON | COURSE | QUALIFIED | SCORE | DATE

41.  AWARDS, DECORATIONS AND CITATIONS
TYPE | AUTHORITY AND DATE | PRESENTED (Yes or No)

42.  REMARKS

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43.  FLYING STATUS
AUTHORITY | DATE | RESTRICTIONS

44.  RATINGS, SPECIALTIES, AND DESIGNATIONS
RATING, SPECIALTY OR DESIGNATION | EFFECTIVE DATE | AUTHORITY

45.  AIRPLANE QUALIFICATIONS (Military)
NO. OF ENGINES | TYPE OF PLANE
CONVENTIONAL 1 | -
2 | -
OVER 2 | -
"JET" 1 | - 
2 | -
OVER 2 | -
OTHER | -

46.  FLYING HOURS
HOURS | MONTH AND YEAR
250 | 
500 | 
750 | 
1000 | 
1500 | 
2000 | 
3000 | 
5000 | 

47.  CIVILIAN FLYING EXPERIENCE (Nature, type equipment, no. hrs., last date flown, licenses)

48.  COMBAT DATA (AAF only)

49.  INTERNSHIP
HOSPITAL (Location) | TYPE | TOTAL MONTHS | YEAR COMPLETED

50.  PRIVATE PRACTICE
LOCATION AND TYPE | % OF TIME | FROM | TO

51.  RESIDENCIES AND FELLOWSHIPS
HOSPITAL (Location) | SERVICE | TOTAL MONTHS | YEAR COMPLETED

52.  POST GRADUATE INSTRUCTION
INSTITUTION | COURSE | TOTAL MONTHS | YEAR COMPLETED

53.  CERTIFIED BY AMERICAN BOARD OF | YEAR
SUB SPECIALTY | YEAR
LICENSE (Type) | STATE OR TERRITORY AND YEAR

54.  HOSPITAL AND TEACHING APPOINTMENTS
INSTITUTION | TYPE | HOURS WEEKLY | DATES (From - to)

55.  BOOKS AND TECHNICAL PAPERS PUBLISHED | YEAR

56.  PROFESSIONAL AND EDUCATIONAL SOCIETIES (with degree of membership)

57.  COLOR HAIR

58.  COLOR EYES

59.  PHOTO

60.  COMPLEXION

61.  BLOOD TYPE

63.  AUTHENTICATING SIGNATURE.  TYPED NAME, GRADE AND ARM OR SERVICE OF OFFICER AND DATE

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