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REFERENCES: GIVE THE NAMES AND ADDRESSES OF THREE OR MORE PERSONS WHO ARE WELL ACQUAINTED WITH YOU, BUT NOT RELATIVES OR FORMER EMPLOYERS. | NAME | ADDRESS STREET NUMBER CITY STATE | OCCUPATION | | --- | --- | --- | ADDITIONAL INFORMATION REQUIRED FROM APPLICANTS FOR A POSITION AS PILOT (a) When, (b) where and (c) under what conditions did you learn to fly? (a) (b) (c) What is original date of your rating as pilot (Army, Navy, or Dept. of Com.)? FLYING EXPERIENCE CERTIFIED FLYING HOURS IN | YEAR | TYPE OF PLANE | TYPE OF FLYING | U.S. ARMY | U.S. NAVY | U.S. AIR MAIL | COMMERCIAL | | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Total hours cross country Total hours last sixty (60) days Total hours on multi-motored planes: As pilot as co-pilot Do you hold Department of Commerce transport license? Number Rating Do you hold Department of Commerce mechanic's license? Number Issued If you have served in Army or Navy, have you received your discharge? Have you ever had any crashes? Give details and name of one witness Date of last physical examination Name of flight surgeon Address General physical condition (OVER)