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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)