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I hereby certify that the answers given by me to the foregoing questions and statements made are true and correct, without mental reservation whatsoever. I understand that falsely filling out this application in whole or in part will be considered sufficient reason for discharge. I further understand that this application does not bind the Pan American-Grace Airways Inc. in any way but is merely a means for obtaining information. 

Signature

REMARKS AND ANY OTHER INFORMATION THAT YOU WISH TO GIVE



(not to be filled out by applicant)
Interviewed by ________________
Date ___________
Action taken _____________
Remarks