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FORM P-201 APPLICATION AND HISTORY CARD PAN AMERICAN AIRWAYS SYSTEM __________________________ TYPE OF POSITION DESIRED __________________________ SIGNATURE OF APPLICANT __________________________ DATE OF APPLICATION PRINT INFORMATION IN THIS SECTION IN PENCIL _____________________________ PRESENT ADDRESS _________________________________________________ IN EMERGENCY NOTIFY TEL. NO. RELATION ________________________ ADDRESS _______ SINGLE ________ MARRIED ________ WIDOWED ________ DIVORCED _________ SEPARATED _____ SEX __________ NUMBER OF DEPENDENTS _____ FULL ________ PARTIAL ____________ RELATIONSHIP _____________ CITIZEN OF ______________________________________________ IF NOT U.S. CITIZEN HAVE YOU FIRST PAPERS? ________________________ DATE LAST VACCINATION ________________________________ DATE LAST TYPHOID INNOCULATION ___________________________________ DATE LAST PARATYPHOID INNOCULATION PRINT INFORMATION IN THIS SECTION IN INK _______________________________________________________ NAME (FIRST) (MIDDLE) (LAST) ______________________________________________________ BIRTH: MONTH DAY YEAR BIRTHPLACE ______________________________________________________ HEIGHT: WEIGHT: COLOR EYES: COLOR HAIR: ____________________________________________________ WHAT SERIOUS ILLNESS HAVE YOU HAD? DATE: ____________________________________________________ WHAT SERIOUS ACCIDENT HAVE YOU HAD? DATE: CHECK ANY FOLLOWING DISEASES YOU HAVE SUFFERED: ________ _______ _____________ _____ MALARIA DENGUE TYPHOID FEVER SPRU __________ _________ ______ ____________ DYSENTERY PNEUMONIA ANEMIA YELLOW FEVER HAVE YOU NORMAL ________________________________________ SIGHT? HEARING? SPECTACLES? ____________________________________________ HAS THERE BEEN ANY INSANITY IN YOUR FAMILY? ___________________________________________________________ ARE YOU IN GOOD HEALTH AT PRESENT? SOCIAL SECURITY NO. WRITE INFORMATION BELOW IN INK [[LEFT MARGIN]]EDUCATION[[/LEFT MARGIN]] [[5 COLUMNED TABLE]] |NAME AND LOCATION OF SCHOOLS ATTENDED|DATE STARTED|DATE LEFT|DID YOU GRADUATE?|COURSES TAKEN AND DEGREES| |---|---|---|---|---| GRAMMAR SCHOOL| | | | | HIGH SCHOOL| | | | | COLLEGE OR TECHNICAL SCHOOL| | | | | BUSINESS OR COMMERCIAL SCHOOL| | | | | GRADUATE SCHOOL| | | | | [[5 COLUMNED TABLE]] LANGUAGES (NATIVE TONGUE FIRST)|INDICATE WHETHER SLIGHT, FAIR OR FLUENT| |SPEAK|READ|WRITE|TRANSLATE| |---|---|---|---|---| | | | | | | |---|---|---|---|---| [[LEFT MARGIN]]MILITARY SERVICE[[/LEFT MARGIN]] HAVE YOU RESIDED ABROAD? IF SO WHERE AND WHEN HAVE YOU SERVED IN ANY MILITARY OR NAVAL SERVICE: IF SO WHERE AND WHEN FROM TO WHAT BRANCH (OR BRANCHES) OF SERVICE: ARE YOU A MEMBER OF ANY RESERVE. BRANCH OF MILITARY OR NAVAL SERVICE? RANK STATE BRANCH OF SERVICE DATE OF ENTRY [[LEFT MARGIN]]PREVIOUS EMPLOYMENT[[/LEFT MARGIN]] [[6 COLUMNED TABLE]] NAME OF PREVIOUS EMPLOYERS (LIST IN CONSECUTIVE ORDER - PRESENT OR LAST EMPLOYER FIRST)| POSITION AND DEPARTMENT|DATE STARTED|DATE LEFT|SALARY| |---|---|---|---|---|---| |NAME| | | | | | |ADDRESS| | | | | | |NAME| | | | | | |ADDRESS| | | | | | |NAME| | | | | | |ADDRESS| | | | | | |NAME| | | | | | |ADDRESS| | | | | | [[LEFT MARGIN]]REFERENCES[[/LEFT MARGIN]] [[4 COLUMNED TABLE]] |REFERENCES, NOT RELATIVE OR FORMER EMPLOYEES NAME|ADDRESS|TEL. NO.|OCCUPATION OR POSITION| |---|---|---|---| | | | | | | | | | | | | | | | [[LEFT MARGIN]]AERONAUTICAL RECORD[[/LEFT MARGIN]] SCH. AIR TR. RATING EXPIRING TRANSPORT LICENSE NO. EXPIRING AIRPLANE MECHANICS LICENSE NO. EXPIRING ENGINE MECHANICS LICENSE NO. EXPIRING U.S. ARMY RATING EXPIRING U.S. NAVY RATING EXPIRING U.S.M.C. RATING EXPIRING RADIO LICENSE EXPIRING NIGHT FLYING HOURS OVERWATER FLYING HOURS INSTRUMENT FLYING HOURS MINOR ACCIDENTS MAJOR ACCIDENTS PLEASE ENCLOSE RECENT PHOTOGRAPH OF YOURSELF AND GIVE FULL DETAILS OF YOUR EARLY FLYING EXPERIENCE. (OVER)
