This transcription has been completed. Contact us with corrections.
COLONIAL AIRLINES, INC. Please complete in full. DATE__________ Print or type. Return to: Personnel Dept. 230 Park Avenue New York, N.Y. Name ______________________ Social Security First Middle Last Number _________ Date of Birth ________________________________ Month day year Present Address _____________________________ Street and Number City State Telephone Number _______________ Permanent Address ____________________________ Street and Number City State Telephone Number ________________ Notify in Case of Accident ___________________ Name Address Telephone Number __________ PHYSICAL Sex ____ Single___ Married___ Divorced___ Height____ Weight____ Widowed___ Separated___ Engaged___ Color hair_______ Color eyes _____ Dependents Hearing ____ Wife _______ Wear glasses _____ Husband ____ Boys (No. and age)_____ Girls (No. and age)____ Father _______ Mother _______ Nature of any physical defects ______________________________________________ Time lost due to illness during last six (6) months _______________________ Have you taken a recent physical examination ________ Results __________ Purpose ________________________