The following questions are not required to be answered in accordance with Federal Regulations.   However, such information as you are willing to provide is acceptable:

Date of birth

Age

Hair Color

Eyes

Height

Weight

Number of dependent children

Number of other dependents

Male     Female    Single    Married     Widowed    Divorced     Separated

EDUCATION

High School

Name and Location

Dates Attended    Did you graduate?    Degree Received

Trade or Business School

Name and Location

Dates Attended    Did you graduate?    Degree Received

College

Name and Location

Dates Attended    Did you graduate?    Degree Received

Graduate Work

Name and Location

Dates Attended    Did you graduate?    Degree Received

Other

Name and Location

Dates Attended    Did you graduate?    Degree Received

EMPLOYMENT RECORD

Chronologically list your employment, starting with the present or most recent position

From (day/month/year)             To (day/month/year)

Employer's Name

Address

Supervisor's Name    Department

Reason for Leaving    Wages

Full Job Description,  Title,  Duties,  Work Performed, etc.

From (day/month/year)             To (day/month/year)

Employer's Name

Address

Supervisor's Name    Department

Reason for Leaving    Wages

Full Job Description,  Title,  Duties,  Work Performed, etc.

From (day/month/year)             To (day/month/year)

Employer's Name

Address

Supervisor's Name    Department

Reason for Leaving    Wages

Full Job Description,  Title,  Duties,  Work Performed, etc.

MILITARY SERVICE RECORD

Branch of Service 

Description of Duties and Work Performed   

Date of Entry                                                       Date of Discharge   

Type of Discharge                                               Rank of Discharge 

Present Military Status:         National Guard       Reserve Active         Inactive

Rank         Type of Duty 

Selective Service Record:        Local Board#            Classification 

Submit any additional information which you think would be helpful in establishing your qualifications include your hobbies:

Have you ever been convicted of a felony?     If so, explain

Do you have any part-time business interest?     Explain

Do you have any relatives or friends employed by this company?    Who?

Who referred you to this company?

Were you ever employed by this company?

REFERENCES:  Do not give relatives' names other than supervisors

Full Name

Address

City and State

Occupation

How long known?

Full Name

Address

City and State

Occupation

How long known?

In case of emergency, notify:

By submitting this application

   1.    I authorize Piasecki Aircraft Corporation to investigate these statements and references without liability arising therefrom.

    2.    I understand that any misrepresentation of fact in this application will be cause for discharge if employed.

    3.    I agree to abide by Company rules and regulations, if employed.

    4.    I understand that employment is subject to my passing a physical examination by the Company physician and I authorize disclosure of such examination to the Company.