DRDER NO. 19824 APPROVAL OF HIRING KELLY L. CRUNK AS ENVIRONMENTAL HEALTH TECHNICIAN IN KERR COUNTY ENVIRONMENTAL HEALTH DEPARTMENT On this the 20th day of September 1990, upon motion made by Commissioner Ray, seconded by Commissioner Holekamp, the Court unanimously approved the hiring of Kelly L. Crunk as Environmental Health Technician, in the Kerr County Environmental Health Department at Pay Group 16, Step 8, 519, 356. 00 annually, 51, 613. 00 monthly, and 5806. 50 semi-monthly, effective September 24, 1990. COMMISSIONERS' COURT AG NDA REOUE T • PLEASE FURNISH ONE ORIGINAL AND S V N nPIFS nF THI R QU TAND D M NTS . ' TO BE REVIEWED BY CIE COURT_ .;~ MADE BY: DAVID T,TTUF OFF ICE: ENVIRONMENTAL HEALTH ~. ' ~~ .MEETING DATE: 9-20-90 TIME PREFERRED: open . SUBJECT: (PLEASE BE SPECIFIC): APPROVAL To HIRE PERSONNEI: ' SUPPQRTING DOCUMENTS ATTACHED ESTIMATED LENGTH OF PRESENTATION: 5 MINUTES IF PERSONNEL MATTER -NAME OF EMPLOYEE: xELLY CRUNK NAME OF PERSON ADDRESSING THE COURT: DAVID LITKE Time for submitting this request for Court to assure that the matter Is posted in accordance with Article 6252- 17 is as follows: ' • I"leetings held on second Monday: 12:00 P. M. previous Wednesday • Meetings held on Thursdays: 5:00 P. M. previous Thursday. If preferable, Agenda Requests may be made on off Ice stationery with the above Informatrlon attached. ' THIS REQUEST RECEIVED BY: ~-~- THIS REOUEST RECEIVED ON: ~~~~ ~~% @ ~~- ~~/-~ All Agenda Requests w111 be screened by the County Judge's Off Ice to determine If ~~ adequate Information has been prepared for the Court's formal consideration and action at time of Court meetings. Your cooperation will be appreciated and contribute towards your request being addressed at the earliest opportunity. DATE: 9-12-90 TO: COMMISSIONERS' COURT FROM: __ DA_VID_LITKE_________ Person Requesting Budgetary Approval __ENV_I_RONMENT_AL HEALTH ____ Section/Division ~r SUBJECT: l~New Hire ^ Promotion ^ Merit ^ Lateral Transfer ^ Demotion ^ Other EFFECTIVE: _~9 _24_90x_ I WISh t0 employ KELLY L. CRUNK Date Person AS a~ ENVIRONMENTAL HEALTH TECH.at 16/8 at a Tide of Position Grade/Step salary Of $19, 356.00 annual 1,613.00 monthly 806.50 s~ni-monthly In accordance to Order No. 18631 approved April 27, 1989, the following documents are submitted for your approval: • The actual application for employment along with any letters of recommendations; • The written physical report signed by the doctor,(CK-05) with completed evaluation form signed by department head, and; • **The Workman's Compensation Inquiry report (verbal to Department Head and followed up by written request.) ** VERBAL APPROVAL 9-10-90. C K-01 KERR COUNTY MEDICAL REPORT (APPLICANTS COPY) I, ~ ~ ~r-~., ~ ~ ~- ~ « a licensed physician, hereby certify that I have on this date, medically examined ~-~- I ~ ~-I ~ `~~~"` ~~ and find him/her to be in sound physical condition and free from any physical defects that could prevent or adversely affect the performance of his/her duties as ~- ~-~r ~~ 1 fi u- I r- C- I-1 Date Sign re of Physician fay ~~~ Physician's License Number PLEASE GIVE THtS PORTION TO APPLICANT TO BE RETURNED TO KERB COUNTY DEPARTMENT HEAD. CK-05 TE S WORKERS' COMPENSATION C .MISSION 200 East Riverside, Austin, Texas 78704-1287 WAIVER OF CONFIDENTIALITY ( understand a!I information in my worker's compensation files} is confidential under the Texas Worker's Compensation Act. However, I hereby waive any such right of confidentiality and authorize the information outlined below from my records to be released to the undersigned employer for a period not to exceed fourteen days from the date of application for employment. SECTION 2.33. INFORMATION AVAILABLE TO PROSPECTIVE EMPLOYERS. (a) When a person applies for employment, the prospective employer who has workers' compensation insurance coverage is entitled, on compliance with this chapter, to obtain information on the applicant's prior injuries. {b) The employer must make the request by telephone or file the request in writing not more than 14 days after the date on which the application for employment is made. (c) The request must include the applicant's name, address, and social security number. {d) The employer must obtain written authorization from the applicant before making the request. (e) If the request is made in writing, the authorization shall be filed simultaneously. 1f the request is made over the telephone, the employer shall file the authorization not later than the 10th day after the date on which the request is made. THIS FORM MUST BE FILLED OUT COMPLETELY AND NOTARIZED TO COMPLY WITH THE LAW Telephone ~ NO s-~6.~'D --------------------- Date of Request (Must Circle O e) Signature / ,, L 1. ~/~ C~~.L~~_~L~ 2GTcN = Requester's Full Name and Title /C .C . F'. 7~•~. 2. 74-6001494 Federal Tax I.D. Number Employer's Full Name /'` Street Address City State Zip 5. -- -~1`s 1S o Dat/e~of Appl'catio -- __L__ --~.--- Signatu Print or Type Applicant's Full Name Social Security Number 8. ~o ~ _ y 6 E ---- -_- Street Address City State rp IF REGZUESTED BY PHONE THIS FORM MUST BE RECEIVED WITHIN 10 DAYS IN THE COMMISSION'S AUSTIN OFFICE. • ~ t t f t t r r r • - r * r r • r • r + • * * * * * + * * * : r r : r r r • • • r r • • * * + * • r • • + • • r r r t • • • r ! • f * r r r • • r • r r STATE OF TD(AS § COUNTY OF KERB § SWORN AND SUBSCRIBED TO BEFORE ME THIS )~~t day of ~ , 1910 . Signature of Notary Public Printed Name of Notary Public (Seal) My Commission Expires: R-12 {Rev. 4-90) CK-06 a~~soooa •°"~~~~9`~ LfD1A S. BETTS Notary Public. State of Tpus bty Commission Espues 815191 ~~_o< rough (mo/day/yr) Final Salary %~ < i - ' Sz . G ns Sc a ~. ~. ~ l $ 3 y cr i ~ , Name of Organization ~ Address (I'0.13x, St, A t ,City, State, Zip) Phone (are co e & number) Full- Part -Time If art-time a roximatc number of hours cr week: Name of Supervisor Title of(Supervisor en! M~JSP S PASu r t-~T ~' 1 _ c 0 ca T I nr ~a t L o r ~t a Number and job types of employees superv/ised by yo/7u, if .Jany (e.g. 3 managers, 2 technicians, 2 clerks): i~ ~'o y c~i.S ~l Sri<•~<:~ r ~., r ~ ~~rc~ A~.Y /F~ ~.~lr s«l" F;~~I~ v`~ .i•'„ '/• 'r /1n~J P~I.+1 6~'r~,:re..V v nrt.. Of'e,n£~.,7.1 .•a Mirf~.+~li~af ~.1J /e~~£3 ~q.~.Y ~.~ef~ici.ar p ~ ,:i ., . /, ~'~f Arri ~_ EMPLOYMENT RECURll 'N"1'1NUEll Pa~c 3 of 4 Job Title ,^/ /J From (mo/day/yr) Through (mo/da /yr) Final Salary '~.~:.Ic~7' Number and job types of employees supervised by you, if any (e.g. 3 managers, 2 technicians, 2 clerks): n t . n •„t Reason for Leavin//g //' /~ 1 Describe the duties of oa' osition in order of im ortance: 1^I ( l , , _ }{,Y'.ti/-~.e~.r .;F e/:c~T.~tr~ 1N ../ISc.rQM...rr/' 'CC4rP~.!.ra~ 1 CAC JZIMel~t RJl a~ C/~1zOr~lA+CS~-AP~Ir _ ~'~n..~~...Tr, ~~rrac/Y.sSi.tf d~J /.'1