ORDER NO. 19823
APPROVAL OF HIRING KIMBERLIE GRAY AND
BRENDA NICHDLS IN THE KERR COUNTY TA}{
ASSESSOR-COLLECTOR'S OFFICE
On this the 20th day of September 1990, upon motion made by
Commissioner Holekamp, seconded by Commissioner Ray, the
Court unanimously approved hiring Kimberlie Gray as Auto
Title and Registration Clerk in the Kerr County Tax
Assessor-Collector's l7ffice at Pay Croup 10, Step 2,
512, 907. 00 annually, 51, 075. 62 monthly, and 5537. 81
semi-monthly, effective October 1, 1990, and Brenda Nichols
as Auto Title and Registration Clerk in the Kerr County Tax
Assessor-Collector's Office at Pay Group 10, Step 2,
512, 411. 00 annually, 51, 034.25 monthly, and 5517.13
semi-monthly, effective September 4, 1990.
DATE: September 18, 1990
TO: COMMISSIONERS' COURT
FROM: PAULA RECTOR
Person Requesting Budgetary Approval
_Tax_Assessor-Collector ______ _
Section/Division ~N ~~
SUBJECT: ®New Hire ~ Promotion ~ Merit
D Lateral Transfer ~ Demotion D Other
EFFECTIVE: 10_1_1990__`_ I wish t0 employ Kimberlie Gray
Date Person
AS a Auto Title & Registration Clerk at 10/2 at a
Title of Position Grade/Step
salary Of $12, 907.00 annually, $l, 07.5 ~ monthly, $537.8 semi-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.)
CK-01
TEXAS WORKERS' COMPENSATION COMMISSION
200 East Riverside, Austin, Texas 78704-1287
(512) 448-7934
.. WAIVER OF CONFIDENTIALITY
I understand all information in my worker's compensation file(s) 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) Tt: ~ 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. If the request is
made over the telephone, the employer shall file the authorization not Eater 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 YE NO .
J
-Q~--~~'-- -------- --
Date f equest (Must Circle One)
- -~~ ms`s"-o---- ---
Signature
. ~6s~~~~T~~CP~~s_s~s so,~ =
Requester's Full Name and Title GQLL~,-rOjZ,
2. 74-6001494
Federal Tax I.D. Number
3. ~iCRi2~~tZ~t~ ~AX~~FIGE-_--
Employer's Full Name
4. _~~~-~_ _ --
Street Address
-~z~v.~~ -fix .___ ~~o~~
City State Zip
5. --- ~~-r ~~ ~----------------
Date of A~pp~li~ca~tion /~
Signature 0`
Print or T//ype Applicant's Full Name
Social Security Number
s. _~ ~~_~~`~-------------
Street Address
~ P P~ ~.~~ --fix -__- ~b~~--
City State Zip
IF REQUESTED BY PHONE THIS FORM MUST BE RECEIVED WITHIN 10 DAYS IN THE
COMMISSION'S AUSTIN OFFICE.
t! !! f f t f f!!! f f f!! !!! f f 1 t f f ! f f !!! f! f! f f f f! f!! f f!! f f! f f! f!! f!!! f f! f f!!!!!!! f f f f
STATE OF TEXAS §
COUNTY OF KERB §
SWORN AND SUBSCRIBED TO BEFORE ME THIS ~ day of D,~,C' »z rte, i) , 19 ~~
%~.~ i ~'~.~ /,J / lei ~: [,
Signature of Notary Public
My Commission Expires:
R-12 (Rev. 4-90)
CK-06
Printed Name of Notary Public
(Seal)
~'~~'`~ LIDIA S. o~TTS ,
Notary Public. State et Texas
iAy Commission E.cpires 8!5191
~`~rt f, u~~
KERR COUNTY MEDICAL REPORT
(APPLICANTS COPY)
I , C~ +y~ ~~.r ~- ~o ~ ~~' a licensed physician, hereby certify that
have on this date, medically examined ki n-,-~~~.r-~ ~r E~K~~ f 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
~~~c~
~, ,~-~
Date
_ ~ ~ 2-__
Sig re of Physician
1-~ a ~ ~ ~
Physician's License Number
PLEASE GIVE THIS PORTION TO APPLICANT TO BE RETURNED TO KERR COUNTY DEPARTMENT
HEAD.
CK-05

DATE: september 18. 1990
TO: COMMISSIONERS' COURT
FROM: PAS RECI'OR------------
Person Requesting Budgetary Approval
Tax Assessor/Collector
Section/Division
SUBJECT: ®New Hire ^ Promotion ^ Merit
^ Lateral Transfer ^ Demotion ^ Other
EFFECTIVE: _9-4-1_990
Date
wish to employ Brenda Nichols
Person
AS a Auto Title & Registration Clerk at 10/2 at a
Title of Position Grade/Step
salary Of $12,411.00 annually, $1,03.4.25 monthly, $517.13 serif-mthly
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.)
CK-01
TEXAS WORKERS' COMPENSATION COMMISSION
200 East Riverside, Austin, Texas 78704-1287 ~ _
(512) 448-7934
WAIVER OF CONFIDENTIALITY
I understand all information in my worker's compensation file(s) 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) Tl,s employer must obtain written authorization from the applicant before making the
request. le) if the request is made in writing, the authorization shall be filed simultaneously. If 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 YES 10~
Dat o Re uest (Must Circle One)
L~C!~!.Ir.~i-- ----
Signature
1. ~~v~~~~to~_TTAx~ssES.~r~ ~a~~l~;e
Requester's Full Name and Title
2. 74-6001494
Federal Tax I.D. Number
~•
3. ~~I?,2 I~~I~ LF ~.F1~ F _~
Employer's Full Name
4. -~ 1-~z~ S ~ ~ ----
Street Address
5. __8~~0~1~
------------------
Date of Application
Signature
s. _ REivp~'.~_~ II c l~0 ~ ~----------
Print or Type Applicant's Full Name
7- -~~ -----~~---~ 3 ~------
Social Security Number
Street Address
City State Zip
City State Zip t ,~n,~t , ~- _.. r~~~~_itt? t_C'~
App a r... - ~ , it ~ :~ `; r' ~ ,
1F REQUESTED BY PHONE THIS FORM MUSK' ~~ I ~(;D•=:~T~'fl'I'N 10 DAYS IN THE
COMMISSION'S AUSTIN OFFICE. v3~='~ ~ •
f t t f t•*•• t t f f••• 1 f f t• f t f t t t t t t t t f f t f f• t f f • t t t f Y f N f t t•• r t r•: e l f R* f t t• t• t t f t• t t
STATE OF TEXAS § ~~
COUNTY OF KERB § _ ~ ~~,
SWORN AND SUBSCRIBED TO BEFORE ME THIS~C~~ day of ~; ~~, 19 ~.
~~~ 1 0 1995 ~
g atu e of Notary Publlc Panted Name of Notary Publlc AS ,
(S e a I) AS W~~K MM1 i~
EX y GO
My Commission Expires:
R-12 (Rev. 4-90)
CK-06
0 ~ ~,.r.
~~,.~~v',~ LIDIA S. BETTS
Rotary Public. Stare of Texas
My Commission Eupua 815191
J~J` a,`,~l
NTy MEDICAL REpCRT
KERB CCU that I
hereby certify and
~AppLICANT' CQPYI sician, ; 4ti oIS
~ l+censed Phi defects that
~~- ~Q~ ~ fined ~~'~"~~ any physical
I r~.o~ medically exam and free from as
aVe On this ate, condition of hislhet duties
h in. sound physical
d himlher to be el affect the performance
fin advers Y }
revert or _ ~ _..---' ~ _ ---
could p
. _ +~ ra o{ Physician
'" d
pate Number
Physician's license
ERR COUNTY DEPARTMENT
NT TO 6E RETURNED TO K
TO APPt1CA
PLEASE GIVE THIS PORTION
NEpD.
~K.OS
ORDER N0. 19823
APPROVAL OF HIRING RIMBERLIE GRAY
AND BRENDA NICHOLS IN Tf~ KERR COUNTY
TAX ASSESSOR-COIZECTOR'S OFFICE
September 20, 1990
Vol. R, Pg. 1003