~~F~PkuV~-it_ Lid ~-I1kItJ~~ ;~J1r~CJiE W;:ED Ii•y
1 !-i ~ l F-I :~ / i-i ~'a E `_, ~ tJ !i' `_i U r i- i G ~
iJil ti~15 Lice i~ti•1 day Of H~_lg!iSt 1~'~~~ !_IF~On I71G'` lOTI made 1`Y
LOmm1~510T1B'r' Nolel~amp, =_.e~_onde~~ D'J i~~~~lilm1=~10~",@~'' Ui?il1E'r'~ ~:i~e
Co~_ir± unanieously approved by a vote of 4-0-0, tc~ hire Winnie
Wied efifiect;ive J~_~~y 1~~, ly~`1, at Fay Gro_lp :147, ~t,ep ~,
$lc~ -.4~1 cii-.._ _.,:.11'y, '.•l~ 4'7:x. b~ monthly, a.~id `E`~.~". ~~i =~ml-monthly
1TI ti-le ~ ax E'i55es Vf'~ S L~~~ 1 ~.LC.
COMMISSIONERS'-000RT AGENDA REQUEST ~~
PEASE FURNISH ONE ORIGINAL AND FIVE COPIES OF THIS REQUEST AND
DOCUMENTS TO BE REVIEWED BY THE COURT
MADE BY: Paula Rector
MEETING DATE:
Aug. 12, 1991
OFFICE: Tax Assessor-Collector
TIME PREFERRED:
SUBJECT:	(PLEASE BE SPECIFIC)	Inform the	court of the	hiring of Winnie
Wied	effective 7/15/91 at a 10/2	$537.81 semi-mo.	$12,907.00	annual.
				
EXECUTIVE SESSION REQUESTED: YES NO
PLEASE STATE REASON FOR EXECUTIVE SESSION
ESTIMATED LENGTH OF PRESENTATION:
PERSONNEL MATTER - NAME OF EMPLOYE:
NAME OF PERSON ADDRESSING THE COURT:
Time for submitting this request for Court to assure that the matter is posted in accordance
with Article 6252-t7 is as follows:
* Meetings held on second Monday: 12:00 P.M. previous Wednesday
~ Meetings held on Thursdays: 5:00 P.M. previous Thrusday
THIS REQUEST RECEIVED BY: -- - - --
THIS REQUEST RECEIVED ON : ~ -
All Agenda Requests will be screened by the County Judge's Office 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. See Agenda Request
Guidelines.
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 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 NO
'Z~ ~g 1 ----------- -- 5• --- ~ ~ ~ -----------------
Dal of Re uest Must Circle One) Date of plic lion
------- -- ~- _C~~-~L ----------
Signature Signature
1. ,~ (11.1 ~~T~~_~~-K~-r5y~2 ~LG~L~26. _~1AId11~-yam?~~ ------------
Requester's Full Name and Title Print or Type Applicant's Full Name
2. 74-6001494 7. _~____-_ ~~__-__~Q~ ~ ____
Federal Tax I.D. Number Social Security Number ,,
Employer's Full Na a Str1e>et_,Address ~/Jp
Street Address City State Zip
_ ~~~2/~_[~ -~-------~~~~ - ^.FFLIC~INT HAS NOT HAD TWO Q!~
City State Zip t~iORE GEi~JERAL INJURIES FOR y/~,~I-i(C
fir ~y
IF REQUESTED BY PHONE THIS FORM MUS7KBE~~~C€1C~J1iE1~3~}~ODAYS IN THE
COMMISSION'S AUSTIN OFFICE.
f• f f f f f• f f f f f f f i 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••• • f•• f•• f i
STATE OF TEXAS §
COUNTY OF KERR §
SWORN AN~SUBSCRIBED%TO B FORE ME THIS y L~ day of
19 ~/
Signature of Notary Public - Printed Name of Notary Public
My Commission Expires: RECEIVES - 6
,JU1.161991
R-12 (Rev. 4-90)
CK-06 tC~~ vvv~~(ERS GUMPENSATION
COMMISSION -AUSTIN
(Seal)
,n`: ""4t, THEA SOVIL -
.,,~~ ~ Kotary t?ubtlc, State of 7lexas
+ [Ny Cortunlsslon F.xptnrs
\M^• JANUARY 9, 1995

..._ TY MED1CAi- REp~RT
KERB COIN
Certify that I
OPY7 sician, heCehY and
(APPLICANT C a licensed phy efects that
_ sisal d
all examined and free from any shy
1' is date, medic y Condition nce „f hislher duties as
h sisal
have on be in sound p y erforma
himlher t0 r dVerSely affect the p
find
could rev nt °"`~`'
__---~''
~_e
_~ ~
pate ~ . _~~ ~ ~rense
~~~,-
ERR COUNTY QEPARTMEN
T TO 6E RETURNED TO K
lS PORTION TO APPLICAN
p~EA5E GIVE TR
~{EAD.
~K.05

~~
Number
ORDER. N0. 20456
APPROVAL OF HIRING WIlVNIE WIID
IN TF~ TAX/ASSESSOR'S OFFICE
August 12, 1991
Vol S, Page 353