- _._
_. ,:

COMMISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL AND FIVE COPIES OF THIS REQUEST AND
DOCUMENTS TO BE REVIEW D BY THE COURT
MADE BY: PAULA RECTOR
MEETING DATE: ocT. is, 1991
OFFICE: TAX ASSESSOR COLLECTOR
TIME PREFERRED:
SUBJECT: (PLEASE BE SPECIFIC) xIRINC of PAT$Y_. T.ONNF.7~T. HANKR
IN THE AUTO REGISTRATTON ANn TTTiF nFPARTMFNT Am n In/i S12.593_nn ANNTTAL
EXECUTIVE SESSION REQUESTED: YES NO
PLEASE STATE REASON FOR EXECUTIVE SESSION
ESTIMATED LENGTH OF PRESENTATION: s MIN '
PERSONNEL MATTER - NAME OF EMPLOYEE: PnuLa RECTOR
NAME OF PERSON ADDRESSING THE COURT:
Time for submitting this request for Court to assure that the matter is posted 1n accordance
with Article 6252-17 is as follows:
* Meetings held on second Monday: 12:00 P.M. previous Wednesday
* Meetings held on Thursdays: 5:00 P.M. previous Thursday
THIS	REQUEST	RECEIVED	BY: ~
THIS	REQUEST	RECEIVED	ON : //~ .,3~ ~ ~ -~ ~'~' ~
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.
{
t
~F
t

\\
KERR COUNTY MEDICAL REPORT
(APPLICANTS COPY)
~. C ~„~ ~~ ~~-~ a licensed physician, hereby certify that
1, Fars Lc~inell Flu,ilts and
have on this date, medically examined h sical defects that
find him/her to be in sound physical condition and free from any p Y
could prevent or adversely affect the performance of his/her duties as
fC eshahUn dank- -htl~ eletr~
9 23
Date
PLEASE GIVE THIS PORTION TO APPLICANT TO BE RETURNED TO KERR COUNTY DEPARTMENT
HEAD.
CK-05

~D~~f"
Physician's License Numbar
TEXAS WORKERS' COMPENSATION COMMISSION
200 East Riverside, Austin, Texas 78704-7287
(512) 448-7934
WAIVER OF CONFIDENTIALITY
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) Tr:e 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
9/1 /9~1 5. 9/18/91
--- -- ------------------------------
--- --------------
Date of Request ~ ( ust Circle One) Date of Application
Signature Signatur,~'
1. Paula Rector~Tax Assessor=Collector 6. -p~gV~~ntLelLHanks______________
Requester's Full Name and Title Print or Type Applicant's Full Name
2. 74-6001494 7, 449 23 5471
--------- ------ -------------
Federal Tax I.D. Number Social Security Number
3 Kerr County g 325 George Court
------------------------ ----------------------------
Employer's Full Name Street Address
700 Main St. Kerrville Tx. 78028
----------------- --------------
street Address pp~S~~CANT HAS NO'64~~~~ Zip
Kerrville Tx 78028 ~ r
------------------------------ MORE GENERAL IN.;~+{IcF, FOR WNICI~
City state Zip WEEKLY GOMPENSAI'4UN WA5 PAID
IF REQUESTED BY PHONE THIS FORM MUST BE RECE,~(~D.~1WTI-ftN~'70'TAYS- IN THE
COMMISSION'S AUSTIN OFFICE. """"""""
f! f}!}!}!} f f f f f f f f 1 1 1 1!!! f f f f f!! 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! f
STATE OF TEXAS §
COUNTY OF KERB §
-- SW-~ SUBS BEFORE ME THIS 1 /~''~day of , 19 ~_
-- - ---- ` -----------1 ~L=q`-`tio ~. , ~- ----- c --
Signature of Notary Public Printed Name of Notary',/~~
(Seal) ~yee
My Commission Expires: ,
'",;,'' Tx~ sovu ~9EP 191981
. C~ , No4vy Publk, State otTexns ~ }
R-12 (Rev. 4-90) .,may MyCommleslonflrptres }
•nu. o• JAIYUAf21'9, 1995 TEXAS WORMlr~~
CK-06
~.
ORDER NO. 20604
Approval of Hiring Patsy
Connell Hanks in thz Rear
County TaxlAssessors' O~£ice
October 15, 1991
Vol S, Page 440