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i:=o~.ir-t unani®ously approved by a vote of 4-0-0, t: c, tii.rr' Wi.nni.e
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7. T1 {': tlB lci ii Fib fS P.SF: ~:7 r-" E i.l (-'i~1C[ih.
COMM I SS i ONERS' -COURT AGENDA REQU-EST ~~
~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 (or submitting this request for Court to assure that the matter is posted in 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 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 opport.unlty. 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) Tf~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
2~l ~GI I 5. ~ ~ ~ ------
------------------ --- ------------
Dat of Re uest Must Circle One) Date o plication /
r~ ,~/~~r '
Si nature -~/~, /,P i ~Z~~!,~.! ____-__--
9 Signature
1. ~1311y-.13__L~~T.D->~?-1~~.K-/!,~~'55%2 -L.aLL~GTo2.6. _~1d~.Lsll~-Y" 1 ~1~ --------------
Requester's Full Name and Title Print or Type Applicant's Full Name
2. 74-6001494 7, -L~----_- q~-- --/~~ 3 ----
Federal Tax/'I~D.N~umber Social Security Number /
3. ~~~ 'rJ-1G'-(~~~1r~ ----- 8• _l~c~i__ ~~~ r`11 _
Em to er's Full Nanie -- '-
P Y Street _Address ~o
a. _~~l~r~l ST ------------ KEKRY1~L~ ----~------_--~-aQ.~~
Street Address City State Zip
_ K~-~V~-~~_~~-_-----~~Qm~ _ APPLICANT HAS NOT HAD T ~,tr~
City State Zip tviDRE GEi~lERgl w0
,_~ ~~v w~uRlEs r-oR v~rE,rc~
IF REQUESTED BY PHONE THIS FORM MUS~'Ke~~~€~b1Qti'r11G~!!S ~~DAYS IN THE
COMMISSION'S AUSTtN OFFICE.
f f 1, f f 4 f f f f f f f R f f f Y t f f f t f t R f f 'f f f t f f f Y 1 f f f f Y f f f f Y f t f f f Y f f f f Y Y f f f f f f f f f f t f e f f 1 f f
STATE OF TEXAS
COUNTYOFKERR
SWORN /
~~
Signature of Nott
My Commission Expires: ~ECENEC - 6
JUL16199i
R-12 (Rev. 4-90)
CK-06 Icnr+~ vvvrtt(ERS GUMf tNSATION
COMMISSION -AUSTIN

UBSCRIBF~D%TO BEFORE ME THIS 7 L~ day of
Printed Name of Notary Public
(Seal)
~~i~ Notary Pubile, State of 7tixas
~,, M Cmnmtsslon t3xplrrs
~"^` JANUARY 9, 1995
19' %~ .

KERR COUNTY MEDICAL REPORT

(APPLICANTS COPY)
- ~ a licensed physician, hereby certify that I
1, .
have on is date, medically examined %%'~~- ~ i-P->~ > and
find him/her to be in sound physical condition and free from any physical defects that
could rev nt r dversely affect the performance of his/her duties as

PLEASE GIVE THIS PORTION TO APPLfCANT TO BE RETURNED TO KERR COUNTY DEPARTMENT
HEAD.
CK-05

~(~ T ~ 7
Physician's license Numbar
ORDER. NO. 20456
APPF~VAL OF HIRING WINNIE {VIED
IN THE TAX/ASSESSOR'S OFFICE
August 12, 1991
UoI S, Page 353