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Home My WebLink About32112 / 82-14September 16, 1982 PURPOSE: EXTEND RETIREMENT DATES INITIATED BY: PERSONNEL DEPARTMENT �k 14 RESOLUTZON WHEREAS, the City of Oshkosh, on the 6th day of December, 1979, adopted a Uniform Extension Policy for employees of the police and fire depart- ments; and WHEREAS, the following fire and police department personnel have met the requirements of said IIniform Extension Policy and have requested a one-year extension of their employment: JAMES TADYCH - lst Request - Police Dept. Date of Birth: October 22, 1927 Original Retirement Date Is: December 31, 1982 Employment Extension Through: December 31, 1983 WILLIAM BOUSHELE - lst Request - Fire Dept. Date of Birth: October 25, 1927 Original Retirement Date Is: December 31, 1982 Employment Extension Through: December 31, 1983 NOW, THEREFORE, BE IT RESOLVED by the Co�on Council of the City of Oshkosh that the foregoing extensions are hereby granted. SUBbfITT�D BY' APPROP�;D - 14 - .. �-^� ,�:. �� `x`� u��:. .^'n.,. �"i,.; �,.``9' A' y,y,�Pf`�'�('�i e Oshkosh City Council City Hall Oshkosh, Wi. 54901 Dear Council Nembers: September 2, 1982 COUNCIC-fAAf14�E?. -_+'.'.`��15i%>.Ai."� I respectfully request a one year's employment extension with the Oshkosh Police Department and the City of Oshkosh. Yours truly, �L�/'CP2 � ,�Gh,.i mes Tadych Police Officer SAFETY BUILDING • 420 JACKSON ST. • OSHKOSH, WI 54907 ..i � CITY OF OSHKOSH HEPORT OF MEDICAL EXAPfINATION FOR POLICE OFFICER -�iy This iafoxmation is for offical use only aad will not be released to unauthorized persans. 1. LAS,,T NAME - FIRST NAME - MIDDLE NAME � 2. DATE OF BIBTH ��}Dy�H , J,�n�ES oscR� l�-a�--a� 3. HOME ADDRESS ' NUMBEH, STREET CITY OR TOWN, STATE AND ZIP CADE 3037 N/A-L,Dav�� Ls�. �S�/fi�ss,� .��. �.�,�a.� i ✓ / J ✓ ✓ i ✓ I � r v ✓ CLINICAL EVALUATION 1 Check each item in appropri column; enter "N.E." if aot evatuate�. . Eyes-General (Visuat acuity and color vis : Lungs, Chest (Include breasts) . Heart (Thrust, size, rhythm, sounds) . Vascular System (Varicosities, etc.) . Abdomen and Viscera 15. Anus and Rectum (Hemarrhoids, fistulae) (Prostate if indicated) 116. Endocrine Svstem 117. G-U System �18. Upper Extremities � (Strength, range of cw; �19. Feet �20. Lover Extremities ; (Except feet) . ..Y�..�, .,�..�� Musculo-skeletal . Identifying Body Marks, Scars. Tattoos � �24. Psychiatric (Specify any personality deviation) Remarks and Additional Defects and Diseases noces: liescrine every abnormatity in detail. (Enter pertinent item nuuber before each comment; contiaue in It� 39 and use additional sheets if necessary. �M �ri� 'a'`a" „r,,,_� t�,; � -�,�.� �^^�.�.�;, �„ �- � �-`j� T.CRORATORY FINDINGS 25. URZNALYSIS: SP. GR-.. ' 27. EKG (Optional) 2S. TZNE TEST (TB) �� y�y��y � G.�,.�-.. J �'- �i_PZv� �t/p�a 1z�{ �fi �,�„ BUILD: SLE:TDER -��'S� � .s�,uco HEAVY OBESE �� e ��,s . � �� . .......... ............... ../ � X . DISTANT VZSIO 37. CALOR VI5ION RIGHT 20/ � COB$. TO 20/ o� LEFT 20/ � CORR. TO 20/ �(7 �� 0 . SUMMA3X OF DEFEGTS AND DiAGNOSES (List diagnoses with item number) p _a, e� i v > > �w�o -w..�.L� - 0 �^�°"'� �j2�.'-'.' ��. �`i1 n e ii1.` 0 e /.,_ " ^-C C J 41. RECOI4�NDATIONS - FURTHER SPECZALIST EX.�`SI�`IATIONS INDICATED (Specify) ' �9Y`Q �� 42. EXAAiINEE (Check) ( �) IS QUALIEIID FOR E�iSPLOYMEVT AS LAW ENFORCEMENT OFFZCER ( ) IS NOT 43. IF NOT QUr1LLFIED, LIST DZSQUALIFYING DEFECTS BY ITE�iI W�ffiER OR PRINTID PL9.�� OF PHYSICIaN G`l N l.J o o �.i r��' � SIGNATURE �i/rs �-- �x��y � �/� .�iepte�ber 7, 1982 To: i•ir. �liZ�i� Frueh i�:enbers oi Cocr.�on Couacil Dear yir. Frueh & Honorable T�;emoe�s of Connon Co•ancil; I aa requesting an extension beyond cy normal retireaent date of Dececber 31,,1982 to Dece�ber 3', ��'3. ti �tatemert fron my ianily phgsician, Dr. I�ion3ay, is attached. I re�pectfully subnit this recuest �or your consideratior_. !'V�nw ��>�T�� +�illi2n Boushele Capt. O�hho�_�,Fire Departaent � .� �� -�/� CITY OF OSFiKOSH '�.` REPORT OF MEDICAL ERAMINATION FOR FIREFIGHTER This infotmation is for offical use only and will not be released to unauthorized persons. .�� .i/. GgzK .�r c�s[��vsc� w� s S�fYo� _ v v U « ✓ f� � CLLNICAL EVALUATION 1- Check esch item in apprepri� columa; eater ".i.E." if not evaluatedo y. Ears 0. Eyes-Geaeral (Visual acuitv and eolor vision 1. Lungs, Chest (Include breasts) 2. Heart (Thrust, size, rhythm, sounds) 3. Vascular System (Daricosities, etc.) .4. Abdomen and Viscera (Includa hetnia) S. Anus and Rectum (flemorrhoids, fistulae) (Prostate if indicated) l6, Endocrine System .7. G-U System �.8. Upper Extremities (Streagth, range of mot Ly. Feet Z0. Lower Extremities (Egcept feet) (Stiren�th range of mo� Z1. Spine, Other Musculo-skeletal. l2, Identifyi¢g Body t4ar:cs, ' Scars, Tattoos 23. Skin L ha[ics 24. Psychiatric (Specify any �� 'E-� ersonal it deviation) Remarks and Additional Defetis and Diseases � Notes: DescriUe every ancormaiiry m detail.. (Enter pertinent ite� namber before each comment; contiaue ia ltem 39 aad use additianal sheets if necessary. � �' �� =c ;.y? ,K S 15 / ✓ Q�QC EACH ITEM YES OR NO. EVERY ITEM CF�C'�D YES MUST BE FIJLI,Y EXPLAINED CN THE SLANK.SPACE ON RIGEIT. 3. Have you been refused employment or been unable to hold a job because of: A. Sensitivity to Chemical5, Dust, os�.ca�ns : MOtions: ✓ � 14, Have you ever Sul�stance? � H ✓ 15. Have you eoer been denied liEe insurance? (If es, state reason and ive details.) � 16. Have you had, or have you been advi.sed to Tli��o/J -�i� haw ang operations7 iIf yes, describe and �ER.�� `f�GE'�g ive a at which occurred.) 17. Have you ever been a patient in any type ,�.��,emy - S�RGF�y 63/ of hospital? (If yes, specity when, where, prt. S7FE� - pQ /sO"+ why, and name of doctor and complete address o£ hesnitai_1 1�173 -�Ki K'vDU' �f�• �% 18. Have you ever had any illness or in7ury other than those already noCed? (If yes, 19. Eave you consulted oY been treated by clinics, physicians, healers or other practitioners within the past 5 years for other than mi.nor illaesses? (If yes. give � complete address of doctor, hospital, 20. Have you ever been rejected for Militaxy Service because of physical, mental, or other reasons? (IE yes, give date and reason for rejection.) 21. Have you ever been discharged fzom Military Service because of physical, mental, or other reasons? (If yes, give date, reason, and type of discharge: whether honorable, other than honorable, foz unfitness or 22. Have you ever received, is there pending, have you applied for pension or compen- � sation for exi.sting disability? (If yes, specify what kind, granted by whom, and I� /�2EC Sr OSIr�� ?.3 � DQ• E✓E2S I certify that I have reviewed the foregoing in£ormation supplied by me and that it a.s tzue ana comnlete to the best of my knowledge. I authorize any of the doctors, hospitals, or clinics mentioned above to furnish the City a com- plete transcript of my medical record for p„*r+oses of processing my application for this employ- ment_ TYPED OR PRINTED NAME OF� EXAiAINEE SiGNeiTU?2E ^ q.�t J. 3o�st{ccc 23. Physician's sut�azy and elaboration of all pertinent dataU(Physician shall cou�ent on all positive answers in items 11 thzu 22. Physicians may develop by interview any adcti.tional medical history they deem i.mportant, and record any significant findings here.) ;D O PRINTED NAME OF PHYSICIAN OR EXAMLNER I DATE ISIGNATURE .v�. vr ti. [ /�� /�ED SE�ETS � � S �J�� ..� �/<'�� i✓v�i'7��1�i`-'LV TO APPLZCANT: FILL OUT THZS FORM BEFORE GOING TO SEE DOCTOR. � �� CITY OF OSHKOSH / REPORT OF MEDICAL HISTORY This information is for official and medically-confidenti.al use only and will not be released to unauthorized persons. 1. LAST NAt�-FIRST NAME-MIDDLE NAt� 2. TITLE OF POSITION 3. SOCIAL SECURITY NO. 4. SEX f3c�-n�« w,��R.., J�,� F�PCF,��,-r�a 3s�-�-�-337•7 � 5. HOME ADDRE/SS (NO., Street or RFD, City or Town, State, ZIP Code) 6. BIRTHDATE 7�...HIItTt�LACE ZSl �y. LRiZK Si QJl�KoS�l ,WIS ��`'/OI [a�Z��27 OSMeCVSIt 8. DATE OF EXAMINATION 9. EXAMINING FACILZTY OR EXAMZNER, AND ADDRESS (Including ZIP Code) � jc / ��z� �•/,N � ..�p �^.-, a� .) �/o s � ;y P U .9v�v- �i�lrf��os G�-'-p/•. 10. STATE OF EXAMINEE' PRESEPT F�ALTH MEDICATIONS CURRENTLY USED (F011aw by description of past history, if complaint exists) ✓ ✓ Check at left ck Each Item) asses or Cont llen or Painful Soints or Blindness 3uait or Severe Headaci mach, Liver or Frequent or Painful Bone, Joiat, or other NO (Check Each Zt f/ �wear a Hearin Aic wear a Brace or Bz Left of Each Iteml: NO DON'T IINOW �(Chec} ./ Asthma ,/ Shortne ,/ Pain or Heart �ny ss of sreath Pressure in Co¢gh � ood Pressu:e t Indigestio� tion or ?oun� Loss e Bones or telnumia in �r " or L.ocked Knee � Stane or Blood v to Deoressian or Excessive �J ..5 �/v .. BUZLD: SLENDEH 1 :e, date, �L � fa HEAVY , _ ,� —. . TINE TES7 .--. �2-r�-w^t— 34. TEMP. OBESE � C 1 �� . r3 � � cucai�zoj+V �D coxx. To 20/ 2a�. V��.. .eV. LEFT 20/ ,sD CORR. TO 20/ '� �i/'�-`-�"� . HEA1tING (Test used and Score)`� � � �- ,� ` i' d� (IIse additional sheets of plain paper if necessary) 40. SUMMARY OF DEF�CTS AND DIAGNOSES (List diagnoses with item number) 41. RECOMPSENDATIONS - FURTHER 5PECZALIST EX2v`SIiYATIONS INDICATED (Specify) � 42. EXA,`lI:IEE (Check) ( ZS QUALIFlm FOR EMPLOYMEi'IT AS FIREFIGHTER ( ) IS NOT 43. IF tiOT QU�Ii.IFIF.D, LIST DISQUALLEYZNG DEFECTS BY IT&"L DIIF`�ER �o.eJp.�-�� f?, D.. SIGNATURE ,r..a �r W ��-- ♦� � � � � � �tk ' � �� J� � � N � �J> � N a��iw W � O U 1� •ri � O oa .� � � � m o m m u � ro aQ � � c� C a� . 'L" C � C � E�� U 0 .� +.� � ti, r N � `� �� r1 � � � J� N � U �.� � � � \�� fL � -� � -----r