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Home My WebLink About31769 / 82-06^Ia_rch 18, 1J82 PURPOSE: EXTEND RETIREMENT DATES INITIATED BY: PERSONNEL DEPARTMENT Il 6 RESOLUTION WHERF.AS, the City,of Oshkosh, on the 6th day of December, 1979, adopted a Uniform Extension Policy for employees of the fire department; and WHEREAS, the following fire deparrment personnel have met the requirements of said Uniform Extension Policy and have requested a one-year extension of their employwenc: ROBERT ELMER - 4th Request - Fire Department ` Date of Birth: May 23, 1924 Original Retirement Date was: June 30, 1979 Employment Extension through: June 30, 14.83 ERWIN BORST - lst Request - Fire Department Date of Birth: April 9, 1927 Original Retirement Date was: June 30, 1982 Employment Extension through: June 30, 1983 ALOIS KRIHA - 3rd Request - Fire Department Date of Birth: .Tune 19, 1925 Original Retirement Date was: June 30, 1980 Employment Extension through: June 30, 1983 NOW, THEREFORE, BE IT RESOLVED by the Co�on Council of the City of Oshkosh that the foregoing extensions are hereby granted. SUBi�ITTED SY � , APPROVED '✓t,-��n! �,j /-�� - 6 - , 0 � �%i/��J� � � -tc-fc1�� z�C , � _�c - ��t �.i c;c��i��-� �---E=��t,�`�� - ;� , / / / � CC - 17 �. �, � v��i-�t �� ,�� J ��.,//,c"'-�'� , r�c T . . � ' _ � ` �� / _ " ,,L( t -('�- - � z � C _ C�2�_. ; �. /.,�=�� , � �< <�t, � r- , � -C� '.�i j �� > �`/ �� ' �( � ` � -z _�� J � — �` �� ( .� z � -E' �� t�� 1 � � � :: t- , �C -� ^��' v � � � i /�� //� � . /�,�72�q �/_-�Li l -�Z L��C'`` ` ` /�� J� ( `` � � J J ' � � �' ` �" y.(". j,. L L7.'� � !� c� G: 'X—�Ll :i. �i,� 1��_,�` �� C' "/i 1 f� �-� � l �t° �� . -��, Ji%� —��z�c-��«� -2: -�� ,j � . r.� ��j ,�� , ,� �� - � , /��i��-�`-��,z�-� , �i MEDICAL HISTORY STATEMENT (To be taken in presence of examining physician.) Do you believe you are sound and we(I now? �"- � Are you subject [o dizziness? %,� To xvere 6eadeche? '<< J. . To pain in t6e breast? '"L `" To fluneriug of the heard -- -�'� To shanoess of brcath? - To toughe? '''� To diarrLea? - � To piles? �"�� To r6eumntism? �"�� Have you had sore eyes ot any defed o( visionl �-' �' � Running fmm either ead �' l�— Is your sease of hearing good?�Have you had 6ts oi mnwlsioas? -' 7� If so, how frequendy? Unconsc�ous spells? -� � If so, how frequendy? Aschma? Appendicitis? °" �f sq were you opetated Whea? A sore of any kiad upon your penis7� '' - _ Any swelling about or of your testicles? �'-7 - � A boil neat the anus? (fistula)?. Have you been ruptured? �' '� " Do you drink �otoxicating liquon w If no�, ro whac eMenc? other narco[ics? �'��— When?— Whac was t6e cause of you: mocher's deach? insanity, epilepry, oz in9amsarory thenmat Have you evet spit blood? Gonorthea? '� Do you use or have you used opium, motphine, coca�ne, oi any What was the cause of your fatheis deathF� �<<%�' �'` �-�1� .�. Has any membec of yout family had cubeccvlosi�, you ever been hua upon the 6ead? �-1.' — Answer tully - ��- Have you had a spiainL -' - A stiH joind -�� "' A bone or joiat out of place? ?�� "— A bone broken/? �-�-�_-�.i:'T� � �� `l / What bones broken7/ �s��/-5�-- Whea? ��/ � Cause? 1� �� "'>_ ��"- Are yo� subject to painfiil corns or so e feed✓ �'- �" Mention carefiilly injuries or surgical operatioas you may have had upon any part of your body, especially bucns, cun, severe bruises, or war waundc-.�=�� "' ? What hospita(ization have you had for U. S. war service?�� `� � � �. f_L" " _ _� c p `�-�- Give name aud address of physidaa who last aaeuded you, for what ailmeac, when? � _� �---� �� — . _ I heteby certify that the foregoing statemenu are true ro the best of my knowledge and belief. Sigvamre of Applicaa[ �i��i ��"`/� l �, � � � t s+go tuu o�e> THE MEDICAL EXAMINATION REPORT j. r� -�� 7 POL[C�_AND FIRE DEPARTMENT � < < ,, � /: Hzamination for �� (� /�s ( � . � / C- - . - (cten tide) _� 1. Name (print) / C ( 4. Sigoature of applicanL 2� 5. Heig6t � � Wichou� shcea �� / / � ' .'- � , � c' : l ��-: L- �.' i L- i )_ � 2 i 2. Date of birth �/ 5 '� 3. AgPTI � � 8. Hyesighr. Snellia Tesr. Leh 20/ �- Cortecced to: Left 20/ �� CI t t�c; 7__.-�� - � I 7. Chesr �f � 5 / : '.' : -� , �% � Ordioaq cicehn E�panded Mobi4ty Namral Right 20/- Both 20/ �. �. Right 20/_ Both 20/ -? r 0 or es 9. Hearing: R ear /•} �� S L. eaz �.L � � Dischazge? �� 10. Nos° i' �- �_' 11. Dental survey: Mark reeth "O" if capped or pivot; "I" if missing; "X" if carious; "F" if false. R S�J i6 L5. 4 3 2 1 1 2 3 4 5� 7 8 L Pnfe Cacies slig6r Good repair�Caries markr� 8'(J/ �(i 4�3� 2,1 I 2 3 4 5 6 j' E� Pyotrhe Need deanin.g- i 12. Tonsil �"�C �-�L-�' 13. T7aoa • : �' 14. TLyro;d '�'�"`"�� 15. Speec�+ � '� "-"`� 16. Lungs: Check for asthma, tuberculosis, bronchi[is, chest X-ray findine �i G�' i 17. Heatt: Cardio-vascular ryste¢ Pulse tatP � �1��-- 18 Gastro-intestiaal tratt•� Check pressure: SYnoli J? y Diu[oli �� i Check for gastric ulcer -" a��-vVv � Gall bladder �"��`�^ 19. Genito-uriaary: venereal d'ueas C� 20 Wasrerm^ -� Hydrocel ��v-- �1 � �^ 21. Vaticose Vein� � (vore form) 'A+_ � � 22. Hand �7`NyZ"l'�x� - 23. Feer �� _ " - _ " (tlat of ocher coudiuon) �.�rc 24. Bones aad join 25. Spin 26. D'uabilities: (chtouic ca rrh, siaus, fisnila, rectal diseases, cutaneous diseases, e?�t �-�� 27. Illness and 28. Oceratioas �u�� 29. Neuro[ic teadeacie 30. Could t6i+ man perform duty invohing being ou 6is feec for 12 hours contiauously?- 31. Could thi+ man perform duty involving long hours of dury involving sitting or riding? 32. Remar`- - I HEREBY CERTIFY THAT THIS IS A TRUE RECORD OP THE MEDICAL EXAMINATION O�^��'H ABOVE EXAM/IN AND THAT I HAVE FOi7ND HIM �QUALIFIED ❑ p SICALLY FOR THE DUTIES OF �-�� '�'`�-��`� � QUALIFIED Q� (da.0 u�k) /� l/ <-'�-'�� M. D. Mcdicel Esvmiver _ � �-I� i"" ,-1oen�-�t �;v� C�`'b. �h, '�J1. `�!<-^1 J�ir, 1?, lyd2 �,--r Sir; '"'rie Ss to f'or�or�ll„ r�que^t �(1) o�:e ye:r er.tension Sr thE- c•araclt? of ^,��t. vn the Oe��kce:� b'lrF ?Je �t, �t :rtir�: or _1^rll 5 1�32 unt_11 �nrll 9, 1�'33, , mr�rt. ,.,u. � C-� `' �- `'--.' ,, � t�� '� �� Examination THE MEDICAL EXAMINATION REPORT POLICE AI�'D FIRE DEPARTMENT (claa title) 1. Nome (prin[) ��'«� � �t. Signacure of spplican <i 5. Heighr �' 6. Weigl Wic6ou[ �600 O/� �%-�l-G �lfj �c i+ .L �: rpld- Ordiv�q cip6a 2. Date of 7. 8. PyesigLt: Snellin Tnr. LeEt 20/� Right 20/ .7C�, Correacd [o: Leh 20/- Right 20/- Co(or cesr 11 D( rv� c � 9. Hearing: R ear �� L. eaz �4 Discharge? �"�'�'� 'l-- . i Date � �N J HOth 20/=!,i- Both 20/- 10. Nos� ��- • 3. Ae� 11. Den�al survey: Mark teeth "O" if capped or pivoq "I" if missing; "X" if nrious; "F" if false. R 8 7 6 5 4 3 2 1 cc�� 1 2 3 4 5 6 7 /8 L Perf.r-* Caria sGghr L�r^��t � /}��C�Ct-" �`y�� Good repair �/ Caria markt� 8 7 6 5 4 3 2 1 � 1 2 3 5 6 7 8 Pyorr6� Need deaning 12. Tom�t. �i�+�'{� 13. 14. Thyroid �Gt- 15. 16. Lunga: Check for asc6ma, mbercutosi; bro/nchi[ic, chest %-ray fin 17. Heart: Cardio-vazcvlaz rysum l�� A'�-�� PuLse rav � 18. Cr+stro-intestiaal traci: Check for guuit Gall bladdez- 19. Geni�o-urinary: venereal d'uease n�� Wasserm �^ Varicocel� � HydrocelP Kidneys �"' ��'��%>-�7 Geae �Z 20. Hemi� 21. Vuicose Vei (oom (orm) �yrf �� 5/J-d 22. Han '�"- 23. Fee� �/� �(fWt or o�ber moditioo) 24. Bonn and join�� °��' 25. SpinL �! 26. Disabili[ies: (chronic cararrh, sinus, fistula, rectal dixues, cu[ancou� diseases, etc.) �'`�x�^ 27. Illow and 28. Operarione 29. Neurotic t 30. Could thi� man perfozm duty involving being on his fect for 12 houn continuouslyt 31. Could this man perfotm d involving long houn of dury involving sitting or ridin� 32. Rcmark< I IffREBY CERT'IFY T7iAT THIS IS A TRUE RECORD OF THE MEDICAL EXAMINATTON OF THE ABOVE EXAMINEE AND THAT I HAVE FOLJND HIM �QUALIFIED ❑ p�SICALLY FOR THE DU'I'IES OF �� QUALIFSED � �,,. �;,i�� !C<_----„�y`fit'�� i.t. D. Medid Fz�minc� �I MEDICAL HISTORY STATEMENT (To be taken io presence of examining physician.) Do you believe you ere sound end well now?�Are you subject to dizziness)�M–�� To xvere headac6e?� �c� / To paio in the brnsdflJl�To 9uc«ring of [he 6ean1 M�� To ahortn<ss of breath? ��+-{� To cwghe? %u�– To diarr6eal�To piles?9qA.�To nc�uma[ism?�q4� Have you had sore eyes or any defett of vuionl �–�� Ruoning from either ear?,ad.{� Is your sensc of hearing goodt� Have you had fits or coowlsions? ��– If so, how frequendy? `— Unconuioue spells?.,,!_1�� If so, how frequendy? � Asthma? �Ly�— �ppendici[is? �/�— if s0. were you opera[ed upon7 G000ahea?� �-� f— �6en? A sore of any kind upon yout penis? �� ' When? Any swdliog about or of your teaides?�6�t� A boil near t6e aous? (fisnila)? 11/� �- i Have you been rupmred? �� Do you drink ia�ozicating Gquors to excess? ./»� If no[, ro wha� estend '� � Do you use or 6ave you used opium, morpLine, cocaiaq or aoy other narcotics? ' When? What wu the cause of your father's deat6?.t,uC�o��'�-�� What was the <ause of your mot6ez's deach? �� p-� Has aoy membec of your family had [ubertulosi�, insaniry, epilepry, or iaflamma�ory rheumatism? Have you ever spit blood? Aaswer Have you ever been hun upon c6e head? Have you had a sprain?�A sti& joind -��-�� A bone or joint out of place? ^� �� A bone broken? �-�` Wha[ bones broken? � When? Caux? Are you subject to painful mrns or sore feed .!�17 Mencioo carefully injuries or surgical operacioos you may have had upoa any paR opf your body, especially burns, cvu, severe bruises, or war wound � �C K l�lQ/ O� S.�L 'uTf'mH'J �j W6at hospi[alization have you 6ad for U. S. waz servicd �— Give name and address of physiQan who las[ arteaded you, for w6at ailment, when7 ,V n ��-� I Lereby certify that the foregoing statements are trve to the best of my knowledge and belief. Signamre o�plicaat e�.i , � L /wcrt�. 'a"�// cs;8o tuu n��) � T'arch 2, 1982 Mr. Don I;utchera Mayor of the City of Oshkosh 215 Church Avenue Oshkosh, ,'Jisconsin F�onorable Mayor and Members of the Commcn �ouncil: I would like to apply for an er.tention of duty as an employee of the City of Qshkosh Fire Departrnent. My normal retirement date would be June 19, 1982. I would like the extention of duty to extend to June 19, i983. Thank you for your attention in this matter. Sincerely yours, � i ' � c .i ( - C—1 '� AJK : rk �.- — � '�. `. a �� MEDICAL HISTORY STATEMENT (To be caken in presence of examining physician.) Do you bclieve you-sre sound end well now? `-� �" � Are you subject to dizziness7 '�� • To xvere 6eadxhd '�" � 7o pain in the brcast? � To fluttcring of the heatt7 j� To ahonuess ot brca[67 To rnughf7 '� i To diarr6eal To piles? To rheumacism? Have you had sore eyes or any ddec[ of visionl z�^ ` i �l� � Running from cither ead i�� - Is your sense of heariag good? Have you had fics or conwlsions? �� If so, how frequendy? Asthma? '� � �ppendicitis? Unconuious spells? sq were you opera�ed upoo? When? A so:e of a�y kiod epoa pouz Any swelling about or of your cestides? If so, how frequently? A boil aear [6e auus? (fisnila)? Gonorr6ea? '< < � Have you beeo rvptured? � l' � Do you drink inmxicacing tiquors to ezcess? '° � � " �x.-�.�. �.�� If no[, to what ezcend �'-� ��• r�`-- '- —�-1 � Do you use or have you used opiuuy morphine, cocainq or any other narmtics? �� When? Whn[ wu the cause of your father's death? �� What wa5 [he cause of your mothei s deach? `�-�'� - - Has any member of your Family had mberculosie, insauity, epilepsy, or iuflammatory rheumatism? ' � - Have you ever spic blood? Aaswer Have you ever been 6un upon t6e Have you had a sprain? �' ` A sci& joint? '� � A bone or joint ou[ of place? � � A bone broken? /t ,. What bones broken? Whea? Cause? Are you subject ta painful coras or sore feed �° � Meation carefully injuries or surgical operations you may Save had u�n a�� psrt of your bedy� espxeally bc:�s, cuts, sevete bruises, or war woun.�,� �/��`��-' �, tii _ W6a[ hospi[alizatiou have you had for U. S. waz servi<e? °" � Give name aud address of p6ysiriau who last attended you, for whac ailmeuc, w6en7 �� +��"�""""'--�- �, _«.-.-u-� 4� <_._ , _,._ F— � i,` :Y� I hereby mnify that the foregoing s[atemen[s ue true to the best of my kuowledge aod belief. Signamte of Applicant i (siga f¢ll name) &�m;��oo THE MEDICAL EXAMINATION REPORT POLICE AhD FIRE DEPARTMENT �<�v ��o � / 1. Nemc (print) � 2. Date of birth �� j�� j. AgP � �(. Signanue of applicao� � 5. Hcighr "c-� .. 6. Weighr .'� � - 7. Ches� -', i, - . . ._ Wi�6ouo �bon Svippcd � Ordio.r� do�ha FsD•oded Mobi6p Natunl 8. Eyesighr. Snelliu Tesc: Lefc 20/ -=L RigLt 20/ 1� � Bo[h 20/— Corrected to: Le$ 20/ ? t � Righc 20/ �; Bo[h 20/= Color cesc.— �— 9� Hearing: R eaz ��' �� L. eaz Dischargd %� 10. Nos � 11. Deatal survey: Mark [cc�h "O" if capped or pivop "Iy", if missiag; "X" if carious; "F" if falx. R��,7 6 6[i� 3 2 1 1 2 3�' S�p � 8 L Perfe<* Carin sligh• Good repaiz � Caria mark^� �� 7 b�j 4 3 2 1 1 2 3 4 5 6 L7, �_ Pyorrhea Need deaning 12. Toasil ti "- 13. � 14. Thyroia � "�� - � +.�. 15. i 16. Lung�: Check for asthma,•�tubectivlosis, bronchitis, c6est X•ray fia 17. Heart: Cardio-vactulaz rystem - �" Pulse racP ��'-- nlood pressure: SY�olic IS. CYertiO-illt[Sti�BI tLd[t: CLCCI[ appendi: �_• . _� Check for guuic ulca 'ti ••`` � Gall bladder '�1 �''~ 19- Geni[o-urivary: venereal d'ueas '� '� , ,._._ � Dissroli� �' ' , � ma� � - - " General '' ` � 20. Herni '� �'" 21. Varicose Vei � '� (nom form) 22. Hand. . � : - , � ( 23. Fee �7 . . , .. �: ttla� ur ucner mna:aon) 24. Bonee and join • -L - � • C 25. Spine � . .. . . -. • 26. Disabili[ies: (chronic cararth, sinus, fisnila, rec[a( diseases, cuuaeous diseasrs, ecc-)— �i — h_e-.�- -''--a ,, � ..,C.'.-.. '1-.. < 27. ILLnas aud injurie " A� c z-�. _ � - 28. Opention ' `� 29. Neurotic tendrnci i� - � - 30. Cauld thi+ maa per(orm dury iovolving being on his fee[ for 12 6oun coa[iauously?_ 31. Could this maa petform duty involving long houn of dury iavolving si[�iog or tiding? 32. Remar'- :ti c l I IIEREBY CERTIFY 'IT�iAT THIS IS A TRUE RECORD OF THE MEDICAL EXAMINATION OP THE ABOVE EXAMINEE AND THAT I HAVE FOiJND HIM �QUALIFIED ❑ p�SICALLY FOR THE DUTIES OF � "�A "' QUALIFIED �j <dus �ide) i C ��c i.i. D. ' Mcdial Fslminer � a � � � � N Q N Fa .� C=. � > _� o z� a + a � �. 0 � d 0 .� � � ri O N v a � � � N i� ss w � � N s � 0 � a a w � v � � 0 � R� � W +� W G q N O s •� � m � +� �, a ¢ 0 ,� .. ¢ ro v o .,� H F+ Fi � F' U O .� � O � N � � � �\,� x 3� z� � w ri � �-i U � V � � 1�U