HomeMy WebLinkAbout30780 / 80-13June 19, 1980 # 13 RESOLIII'ICCv
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�.PS, the City of Oshk�h, on the 6th day o£ Decenber, 1979, adopted a
Uniform Extersion Policy for eir�loyees of the police and fire depar�ments; and
Wf�'�S, t'�e following poLice depart-�nt and fire depart�rent �rsonnel have
iret the rx�,; rn�nts of said Uniform ExtEnsion Policy and have reqnested a one-
year e�ension of their e�loynent:
RIC�iARD ZARTER - 4th Re�uest - Police Departrcent
Date of Bisth: July 30, 1922
Original l�tireirant DatP Was: Septe�r 30, 1977
E�loycm_�t E.xtension Thmu�: Sep*..eirber 30, 1981
RAYNDND STANBORSKI - 3rd Fequest - Police Depar�c�nt
Date of Birth: July 10, 1923
Original Retirem�nt DatE Was: Septelnber 30, 1978
II�1oy�nt Ext�nsion Through: September 30, 1981
Q.FII2IIVC� SA[�R - lst Request - Fire Denar+srp_nt
Date ��i Birth: Ju.iy 18, i925
Original Retiter�nt DatE Is: Sept�rber 30, 1980
F�mloynrent Extension Through: Sepeenber 30, 1981
NQ4, Tf�:E2EEURE, BE IT AESOLVID by the Coccmon Council o£ the City of Oshkosh
that the foregoing extensions arz hereby granted.
S'JBMITTBD BY
�°PROVF,D
- 13 -
Mr. William Frueh
Members of the City Council
City Hall
Oshkosh, Sdi 54901
Dear Pir. Frueh and riembers of the City Council,
Mr. Clarence Bauer
122 W. 12th Ave
Oshkosh, Wi 54901
�
I hereby request an extension of employment with the Oshkosh Fire Department
beyond my normal retirement date of July 18, 1980 to be extended to Ju1y
Z8, I9S1.
A statement from Doctor Kivlin, my family physician, is enclosed for your
information.
Respectfully,
_ ���:�-����--�-, �y-��
Clarence Bauer
Captain, Oshkosh Fire Department
• T. M. KIVLIN, M. D.
LL S. Reg. No. 7242
�' PHONE 23i-6800 OSHKOSH CLINIC BLDG. — 400 CEAPE AVE. OSHKOSH, W15.
A9e
R For Date2 3 ��
1 �U
Address ��
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This pres<npfion can be Fllled at
MUELIER�POTTER DRUG STO0.E5 '
t01h 8 Oregon Sts. — 400 Ceape Ave. __, ___ .— _ —- M.D.
210 N. h1am 5�. — 317 N. Sawyer St. BNDD 2_�. . AK 353577 ..�
�sry�� i C 2 � 3 I] a i] PRN • NR
i
MEDIC�1 HISTORY STATE,�r1EA7T
('To be taken in preseace of examiaing physician.)
�
'.
Do you believe yoa aze sound and well aow? ' S Ate you subject [o dizziaess? �� `� To ervere headac6d�
� ii/ �" � , � y �(/ �
To pain in [he brenat. To flntcering of the heart7 To sho[cnem of breath.�To coagha?
�{/ /a' �
To diarrhea7 �'� To pilo? 6-� To zheumatiwm7 Have yoa 6ad sore eyes or aoy defcxi of visioa.� U G
Ruming fmm either ear?—,C_—Is your smse of heering good?�Have you had 5[a or coawlsioas2�
'�'--
]f so, how frequenciy? Un<onxioua spells? � If so, how frequmdy?
As�hma? �`� U Appeadicitis2 � J TE sp were Yw operated upoe? Govorrhea� �°'�-�
A soce of any kiad upon yoar
v�
Any swdling abou[ or of yout cescitles? v A boil aeac che aaus? (EisculaJ? "' eJ
Have you beea mpcuced? �� ����� o you drink intoxicaciag Gquon to eacnsi ° v��
I£ not, ca what exceac? Do yau use oz have you nsed opinm, morp6ine, cocain/S oc any
other nutotics?�W6en? Whaz was the causc of your fathers deat6? `�=C���`�'-��L'� f
What was t6e cawe of your mothefs derch? �jLT ��T� - Hat any member of your fam�ly hsd tnDerrnlosi;
insaaicy, epilePsS or inHammacory rheumatism? �'y� �
Have you ever spic blood? ��� Have you ever been hurc upon the head? ��
Answer fully
Ci
Have you had a sprain? J A stiff joind �U A boae or joint ou[ of place? A bone bm&en? � G
What boan broken? Wheu? Cawe? . dre yon subject to
T
paiaful coms or soro feed �� I Meo[iOn catefiiliq injuries or surgical operacious you may
have had upon any part of yonr body, especially barns, cun, sevue bruises� or war wounds��-/� ��-� r'C_ GjJ�'N�/r �s%
�
What hospiralizatioa have you nad for U. S. wsr servicd ��`? �-
Give name and addrns of phyeidan who laat atxe,�aded yo¢, for wbat aJmeay when? ��L.I /`�' // ��
��1 r-�_l �%i,, �'c2 s!�
I hereby certify that the foregoing swtemmcs aze srue co the best of my knowledge and belief.
Sigaamm o Applicaa[
( . � LC�'"<z� -i -:_ G�� / /'��L:'L'-,� '
(sign fiill name) �
Fsamiaatiou
1. Name (princ) � hrt'ri`
4. Signanue of appticanL
TNE M�DlCAL EXAAAOP�i�i1��1 RE�ORT
POLICE AND FIRE DEPART�IENI'
'-'� 2. Dam o£ bush � ��� �' S
�
��
�'oZ3'2S'�
pgr .5 `�
5. Heighr 5� 1���1.� 6. WeighL 1�� 3 t�{ S 7. Chesr .
Without shoea 5[tippeQ � Ocdinan do�ha Ezpauded Mobilip Nanud
8. Eyaighr. Snellin Test: I.efc 20/ 30 9�'f i•"" Righs 20/ 3 c Hoth 20/'sc
Coreec[ed to: Lefc 20/_ Right 20/-.. - Both 20/_
Color cae d.L
9. I-Iearing: R ear O r< y� a�c Duchacgd �u 10. Nos� O/L
11. Deatal survey: Mark ceeth "O" if apped or pivor, "I" if missiag; 'B" iE carious; "F" iE false.
R 8 7 G 5 4 3 2 I 1 2 3 4 5 6 7 8 L Perfw+ Caria slighr
Good repair Carin mukeA
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Pyor ea Need ����ng
12. Toni 13. Th=o�• -
14. Thyro'd � 15. Sp�ti
16. Luvg�: Check for u[hma, mbeic¢los:s, bronchitis, chesc X-rav fi_dings
17. Heacr Cardio-vasculaz r�sc
Pnlu rat. �/^-e� nlood uressuce:_S!�sWti� l\0 Diasmli� �(i
18. Cmstro•into[inal [nct: Check �ppendix «� � ��f�
Check for gss[ric ulcer
GaLL bladdez
19. Geai[o•uriaary: venereal diseas
Vazicocel
20. Hemi� ��• -^-�
(noa form)
22. Han� ��
21. Vazicose
23.
fflac oc oanm eod:uoo)
24. Boue� and ioin��= 25. $p�• d� �'-
26. D'uabilitiu: (chconit mrarrh, sinus, Eistula, cectal diseaus, cutaneous diseases, ecc.)
27. Illness and injuri v
2& Operation � �'�""�'K'/4"
29. Neurocic tendenci
30. Could this maa perform dury involving being ou his fee[ for 12 houn con[inuously?
31. Could chis man perform dury involving long houn of dury invalving �itting or riding? ��
32. Remaz
I HEREBY CERTIFY THAT THIS IS A TRUE RECORD OF THE MEDICAL EXAMINATION OF THfi ABOVE EXAMSNEE
AND THAT I HAVE FOWi D HI.�I �QuALIFIED ❑ p�SICALLY FOR TAE DUTIES OF ��"ZU''°�^
QUALIFIED [7� (das ride)
.i��/// (%� 'K. D.
M ical Ezaminer
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OEPARTMENT OF POLICE
Oshkosh, Wiscor.sin
January 15, 1980
Oshkosh Co�non Council
215 Church Ave.
Oshkosh, Wi. 54901
Council Members:
S. J. GRAIEWSKI, M. D.
PHYSICIAN and SUxG:ON �
Houn kr-�:.aytment
Addrov.
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�,k'�� ��� ��-
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COE DRUG CO.
310 N.!/c1n 1211 Oreppn 51.
Oshka�h, Wia.
�a�
, WISCONSIN
./.�� �
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......................................ru. v.
U. S Rq. Na 10.57
I hereby respectfully request your consideration for extended employ-
ment as an officer of the Oshkosh Police Department. Such extension to
become ef£ective July 10, 1980 for a period of one year pursuant to
Oshkosh City Ordinance.
Enclosed please find results of a physical examination also required
by Oshkosh City Ordinance.
Respectfully yours,
� /j
f, � `��
N
Raymond D. Stamborski
�e���.�/�.
-" � �'''` ` - • ..' , ,-`:';^;��; ;+� ��':�%f ° p, O. BOX 1130 • OSHKOSH, WISCONSIN 54901
Oshkosh Common Council
City Ha11 215 Church Ave.
Oshkosh, Wisconsin. 54901
Dear Sirs:
I am submitting this raquest to you for
an extension of service to the City of
Osbkosh, ia coiapliance with the �-ule
adopted by the Citp of Oshkosh.
My birthday is July 30, 1922. I am also
encolosino the doctor's report of my
physical condition.
Respectfully submi.tted
V. G. Guerdher, Mo, L D. Graber, M.o. fl. G. Isom, M.n. R. C. Hughes. xo. R. N. Woodm(t, M.q
INT`qryp� MEOICINE SURGERY SORGEaY INTERNAL M'cDICINE IMERNAL NEDIGINE
. No. qG 35a?3do aaq. rvo. qG 35423T9 Reg. no. qi y5np�6 qag. No. AN d5dn92 Reg. No, qW 650d555
/ 650 DOCTORS COURT PMONE y1f-a� 37 OSHKOSH W�SCONSIN
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