HomeMy WebLinkAbout30495 / 79-24Dec��rber 6, 1979 # zu
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WiiExE�S, -_.e City of 0.shkosh, on the 6th day of December, 1979, adoptecl a
Uniform Exters_on Policy for e�loye�s of the police and fire departr�nts; and
�+II�irEAS, t'�� following police and fire departrre.nt personnel have met the
requirem�nts of said Lh�iform Extension Poliey anc3 ha�re z�questecl a onryear
extension of their e�Ioyi[ent:
%�BEKP BOI�I - 6th i�uest - Police Depart�nent
Date of Birth: Nov���rber 15, 1919
Original Retire.icent Date Was: I�cenber 31, 1974
F�lolmp.nt Extension Throuc�: Deceirber 31, 1980
RICiiARD PHIZ;LIPS - 6th i�uest - Police Departrrent
Ik3te of Birth: No�mber 2, 1919
Original Rstire��nt DatQ Was: Ikce.nt�er 31, 1974
�loytrent F.xtension Through: De�er 31, 1980
DCf�IALD NII�ND - lst ii�Zuest - Police Departr[�nt
Date of Birth: March 24, 1925
Origir�31 REtireirnnt Datz: Masch 31, 1980
�loyirent Extension �rough: March 31, 1981
�'�.LD SQII,INSKE - 4th I3�quest - F].re t��partr�nt
Date of Birth: February 25, 1922
Original Retire�nt Date Was: March 31, 1977
�loynent Extension Throuc}h: March 31, 1981
NQ�7, ''iT-�"�?=,', B� IT RFSOLVID by the Ccs�nnn
that the fo_�oing extensions aze hernby granted
—24—
SliBbfITTED BY
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November 2, 1979
Oshkosh Common Council
��i.l,'.:rll r.,:.�n,., �� ni,�,. I .
Please accept this letter and doctors report of my
physical examination as a request for an extension
to March 31, 1981.
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_ , �' C--�.'�'C�<' �// � lt«/'
Detective Donald Mand
HANVEY MONDAY. M. D.
OSHKOlH CLIMIC BUILOING. INC.
�00 C[AP6 AVEXUE
09HKO6H. WI6. E4901
Nov. 2,1979
To Whom It May Concern;
I have examined Donald l�;and on this
date and find him to be in good physi-
cal and mental health.
Sincerely,
�/��/�i�/L�; j.�/�c; C�
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L
H.Ivionday, M.D.
HIv1�bb
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OSHKOSH. WISCONSIN 54901
CITT
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OfMIOfX
DEPARTMENT OF POLICE
September 5,1979
To The Oshkosh Common Council:
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pOLI
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Please accept this letter and a report of my physical examination as
a request £or an extension through 1980.
Capt. Robert 0. Boheen
Oshkosh Police Department
TELEPXONE 231—BBOO
�
BNDD No. AB35�5f25
DEAN B. BECKER. JR., M. D.
400 CEAPE AVENUE OSHKOSH, WISCONSIN
N�M[
AGE
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V �%
MEDICAL HISTORY STATEMENT
(To be taken in presence of examining physician.)
�
�
Do you 6elieve you are sound and well now71�_ Me you subject to dizzinessl 'n � To xvere headec6el�_
To pain in the breast7 u—Lu _ To 9utteriag of the 6eart7�� To thortoess of breath7� To coug6s?J�
� ��l r, s
7'o diarrhea? � To piles?� To rheumatism7� Have you had sore eyes or any defect of vision7 4sSe5
Running from either earl 1J� Is your sease of heering good?.�� Have you had 6n or mnvulsions? I`��
IE so, how ftequendy? n��7 Unconscious spells? � I n If so, 6ow frequeudy? n I�
Asthma? � ♦ppendicitis?� 1f so, were you operated uponl�Gonotr6ea7!`-'1�
�
When? —• A sore of any kiud upon your penis7 Whrn7
Any swelling about or of your testides? nOh'Q A boil aear t6e enus? (fismla)? "'�
Have you been rupmred? ,v � Do you drink inroxicating liquots to ezcess? rv �
If not, to what entent? Do you use ot 6ave you used opium, morp6ioe, cocaine, or any
Mher narcotits? 1�f�V1'�
What was the cause of yout motheis death?
iasaoity, epilepry, or inflammarory rheumatism?
Have you ever apit blood? ��
Aaswet fullv _. ._
�
What wes the cause of your fatheis death? ��
Hu any member of your famiiy had mberculosis,
Have you ever been Lur[ upoa the head? ��
O �bfeQlm 0.�e {�
Hsve you had a spraiot�A sti8 joinN�A boae or joint out ot place? � D bone broken?
W6at bones brokea? y�ftQ.rw-� Wy�o7�/,a e. �� ��� Are you subject to
�—
paiafiil totns or sore feeN �� Meation carefull in'uries or sur ical o
Y / B peratioas you may
have hed upon any part of your body, especially burns, cuu, sevete bruises, or war wound "' a
What hospitalization 6ave you 6ad fot U. $. war aerviml C-�C-w"ti- C.� SiO�
l
Give name and addres� of physician who last attended you, for what ailmeat, when?
I hereby certify that the foregoing sutemenu are [rue to che best of my knowledge and belief.
$ignature of Applicanc
/� ` �
(sign full aame)
THE MEDICAL EXAMINATION REPORT �
POLICE AND FIRE DEPARTMENT
Bnminstion for �^". ��'/ � Oyjj�r�`l�rr�.�� Dace ���/%%'
(clua cide) 5'
1. Name (ptiat) l 7�' (-0.
4. Signanue of applicanL
5. Heig6t�_ 6.
WiaAOUe �hoea
8. HyesighL• Snellin Test:
Corrected to:
.�
2. Date of bir�h .� ��5 J� ci� 3. AgPS%
Weig6� "T."?-fi J i i:_ ri �`� �` 7. Cliesr �S
Saippcd Ordinery cluhn E:povded
Left.20/ � �� Right 20/'� ��
Le@ 20/_ ��� Right 20/ /,$
Hoth 20/ y-•
Both 20/' �
Color cesc `�� � �vl? i
9• Hearing: R. eaz ��� L. eaz �/L � Discharge7 ��s"� 10. No�a Q/L �
11. Dental survey: Mark teeth "O" if capped or pivot "7" if missing; "X" if carious; "F" if false.
R 8 7 6 5 4 3 2 1 1- 2 3 4 5 6 7 S L Perfe�* Cariee slig6r
Good repa'u � Caries markea
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Pyorrhea Necd cleaniag
12. Tonsil. .��{! 13. Throar r'��
14. TLyroid C7L 15. Speecti C/G...
16. Lungs: Check for atthma, tuberculosis, //bronchitis, chest X•ray findiao /����t-' �
17. Heart: Cardio-vascvlar rystem N•S� 7�u^fix-d� AJC d 1» .
Pulx ratP �2� Blood
� LarG�
18. Crastro-intestinal uact: Check aPPandis
C6eck for gascric ulcer
Gall bladdet ' �`�'
$ys[olir ��C' DiastOli� / �
19. Genito-urinary: venereal diseasP Wasserm '
Vazicocel L Hydrocel� j���¢
Kidneyc �C �Q �tt�
Genernl ��L
20. Herais �1�`�+ 21. Varicose Veiaa ��'
(nom fo�m)
22. Hand. ��� 23. FePt 6��i
(Flet OI OfbCl COOAl40OJ
24. Boaes and join�. �� ' 25. Spine �L•
26. D'uabili[ies: (chronic catarr6, sinus, fistula, [ectal diseazes, cvtaneous diseases, etc.) �xsx"�
2�. tuo�9.oa
28. Operetion 6` ""'°`�`"
29. Neuro[ic tendencie�
30. Could this man perfotm duty involving beiag on his feet for 12 houn continuously?_
31. Coald this man perform dury involviag loag hours of duty involviag sitting or riding?
j2, Remar4a
s/
I HEREBY CERTIFY THAT THIS IS A TRU& RECORD OF THE MEDICAL EXAMINATION OP THB ABOVE EXAMINEE
AND TfiAT I HAVE FOiJND AIM �QUALIPIED ❑ pmSICALLY FOR THE DUTIES OF �,i,f � r r'
QUALIPIED �' (daaa dc4)
�/!� , t��-r�'_'
M. D.
Medical E:amine�
�
a
September 1%� 1979
To Members Of The Oshkosh Common Council
I respectfully request a one year extension as an active
member of the Oshkosh�Police Department. I vaould appreciate
if I could get a one year extension from January 1. 1980
until December 31� 1980. Attached is a certificate from a
licened physician.
Sincerely Yours,
C /ij��� �� {j�� //��( ,/ °'/�r
,���Y"u•�'•� U✓ �// �
� � J�
MEDICAL HISTORY STATEMENT
(To be taken in presence of examioing p6ysician.)
�
Do you believe you ue sound and well now7��Are you subject to dizziness? �� To aevere headac6et �-'
To pain in the breast? np;, To fluttering of the heartt�s�_To shonaess of breat67 �+'<� To cought? /�'t�
To di¢rrhea7 � To piles?� To rheumatism? � Have you had sore eyes or any defM of vision? N`��`��
gL e��..
Running from either eart� Is your srnse of hearing good?1�n- Have you had fiu or conwlsions? N+e
If so, how frequently? Uaconuious spells? /j,,d if so, how frequendy7
Asihma? � ♦ppendititis? � �f so, were you operated upont Gonortheat ��+
sore of any kind upon your peais? "�"'�
Any swelling about or of yout testides?�/,y A boil neaz t6e aaus? (fistula)?
Have you been tupmred? �.. Do you driuk intozicatiug liquors ro eztess?
�>
��
I( na, to wha[ enent? ��etgi .� Do you use or 6ave you used opium, morphine, cocaiae, or any
othet nazcoti<s? > > ,_o�, �
�g When. What was the cause of your fathec's death. +z'
What was the cause of yout mothei s death? °�
insanity, epilepsy, ot inflammatory
Hu any member of your family had tuberculosis,
Have you ever spit blood? �^U Have you ever been hun upon the 6ead? ��_
Answer fuLLy
r—p-�.,,�-a"^ �t
Have you had a sptaio?� A stiff joint? �� A bone or joint out of place? � A bone broken?
W6a[ bones broken? W6ea? Causel Are you subject m
painfiil corns or sote fett? � �fention catefully injuries or surgical opera[ions you may
have had upon any part of your body, especially burns, cuts, severe bruises, or war wound< !�
What hospitalizatioa have you had for U. S. war
Give name and address ot physiaan who last attended you, for w6at ailmeuy
I heteby certify t6at the foregoing s[atemena sre we to [6e best of my knowledge and belief.
Signature of Applicant
�V����� �
d6�^
(siga full n e)
Hzamivation
1. Name (ptint) .�• �
4. Siguanue of applicancl
5. Heighr � � << � 6.
Wiehoue ahoea
& Hyesig6t: Saellin TesC
Correc[ed to:
Color
THE MEDICAL EXAMINATION REPORT
POLICE AND FIRE DEPARTMENT
-a i /
(claa vide)
�. .i (r'A c�� io c
�
Dau 4•LZ'�9
Dau of b�Kh l(' �"- ! 9 3. Agp S 9
Weighr �i �Y � 7. Cliesr i{ 3 . . �C�
Sttipped � Ocdinary dothn Ezpaoded Mobiliq Namral
Leh 20/ �,,� Righc 20/ Bo[6 20/-
Lefc 20%�i!_ Rig6t 20/� Bot6 20/ ���
9. Heariug: R ear Q�.6 L. eaz �� Dischacge7 �j 10. NosP ��-
11. Dental sutvey: Mark teeth "O" if capped or pivoq "I" if missiug; "X" if carious; "F" if false.
R 8 7 6 5 4 3 2 1 I 2 3 4 5 6 7 8 L Perfea* Caties sliglu
Good repair '/ Cuies marked
8 7 6 5 4 3 2 1 1 2 3 4 S 6 7 8 PyorrheA Need desnin
e
12. Tonsil. � -F � ., �� < < 13. Tluoa• U �
14. Thyroid Fi9 �..�--�0 I5. Speefti �'�'
16. Lunga: (3eck for asthma, rubetculosis, bronchitis, chest X-tay findino+ /�S
17. Heatt: Catdio-vasculat ryste�n !i�
PuLu tatP �7 +� Blood pressure: Systoli� l`1 0 Diavtoli� 2 d
18. Gas[ro-ia[es�inal uatt: Check
Check for gascric ulcer_
Gall bladder
19. Genito-urinary: venereal diseas v
Varicocele C�
20.
Liver 0 k-
21. Varicose
(aom form) "
22. Hand< �k 23. Fee* ��-
(flat or other mndiuov)
24. Bonn and joiat 6� 25. Spine OQ
26. Disabilities: (chronic �atacrh, sinus, fisnila, recral diseases, cutaaeous diseases, etc.) ,-U tr^�-a .
27. Illaess and
28. Oceratioas
29. Neurotic o
30. Cauld this man perfocm dury iavolving being on his feet for 12 hours continuous(y? �9-
31. Could tLi� maa perform duty iovolving long 6ours of duty involving sittiag or riding? �y %�
32. Remath /li_„__ -
[ HEREBY CERTIPY THAT THIS IS A TRUB RECORD OF THE MEDICAL HXAMINATION OP THE ABOVE EXAMINEE
AND THAT I HAVE FOi7ND HIM �QUALIFIED ❑ pmSICALLY FOR THH DUTIES OF �� "�' �+�-� -�
QUALIFIED g ���� ������
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