HomeMy WebLinkAbout29998 / 79-11March 15, 1979
• ••�. .M I� - 7 CII �•
INITIA'Ir,"'Q BY: PIIZSONNf� D�AR�,'NT
# 11
RESOIJJTION
WI-II��2EAS, the City of Oshkosh, on the 21st day of March, 1974, ad.opted a
Unifarm F�ctansiun �blicy for cmploy�s of the police and fire d��partment,; and
Wf�R,SAS, the follaaing fire department pexsonnel has �t thP requiresr�_nts
of said Uni.form �7ctension Fblicy and has rc�quest:�1 a one-year extension oi his
employrrent:
ROBERT I�_ EL'�.1t - lst Request - Fire L�partrnp�t
t Date of Birth: May 23, 1924
(h�iginal Retirerr�nt Ltiitn_: June 30, 1979
F]nploymPSit F�ctension tnrough: June 30, 1980
r;aa, Tf�I2E��pRE, BE IT RESOLULJ by the Cc7nmon �buncil of the City of Oshkosh
tl�at the foregoi*�y extension is h-:reby granted.
S?iB�iTTED $Y
- 11 -
..�
i
;
�� €�
_. January 8, Z979
�shkosh City Council .
Attn: Mr..Kenneth Schiefelbein, President � -
-Dear Council 2�er.�ers:
• My narae is Robert Elmer. I have been a member of the
Oshkosh Fire Department for 28 years. T am now serving
as a Lieutenant.
' I
-T will be 55 years of age on Z4ay 23, 1979, I wzsh '
to continue �aorking for the Fire Departnent, I am re- .
questing a one (Z).year extension to my SGth birthday.
My doctox�s nedical exan report is atiacied.
Thank you.
�'c ��---'!')'l�i.f�, .
, ,
Fsaminatioa
1. Nama (prinx)
4. Sigoature oF applicanL,
S. He;g1,r G � � �` �
Withooe �hpy
& 1;qesi8b�: Snellin Te�r.
� Co+mted to-
Tii,� IV1��9C,�� k1{AJYlli��k7iLl�3 ��;��R�'
, POLICE ANA FIRE DEPqRT1�iENT'
- Y T�/ v .;/
Trt r�. ..� � 2 .
!/_ . . -� �.,i � . 2. Date of
We;gLL, -s : 23 5 7. C6ac_
5[r:Dxd •O+dio+? clo[La
Left 20/�?� . �Right 20/ - 7 O
� zo
,,
O ��
ii�K 3 � S�
/ . Both 20/?'-8 �. '
x;8sc zo� _
_ co3or ces -�+��..` o BocL so� ' - .
9. Hearing: R eat 7"''^-� 1-a.. � � . � �.?v����� . ,
L ear----,�+i.,Dixhargd � . � 10. Nose__ � .
1L Dental surney: blatk teerh "�•• � ca � � �
. . � PP� odpivor, °I" j( mpys;nS: '7C" if rarioug F" if falsa ' . - .. . . . .
-�- 7 6 5 4 3 2 1 1 2 3 4 5 6 7 L ° �
. . . . � . . . . Pa� —___________Cario siighr "� . . _ .
?- _ GE+od tenr's :� .
�tr. 7 6 5 4 3 2 1 1 2 3 4' S 6 7� � Caria mark.a
� �12. Tonsil . � Q�%'-e.;c. � . PYozr� -------.--_.`�4eeJ cleaning - � •-'
14. TLyroid !?,�tz z..--.,-, w-k-� � . 13. Throa��''�� X=-F� ��-� �t= - .
------, 75_ .Speec �--�?.._ . .. . ^-�--�„ .
1G Luugs: C6eck fot asthm". p+�.�cu)as' b�actuti; c6rst X-rap Lnding - -C�/--� . � . �..,
17. Heart: Cetdio.rasrutaz syscem. _ . ���.�-'rz-c�.� de-� - . . .
� � Palx rate—_. �S�J � y�,.,_ --
I8. Gascro-intcstmal. uact: C6eck
Cheek for gauric ulcer_
� - Ga11 bladder__ . .
pressure: Systolic� � .� c .. �'O ' . ..
;,��� --'-----------Diauolir � ;.
� - . .
� � ;19 Genito-urioary; venerea] disease--_ � ��� --�!
. . � Vuicocd� �-`.-� � . .
Wasserm .. '�..��-�/ . - - .. - .
Hydrocel ?-Z c ,, �
� �'. 20. - I3erai ��-+-a..._.--- - . . .
. . � (note torm) . i(. V3IiCO5e V � �✓��-�-L_.� . � . . -
' �2. }IIIL(ii_. �` ?�'L �J.._ (/-� � � . _ ,
23. Feer �-�- �-c.-�.-�.�, ..�� �
.. � 2�i. Bone� and joinr. �t/i�/�-C ',_ C�� � (��r o+ o�6a rn�d,non) �
25. Spin i�"i`�d" � . . � . -
� � 26 pisabilities; (cLron(r catatrb, sinus, fism{a, tectal dise. � � � �
. . . '15e3� eutaDtons disease�, e[C} . .
� j/ai�.�,_�+�_ . . .
. 27. Illuesy and inju.ri ----� � . . . - ..
28. Ocerar:....o _'�' �.�_ � n/. . .... . . _. � � . . .. . � .
. � 29. Neuroue tendenues � �) ,r-��-� . � � � - - . �
30. Could thia man perform. duty involving beieg on his feet for 12 houn �coadnuously? CLf--=--- � ��
. 31. Could thi� man perfarm dnty invol viag long Loun of dury invo3ving si[ciog or riding? � // t�---
� � 32. Rematk. � �
i
�I HERF.BY CER17Fy 17-IAT TFiIS IS A TRUE RE �RD JJg THg �gDI�� E�MINATION OP TfTE qgpyg ��hsINEF.
AND THAT T IiAVE FODND HIM �QUALTPI � �,�
. QUALIFIED � SICALLy FOR THE DLTTIES OF
. - - ' � � � � ' . (cUu tide) .
�
I.CL/ '��� ` . : .. . /l �� �i2 <�.-C� ✓� �\ .
� -t -��1
lv 6 '"� � � ' /'r.ti �' f - C� �'C)J u��h� �m��, t. n.
%'���� ��.. l �
� �-�.<�G,.�"_�v 7 _�Y� �
�%% ../-7 S1 ' .
t' � J
�q� R
�
�y
t�t��l�CAi t39S�'�RY STA'����i��i3 �'�,
(To be taken in pttseece of examining physician.)
3
�
�
Do you believe you a:e sound and we11 aow? � ='� Are you mbject co d�z>iaess? Lt"`` To severe LeadacLd l�
� To pain ia tLe brcrs[T l ��• �_ To fluttering of [be hraat? � L� To shorcness of brea�6> °-9 � To coug6sT %�"' :� �
� 1'o diazrbea2 ���-? - To pile�? l�'''� _ To theumarism? 1�`'`� Have you had sore eya ar�anp defec� of vision? �"`� .
� Running from ei[her eu? �'A � Is your sense of henring good3._...�ta� Have.you Lad fib or convulsiom? .��L"`� � .�
If so, how frequmdy? Uaconsciw� speU�? ��� If sq Low frequenJy? , - � ��
� Asthma? ,�. �ppend�ritis.� Gw if so, were you oper,�trd upon? �� , GonorrLea? i'�•� �. .. . �.
' Whm?- - _ A wx of eny kied upoo your penis� r��� ��� � When? .. . � .. . � , .
� � �Any swdling ab�wt �or of youz testiclea? � �' A boil near the anus? (E'utula)?- ' %"° � � -
. -$ave you beev rvphered? . � Do you drink. iatoxicating liqnora to exew? � �
- If noS �o mhat eztent? Do yw use ot have you used opium, moiphinq cocaine, or an� �
othee na�catics? `A`"� When? � What was the eeuse of your ta[htt'a deat6? �'J�'yn""`�' �`�"`�`�w
� ,.-.
.. What was the cavsr of youe motheia death? �'`"Z)������' I�las any membet of youc famiAy had iuberculaa'v` �.
. " � Lj`�D �• . , "
insanity, epilepsy, or inAammar.ory [hewaatism? , � " � - � .
Have you ever spit b1aa1T� ���'� -� Have you evez� been hurt upon [he hr.ed? .�-�-'�
- � Auswer fully .. -
�-� Have you had e sprain? � �"�. A ssi& joiac? z'"� � A Done or joint out of. place? ��" A bvne bmken? �.�;L� � .
� � � Whax bonr� broken? When?
painful corns or sore feed
Lave bad upoa any part of your body, especiaily bucas, cuts, severe brulscs, or war
you snbject to
cacefu(fy inj�.rin or surgical operationi you ma�
. �io
�W6at hospi[afization have you had for U. S. war servite? ��n"-�u�'��/L`-•�, ��'''� �'� �� �~
. L(i"�C/1:-,<���; �— C_.-C--�-i�-�_.-.._. . ' , . . _ . . . . . . _ ....
. �
Give name and addre�s of pLysiciaa wko last attended y�ou, for wh3c aitmrnr� whrn? ���� ��i��_r��'�" - '
I_ Lereby cerufy that the foregoing:sta[emrnts aze tcue to the best of my knosrledge nnd belirE � � �� � �_� ..-- �, _
. Signature oI Applicavt � � . ` . .'" . � ._ ...
� %��� � ���i�c� .
� � � � _ (s'�gn Iall oame) . . .. . . � .
�
�
�
�:
a_/
L..
��
G�.-
�� k
�
�
�
�
�
�,
�
�
�
�
v
�
N
� •
k -N
a� a
oq
N
� s�'.
o�
•� �,
�
� i
�
o a�
m .N
� �
a�
�
..,
�
v
�
d
�
{� b
o a�
¢ s�.
o m
E o
�
0
,i
�
0
�
,.,, . _ ,; -
1 �..... _. ..�..�.�..�_.�.� .....r._� �
� �.
0
�
ti
�
r-I
�
f'�
�
�
z,
�
�
x
�
N
�
U
�
�
�
U