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TEMPORARY HELP AGREEMENT
This agreement made this 11TH _day of ,JUNL-, 1984, by and
between Jefferson County Commissioners, hereinafter called "Employer"
and RAYMOND BRODERSON , an individual hereinafter called employee.
Witnesseth: That for and in consideration of payments and agreements
hereinafter mentioned:
1. Commencing _-J NE12 , 19 84, the employee shall begin work
for the County in the ROAD department under the Supervision of y
WILLIAM G. AREY
2. The County agrees to pay the employee $8.46 per _hour
for the term of this agreement on the normal pay days, to make the app-
ropriate payroll deductions, and to pay the employer's portion of the
appropriate benefits.
3. The term of this agreement shall be for 90 days from
the date the employee commences work under this agreement.
4. It is understood that during the term of this agreement, the
employee will not be required to join the Union nor pay benefits as
contained herein.
5. Should the employee be hired at the end of this agreement, the
employee agrees to join the union at that time and the County agrees to
pick up all union contract benefits back to the commencement of this
agreement.
In Witness Whereof, the parties hereto have executed, or caused to be
executed by their duly authorized officials, this agreement in trip-
licate each of which shall be deemed a n original on the date first above
written.
EMPLOYEE ON OUNTY C MMISSIOENRS
JEF
Signature: ? •ttoa M
Dy: _
Name: RAYMOND BRODERSON
-? Namr_:--A.M._-0-1MEARA._-r._-
(Please Type) (Please Type)
Title: CHAIRM OF THE 80?1R?
M
AN
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PRE-EMPLOYMENT APPLICATION
?Mi° CAQa/LE/L __
(Position Applied for)
Jefferson County is an Equal Opportunity Employer and encourages applications from
all persons regardless of race, creed, color, sex, national origin, marital status, age
or physical, sensory or mental disability unless based upon a bona fide occupational
qualification. (State Law: Chapter 49.60 RCW and WAC 162)
IMPORTANT: Complete all section. Please use ink. Print name only.
1. Name:__ k3O_DLERS0^/ K4,VA01V0 L C-?
(last) (first) (middle) k
z. Address: f? I"- 0•O_ 0i[. CENE , wA/ 5u37(1-
(street) ?? (city)p (state) (zip)
3. Social Security No: S? •-7610 4. Date of Birth: / (age will not
be/usdd t discriminate)
5. Home/Message phone: 6. Business phone: 7bS-.3S?O +
7. Education - Total years of pre-university schooling:
Circle year completed: 1 2 3 4 5 6 7 8 9 10 11 (
8. Have your passed the General Education Development (GED) Test in lieu of High School
Gradu:ction? Yes No Year -
9. Col.leees attended Years From 1'o Deeree ..
10. REFERENCES: (please do not list relatives)
NAME ADDRESS OFFICE/HOME PHONE
y 00, /C 1"tle,
G??_ 7 ?5-331,?3
I. T/?EO /Z Pa, Box 8
2. L
3.
,-•-
- - -- ----
5.
Form 100-a
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. 11. 6MPLOYpB-NT HIS
TORY
(Begning with latest employment)
2
A. Company Name???.?,[[?CEd%?C' SC{/OOL_ DiS?'RST ya Phone: 7G-J_ .3, .3
Add a
ress:
City
State Zip --
/
Job Title: __T-[?/E,'? Lmmediated Supervisor:)
,. Dates Employed: /, S Salary:_ /Y floc)
d?
j /.?OCR
From
To Beginning Fial
(Monthly)
d•? Specific Duties: '%?i/c 6fiy G- d ?na [`//.rlq - AT ,9GL G?yELS
B. Company Name:_ _Phone:
_--
Address:---.-
City - State Zip
? t Job Title:_ C /6 - Immediate Supervisor:
_
Dates Employed:j&j
From To Beginning Final (Monthly).
t Specific
•l ,
C. Company Nama• - ,aOF//Y? _ _ __ __ Phone.
-
Address: -- 5Z,- 17-7-1-S
??7
---- / -
--
City
State Zip
Job Immediate Supervisor:- (J OHAI
?
Date Employed: /f l? - / ??
Salary: •jGIJ'"- a r
_
i. From 1'o Beginning Final (Monthly)
Specific Duties:
D. Company Nnme•__---- _-^-_-__ Phone•_
Address•
-_-
a
C
ity _ State Zip -??
J
b
o
Supervisor:
Date Employed
F
-
-
u
rom
To Beginning Final .
(t0o thly)
Specific Duties:
Form ]00-c
,?rp
'4-
12.
f/K6 D/.ef?T/S
Talents or Special Skills 1 r AL/ 7
13. Do you have any activities, commitments or responsibilities that may prevent you from
meeting work attendance requirements: Yes No_(_
Comments:- ___ ---- -
14. Do you have any handicaps that may affect work performance which you feel should be
taken into account in determining job placements? Yes No__
, LJZ
please explain: 1 L'a
flf?'
L?
If yes
-
,
,
_-
S LOT O f GUfllk/?l/? D.e /,????y/ C/!n%ly//?? dyE?
40
- 15. Lo?G hY
Do you ave any problems in becoming lawfully employed in this country because of visa
or immigration status? Yes No
",,... 16. Can you provide proof of citizenship, visa, or alien registration number after being
hired? Yes -No_
Comments: _.-
17. Have you had experience in the following:
5 (a) Carrying out varying job situations Yes-)k No
No
rk Yes
2?
id
O
_ _
__
_
e wo
uts
(b) Manual. Labor Yes_'&_NO_ (c)
(d) Use of general hand tools Yes No_
No_
(e) Use and maintenance of power saws Yes_ Y
(f) Driving truck YesjNo (g) Operating small equipment Yes__C No_
,. (h) Had others work under your instructions Yes_?<_No_
(i) Working with others and the (public Yes No_
Continents on the abov
pj An/ 7flE_ O Iii/ ?E!UF ?ox7 FAIiL ?1vES f0? /? ?E?
18. Have you been convicted, or have you served time in a correctional institution within
the past seven (7) years, for any crime which might have some bearing on your qual-
ification and fitness to accept the duties and responsibilities Of the position for
which you are applying? Yes_No---Y-
If yes, please give detai.ls _
- Comments:- -- - --
?? z
19.
PLEASE READ THE FOLLOWING AND SIGN BELOW:
Y I certify that all statements above are true to the best of my knowledge.
I understand that false statements shall be sufficient cause for termination.
A
-
t )
f Applicant) 0 te)
ture o
? Form 100-b,
?W?tih? MP ?(D1 i w ?Yrr??pi `5s r/ ^t1?P4 ids ?1 ? F2?ary? -7 ?, .
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TEMPORARY HELP AGREEMENT
This agreement made this 11TH da of
1 y JUN?_-, 1984, by and
between Jefferson County Commissioners, hereinafter called "Employer"
and - RAYMO_ryD BRODERSON__, an individual hereinafter called employee.
Witnesseth: That for and in consideration of payments and agreements
hereinafter mentioned:
1. Commencing JUNE 12 , 19__84, the employee shall begin work
for the County in the _ROAD_ - _ department under the Supervision of
WILLIAM G. AREY
2. The County agrees to pay the employee $8.46 _. per hour._
for the tern of this agreement on the normal pay days, to make the app-
ropriate payroll deductions, and to pay the employer's portion of the
appropriate benefits.
0
3. The term of this agreement shall be for 90 des from
the date the employee commences work under this agreement.
4. It is understood that during the term of this agreement, the
employee will not be required to join the Union nor
pay benefits as
contained herein.
5. Should the employee be hired at the end of this agreement, the
employee agrees to join the union at that time and the County agrees to
pick up all union contract benefits back to the commencement of this
agreement.
In Witness Whereof, the parties hereto have executed, or caused to be
executed by their duly authorized officials, this agreement in trip-
licate each of which shall be deemed an original on the date first above
written.
EMPLOYEE
Signature: ! 112PPl6rrcl
-t---- -
Name: RAYMOND BRODERSON
(Please Type)
Union:
JEFFERSON COUNTY COMMISSIOENRS
By' - - ------..?
Namc:_-_A --0- MEAPA.--_,-_
(Please Typo)
Title: CHAIRMAN OF -THE BOARD
- - C)I*5T1 aan --
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Jefferson County Commissioners
COURTHOUSE
PORT TOWNSEND, WASHINGTON 99368
CARROLL M. MERCER. DISTRICT 3, CHAIRMAN
A. M. O-MEARA. DISTRICT I
S. O. BROWN, DISTRICT 2
January 23, 1979
Mr. Edwin A. Becker
118 25th
Port Townsend, WA 98368
Re: Retirement
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Dear Ed:
From our previous correspondence, including your letter of
January 16, 1979, we understand that your retirement from the
County will commence March 1, 1979. We are by copy of this letter
notifying payroll that your employment will terminate February 28, -
1979.
The Board of County Commissioners wishes you well in your
retirement.
Ver truly your
A. M. O'Meara, Chairman
Jefferson County Commissioners
AMO:asc
cc: Jefferson County Auditor's Office
Jefferson County Engineer's Office --`1
70
October 16, 1978
Board Of, Jefferson County Commissioners
Courthouse
_ Port I wnsend, Washington. 98368
Gentlemen:
Because of my health, Dr. Scheyer has recommended that I go on sick leave
¢ and total disability.
e In order to make as smooth a job transition as possible, Iwould like to
go on sick l
av
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1 ;
1A e
e a
o
No
em
er 1,
978.
?
Enclosed please find the prescription
recouanondation. slip from,DF. Scheyer showing this r'
??1 Ver
trul
tv y,
y yours,
Ed
i
A
B
w
n
.
ecker, Director
Department of Public. Works
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October 13, 1978
- Board,of Jefferson County Commissioners
Conr t house -
xqK Port Townsend,-WAshington 98368
Gentlemen: Re: Public Disclosure -
aa. - For the purpose of filing a consolidated report in accordance with s .
- Resolution No. 58-78, it is estimated that my lobbying. or legislative
` - `;qr >t
,p•
I activities
for.the third quarter of 1978 have not exceeded one half of +'- 7
' one percent of my time. ,.
t Very truly yours,
+
??
L?act? Edwin A. Becker, Director #?ke+ e P
w.
AVA
WILLIAM J. SCHEYER, M. D.
-
--
LP/ ?rC{GfitG`t
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4
Gene is
s
BNOD NO. AS4402906 i
MCDICAL BUILDING, -T TOWN-.. Wws N,
As Written, ? `