HomeMy WebLinkAboutReel_0026A (5)Vegetation control
r' Jefferson Count -?
IIB S=f CE AGREEMENT ....,,
Participant Name: RC)_Lj ()AG(. &0CI1?7,) Soc. Sec. N: S'11 -39- 3a3' ,
Unit of Service: WE END DATE:
Start Late Review Date:
Se*vi6e Provider Contact Person & Phone Agency address
Northwest Services Coune.l c.Suii W?ISey , 385-5578 1002 Lawrence Street
?r??1 ?ou1'k-i1 Port Townsend, WA 98368
} Sul c_t?mk4 ?ci chlol?cx? ., 3S5 b8ci0 getptaj•, Cm.:h 1 men
} ?1CscClucK , -PO Soy 1220
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Activity/Action Cooperating Agency Weekly Schedule Start/End Date(s)
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WOrIC FJCIY n 2r?c? 1~,
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c{Ohhp?r 1C.
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- O
y Workshops NSC I - n
I O oc' SC.K?llllQL '.
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her Actions Required, Special Conditions Supportive Services Provided
j Failure to attend w,rkehops and appointments can result in loss of hours or
work time.
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R=T, l - - PAGE 'P.90 - - -
GBJECTIVE.S & OUTCOiIS BY COMPETENCY CATEGORY
f
CC111PE-LTNCY CATEGORY OBJECTIVES GAIN ACTUAL OUTC912 DAic
Work Maturity Skills Obtain satisfactory (5)
rating on all work maturit
skills.
Occupational Skills Become proficient at all
tasks on job description.
Pre-Employment Skills Complete all assignments
as requested.
Participate and 'complete
job search assigrunents.
Educational 0 ?`(b Schz ,
r? APR 2 4
c 777
1
R7
EMPLOYMENT_ P
OGRAM
( R
JOB_ESCRIpTION
JOB TITLE: Vegetation Management WORK SITE: Selected
county road
rights of way
HOST AGENCY:
# JTPA PARTICIPANTS
Jefferson County
TO BE EMPLOYED: 6
ADDRESS: P,0. Box 1220
? WAGE: S3.35/hr. to be
supplemented by
Jefferson County
amount of $1.50/hr.
SUPERVISOR: Earl Wells
SCHEDULE: 7:00 a.m. - 3:30 p.m.
Jefferson Co. Supervis
or (or as mutually agreeable with
Supervisor) Monday - Friday
ALTERNATE SUPERVISOR
: William Arey
PHONE NO.: 385-0890
I. SUMMARY OF JOB
A. GENERAL
( Use of manual vegetation management techniques for
the control of
roadside vegetation. Testing
theories of establishment of plant c
ommunities and
validity of non-use of herbicides. Involving
cuttin
lli
g, pu
ng, thinning of noxious vegetation.
Recognition of desirabl
e species and critical areas
for control. I
II. PERFORMANCE REQUIREMENTS
A. OCCUPATIONAL JOB SKILLS
1. INITIALLY REQUIRED
Ability to take directions and criticism.
Good
eye-hand co-ordination. Use of basic
gardening tools.
I
2• WILL BE LEARNED
Skilled gardening techniques. Plant
identification and control methods.
B, WORK MATURITY SKILLS
j 1. INITIALLY REQUIRED
Ability to take supervision and criticism.
Ability to tolerat
e a physically tedious task.
2, WILL BE LEARNED
Work independently in recognizing and
det
ermining treatment for problem areas. Make
i
t
L?
7
effective coherant suggestions for innovative
treatment.
III. TRAINING PROVIDED
'A. ON-SITE TRAINING and FORMAL TRAINING
Will be taught to recognize desirable and
undesirable plant species; sight distance
requirements for road approaches and intersections
l and signs; contour control for potential erosion
j problems, Basic, practical landscaping.
B. EQUIPMENT, TOOL or MACHINERY TRAINING
Basic gardening tools, some machete and chain saw
? work.
1 I
Direct Supervisor Date
?d.
i
1
i
i
i
PRE-EMPLOYMENT APPLICATION
?? (3rl,sh CrC?J ? S?Lrln?er I-1?I?'
os on pp a or .. 1 _
Jefferson County is an EgUat Opportuntty Employer and encourages
Uons from all persons re
ardl
f
ca
A
g
ess o
racx, creed, color, sex. nattonaL
ortgtn, lnarttat status, age or physical,
sensor or mental dtsabLltty un_
less based upon a bona fid .
q
e oceupattonal uaLLfkcatLon. (State Law:
Chapter 49.60 RCW and WAC 162).
IMPORTANT: Complete all sectLons. Ptease use lnk. PrLnt name only.
1. Name: LYo S f?iGN/? E1 ALAN
2. Address: 1310 1. rsa Vnll? 0A m? c,m LJa. 9838
66
s re!
• sc P
1 APFlrr
3. Social Securt4Y No
lv
.
s _,
4. Date of 6Lrth Sea•?. 28, 1967
• -,.-(Age aLLI not be usa 0 t-s er in I
M
S. Home/Message phone 60t) 73? - 41 y N G. Business phones
1. 7. Educatton - Total ears of
Y Ara-untvoraLty sefiootlet
: '
S
CLrcle year completed: 7 2 a 4 E 6 7 8® 10 71 22 .
8. }lave CU t the Censrat Education Development (GE0) Zest Lin lt
?ILgh School G
u 1
d
o
ra
uations Was No Wear
S. . Colleges Attended Wears From To
r1n.d. 1
Dlgr1•
k
'
. P?.
rn 1)n
r,n•rs,?a .?,
1985 l,87
L?
t?
:70. IMFERENMSs (Ptease do hot List tetattves)
Name Addroas Offtee/Home Phone
10 J2c1 i?a?
2. De)n yZoaefS (wcIlccd (-r- L, ri) me
?dr7ii ? GOa
i
i
1
1 12. #*Lents or Special. SkLLLs?l.. v'?I' h,? • {-','I ;, -
=
,?' ------?
(?c:S?Co lav rul P, 7r?rn cc.. C.?/a•3:
15. Do you have any activities„ comAttments or responsLbLLLtLes that may '
prevent you from meeting work attendance n-equLrements: Yss_le--No
Comments:
{ 14. Do you have any handicaps that may affect work performance which you j?
f feel should be taken into account Ln determining job placements:
4
i Yes No ? If yes. please explain:
15. Do you have any problems in becoming Lawfully employed Ln this countr '
because of visa or immigration status: Yes No
16. Can you provide proof of citizenship, visa or alten registrstten
wwmber after being hired: Yes-"- No
Comments: _
17. Have you had experience Ln the fotlowtng:
(a) GrryLl out oaring job situations Yes V No -s
(b) Man
l L
b
ue
a
or Yes ? No
(c) Outside !Rork Yes No
(d) U
f
d
-
se o
general han
s
desNo
(e) Use and maintenance of
saws
Flo
as
(f) DrLvtnr truck Yes ? No
g
to
)
O
--
ft
perat
trg smatL equipment
Ves ? No '
) Had others work under your Lnstrue ons--- Ves 'No
`
(L) Vorktnt with others and the pWblte Yes V No
Comments on the above: C li„? 0 h Arr,.K •- :n I „ s
. - ?[!??, ?f M.?: n;?rl ?? /K II 1 '{' M r C I/ l anI ID I1b r ....
eve you een +LOnVLC a Or ve yyOU serve time n a oonrac Ona
f
ilL
t
•- sc
ty within the pas
seven (7) years, for any orLms wAch sntght
have some bearing on your cpattficatLon and fitness to accept the
elutLnes and responsLbLLLtLes of the
ositto
fo
ht
t
y
1 p
n
r %
o
% you are appt
.
angl Yes Nom/ If Was, ptease jtva dotal.s
-
19. PLEASE READ THE FOLLOWING AND SIGN BELOW: ,
I certify that all statements above are true and to the best of my
knowled
e
1
d
g
.
un
erstand that false statements shalt be sufficient
cause for termination.
21
--
QLgna ure<o#Appt can a e
form >f00c
•
PRE-EMPLOYMENT APPLICATION
5 u nn inn ?=1z W„ ? k / S ? IAN K?I men '
PosLtLon App Led For
Jefferson County Ls an Equal. Opportunity Employer and encourages appLLca -
tLons from aLL persons regardless of race, creed, color, sex, national
orLgLn, marital status, age or physLcaL, sensory or mental dLsabLLLty un-
Less based upon a bona fLde occupationaL quaLLfLcatLon. (State Law:
Chapter 49.60 RCN and N'AC 162).
IMPORTANT: Complete aLL sectLons. Please use Lnk. Print name only.
1. Name:
ddL
e
tLast) ( Lrst)
2. Address: ?l /?n'?[FE S? f??dlo << LJti q`533^a
street city s ate zip
3. Social Security No.: 33;• S,0 _67 b 4. Date of BLrth y'- 1- ( 7
(Age wLLL not be used to discrLminate.
5. Home/Message phone: 3gS'7?(Y°l 6. Business phone:
7. Education - Total. years of pre-university schooling:
CLreLe year compLeted: 1 2 3 4 5 6 7 8 9 10 ll (io
8. Have you passed the General Education DeveLopment (GED) Test Ln LLeu of
HLgh School. Graduation: Yes No Year
9. Colleges Attended Years From To Degree
.
f r - •YS
%nlfenL 4J
e Z g., 66 3-ffe 3 -97
F?.Ilz
j
1
i
10. REFERENCES: (Please do not List reLatLves) ,1
Name Address Office/Home Phone
_
Olson: Z61 AO&Asoo 1-Ic i2 l Cl' ti 732- q770
1. _ ?-Loyd
++
2. ???ert FIg??P?-( i?41-Lrc.,da.?r Rd i/nd 9,S-OS'ZI
3. t??h l?/'7zdnu 4v5 LO 15- 54 1? I, 3?57- 21 FS t3
4. (eA c S ' 1 23a1 oAr Rny_ R,l af4.l 113> -zS9y
5. ?'. shuo ,/G/ Ey?n„1 L I?,I Cl- 732-c41OL
?drm ; 7 0?a i
'I
I
_J
17. EMPLOYMENT HISTORY (beginning with Latest employment)
A. Company Name: f FtJltgSU/A U'a r Phone: ,385--5-:.JD
Address: _ K'ulr„ (P,,, zpg'l 11
Clty State ZLp
Job TLtLe: Ol k_ Immediate Spvsr..•: /t-,
Dates Employed: 3-XL J-9k, Salary: qp(D
From To QegtnnLng FLnaL Monthly
SpecLfic Duties: fev\,14 214212; 2S .. Sall }l card x 4
•....c....c ................................
Phone .. r.
8. Company Name r;2
••(`n,,•,,, • 3Yr--31 707
Address:- ftll AU le-) 9Y'3(-9
CLty State Zip
Job Title: SrS., F3 1 ImmedLate Spvsr.:
Dates Employed: .ac$ 9-85- Salary: 7, 5a '7, YO
From To BegLnnL ng FLnaL MonthLy
SpecifLc DutLes: /_Ghnr.r•
.................
..............•.................?.....................
C. Company Name: Phone:
Address:
y State ZLp
1 12. Talents or Special. SkLLLs?? 5(_JL C 1 ! tl"
nJPr?cr
13. Do?you have any activities, commitments or responsibLLLties that m y
prevent you from meeting work attendance requirements: Yes No
Comments: -- -
14. Do you have any handicaps that may affect work performance which you
f eeL sho
ld b
t
k
u
e
a
en into account in determining job placements:
Y
es No i If yes, please explain:
15. Do you have any problems in becoming LaafuLLy employed in this country
becaus
of
i
e
v
sa or immigration status: Yes No _,'Y,
16. Can you provide proof of citizenship, visa or aLLen registration j
number after being hired: Yes t_ No
Comments:
17. i
Have you had experience in the following:
(a) Carrying out varLng job situations Yes ? No
(b) M
anual Labor Yes 7 No
G
(c) Outside Work Yes-7-
es K No
(d) Use of general. hand tooLs Yes '? No
(e) Use and maintenance of power saws Yes y' _No
(f) D
No
riving truck yes
(g) Operating small equipment Yes
-
No
L
_
_
(h) Had others work under your instructions Yes X No
(L) W
orking with others and the pubLLc Yes ` No
Comments on the above: -
16, ave you een convicted, or have you served: time in a correctLona
facLLLty within the past seve
(7)
f
n
years,
or any crime which might
have some bearing on your quaLLfLeation and fitness to accept the
dutines and responsibLLLties of the position for which you are appLy-
I
Ln
? Y
N
!
g
es
o- If yes, please give detaLLs
19 P
. LEASE READ THE FOLLOWING AND SIGN BELOW:
- 1 certify that aLL statements above are true and to the best of my
knowLed
e
1
d
t
d t
g
.
un
ers
an
hat false statements shaLL be sufficient
cause for termination.
'Lgnature of App Lcant --mate
i
form 700c
f
L.? L
1
c1/ PRE-EMPLOYMENT APPLICATION
,?,\???11/Vey?h4tlo? CRu.? Col?ierfS
Position App Led For
x
Jefferson County Ls an Equal OpportunLty Employer and encourages appLLca -
tLons from aLL persons regardless of race, creed, color, sex, national
orLgin, maritaL status, age or physical, sensory or mental dLsabLLLty un-
less based upon a bona fide occupational quaLLfLcation. (State Law:
Chapter 49.60 RCW and WAC 162).
IMPORTANT: Complete aLL sectLons. Please use Lnk. PrLnt name only.
1. Name: _Qn,d pfFt f?hc N4rc?
Lest Lrst -[middle
2. Address: U0a3 6,+X 9.0 ArtLc DI--
9sac
streetBoy wASN.
/ city [state) zLp
9. SacLaL Securi o
-648_?
e n a_ c o: 1 v / n ?'i
11. EMPLOYMENT HISTORY (beginning with Latest empLoyment)
A. Company Name: Phone: u31 Lddd -/Jr?
Address: Pcr#bd/d--- WfIS --?_Nap
7826-5
City State Zip
Job TLtLe:- CQr,' //andler Immediate Spvsr•..:
/ynWon Q/cYrwell
Dates Employed: kr! - ,Sell _
Salary: L/. SV Hr. d90U
From To [3egLnnLng FLnaL Monthly
Specific Duties: 6?eon C4rt 0) 1_ Course r= Scene drekei
far} a,,,d G/P4hlncl V,d rlL DrMnc /Yr_Q a Wfe7ear
pe
.................... „7U/?o}...
B
Com
an
N .................... .........
........
.
p
y
ame Phone: LJ37-AXJIa-
Address: ArtGddAwr
. Was// q9245
1 -_+r
Job TLtLe: CUT Ave woof crate Zip
Immediate Spvsr.: c{? ScNm:'?t
Dates EmpLoyed:June- Salary: jr_(Jrd 700 -
From To 7po
Beginning FLnaL Monthly
Specific Duties: (uf' rlre woocl a?d SeT/•2 ?crfIUdlo,
'
•.?
........................•....•.... ........................... s..••....•
C. Company Name: -hone:
Address:
City State Zip
Job TLtLe: Immediate Spvsr.:
I
I Dates Employed Salary
From To Beginning FLna Month Ly
Specific Duties:
i
D. Company Name: 'Phone:
Address:
L;Lty State Zip
Job TLtLe: Immediate Spvsr•
Dates Employed: Salary:
From To Beginning Fina Month Ly
Specific Duties:
?Fprm 100b
12. TaLents or SpeciaL SkLLLs_ Wor'K?nxc 'nU --Slde W ri, mY hcw a-.
-,56th2. Macl y"CS
7- U) Arf V?A$ Car'nr trucK, ?lU YI -
'0irle.nf
-
13. .
Do you have any actLvLtLes, commitments or responsibLLLtLes that ma?
prevent you from meeting work attendance requirements: Yes'
No
-
Comments: 5' ie.ai euZr
14. Do you have any handLcaps that may affect work performance which you
feel should be taken Lnto account Ln determinLng job placements:
Yes No If yes, please explain:
15. Do you have any problems Ln becoming LawfuLLy employed Ln his country
because of visa or Lmmigration status: Yes No
j
16. Can you provide proof of citizenL visa or aLLen regLstration
number after being hired: Yes No
Comments:
17. Have you had experience Ln the following: /
(a) Carrying out varLng ?o?sLtuations Yes V No
(b) Manual Labor Yes V / No
(c) OutsLde Work Yes-7- No /
(d) Use of general hand too s Yes ? No /
(e) Use and maintenance of ?So'wer saws Yes t7 No
?
(f) DrivLng truck Yes
No
(g) Operating smaLL equLpment Yes y No
(h) Had others work under your instructLons Y No
(L) Working with others and the publLc Yes ? No
Comments on the above:
18. Have you een conv?c a or have you served: Lme En a conrectLona
facLLLty within the past seven (7) years, for any crime which mLght
have some bearing on your aLification and fLtness to accept the
dutLnes and responsLbil' yes of the position for which you are appl.y-
Lng? Yes No If yes, please give detaLLs
j
19. PLEASE READ THE FOLLMING AND SIGN BELOW:
1 certLfy that aLL statements above are true and to the best of my
knowledge. I understand that false statements shaLL be sufficLent
cause for terminatLon.
S7
I SLgnature o AppI.Lcant ate
form 100c
Mr. Scott M. Fink
210 Coman Hall
Pullman, WA 99163
March 20, 1987 E
Mr. Robert G. Nesbitt, P.E. E
t
County Engineer
Dept, of Public Works
1820 Jefferson
Port Townsend, WA 98368
Dear Mr. Nesbitt
I am writing in regards to our conversation on March 11111 about
student technici I
an employment this summer. We discussed in
paticular the culvert inspection project.
This project is of interest to me because of my desire to develop
skill
i
s
n road management and utilize my education of soils,
fluids and geology. Also
while
ki ±
,
wor
ng for Port Angeles PUD
last summer, I had extensive oppertunity to become familiar with
I
map reading and locating installations. I
From this information and the enclosed resume I hope that I would
qualify for a
it
• pos
ion in your work this summer. I would like to
mention, if I did not durin
ou
di
g
r
scussuon, that my availability
would run from mid May to mid or end of Au
ust
E
l
g
.
mp
oyment for
the county and this project enthuses me very much so I would be
as flexible as possible.
i I look foward to hearing from you soon.
Sincerely,
Ii
I
?jZ
Scott M. Fink
i
civil enqr. (WSU)
ENC:
i
i
1
Scott M. Fink
(? Current Address: ,
I . 210 Conran Hall Permanent Address:
I Pullman, WA 99163 PO Box 817
(509) 335-1721 Port Townsend, WA 98368
385-6511
Objective: Seeking summer employment related to civil
engineering to enhance current education and
futu
re career.
Education: Candidate for B.S. degree in Civil
Engineering, Washington State University,
Decemb I'
er 1988
Peninsula C.C., Port Angeles WA 1983-86
Mathematics:
Trigonometry, four quarters of Calculus
With Analytic Geometr
Di
y,
fferential
Equations, and Probability and Statistics.
I
Comnuters: '
f
i Courses in Basic and FORTRAN language
programming
Bnaineerina:
All engineering courses completed through
1st
semester junior.
I.? Mork Experiences Enaineerina Technician
Underground power inventory, As-Built
mapping, drafting, and surveyors aide for
Port Angeles PUD.
? Meatcutter an,l man'iaement-
Ten years with 'Sunrise Meats in Port
Angeles
Heahershins:
American society of Civil•Engineers i
Port Anqeles Fitness and Raquetball Club '
Personal:
Holder of a private pilots license ,
Coman Hall Floor President.
I Reverences:
Available on request
I'
.1
II
I
V
i
J
PRE-EmpLOyWNT APPLICATION
?GCh7/J7?i? _ 1? l
.. -
I'os« on App • For.
a
Jefferson County Ls an Equal Opportunity Employer and encourages ppLtca .
ional
from aLL persons regardLess of race, creed, color. sex, nat
*Lons
,
orLgtn. marital status, age or phystcaL, sensoryy or mental disability un-
less based upon a bona fide orcupatLonaL qusltfieatton. (State Law:
Chapter 49.60 RCN and WNC 162).
a
n
esse use Lnk. PrLn
mplete alt sections. P
IMPORTANT: C
mee only.
h
o
A p
?
N filik
S p
BC
7. Kame: 1 )
O
rstj-
a
as ?T
m ddLe)- 1
• /I
(
?n
2. I?ddrssss ?l P OR) ??C • I?? C6?IM/ AVM ?/1?? l(?3 Z?
'
CpJ
s reet7 %cLty) s n e) Ts
67
1
3. Social Security Ko.z 537-14' ?1 4. Date of Birth ?Z 31
,,..-•;? ::(Age wttt not be.use to L*cr m ni
S. Nome/Message phone: ! 37 -j-1 77 U G. Business phone: `
is 7. EducatLon - Total years of pre-untvarsity aehooltngs
4 8 6 7 8 9 10 11 p
- CLrele year completed: 1 2 3
S. Nava you passed the Genorat Education Development `GED) Test Ln Lteu 4
4iLSh School Graduation: Yes_ < Ko Ysar ly`?fD
S. C:o44L gea Att need Y are from To Degree
IAgG 1987
A
l-
k
C
m i ?a
nr?
e
k
a
"'.10. 92EFERENCESs 4PLease do trot ttst retstLves)
?. .; Name ddres Office/Home Phone
WAAUO Mt 7qo I?I?s VallpH %. ((11MMCuNI WA 7.3 z -N1t1
1
.
2. TIM (AQa jobuM Valley B4'?k335 ?IZ??
9.
4
Ad 75owxq4 WA 3G Z& 95
ALL EA 3/t
b
I
•
i
I
1.
1
L?
e
77. EMPLOYMENT HISTORY (begtmL wlth Latest employment)
A. Company Name: Phone
: 437 -1ZI L
y
! Address: ?J I Z1S S
bty tote ZLP
Job TLtLe:Ae HAJ Ick Immediate spvsr.•s N? oti QG U1
Dates Employed: ,J .% SeLarys •25 ?. so
Freya To BeltnnL FLna Monthl.
S ectftc Duties:_ SUIIPPUiSQd P
GFI {Pals
Ac1?F
<• -
?
?3 v?einu 0.-E Il?ll?e TvAe tes- frjg 1 al b r
B. Company Name Phone:
Address:
uL y State 2LP
Job UtLe: ImmedLate Spvsr.s
Dates Employed: Salary:
rom To eggtinnir?g FLn-ate Mont r)i `
-SpecifLe Duties: zt!
. .. 0OW80 ieee000900606000000000 0e00ee0•e0e00000666e009eeee00eeeeeeeeee6000;
C. Company Name: Phone:
Address: .1
City state ZLP
Job Title: ImmedLate Spvsr.:
i Dates Employed Salary
:. From o eg nnLng na on
SpecLftc Duties: -
•0e0esee0e0eeee0000000000000600e9e0ee000ee9e000eeee0e0e006eeee0eee0ee9e0?'I
:-i
- 0. Company Namei f'hons:
_
i Address-
CITY ae ZLp "
Job TLtte: Immediate Spvar:
Dates Employed: Salary:
From o BeXLnnLnZ Final. Monthl
Specific Duties:
•?•e0e0e9e600900900969e9se090660ee0s6e0ee0ra00900090000e9006000eee90996s99?1
. ?OOb
t:
-7
r 12. Talents or Special SkiLLs_ bmAd gAl yA1-VLr• On lift/
?nid2Ye2
19. Oo you have any activities, commitments or responslbM tLes that ay %
prevent you from meetLng work attendance requirements: Yes W
" a
Comments:
14. W you have any handicaps that may affect work performance which you
feel should tag taken Lnto account In determintn& Job placements:
Yes No If yes, please explain:
1S. Do you have any problems Ln becoming Lawfully employed Ln this eountr
because of vise or immigration status: Yes No
x
16. Can you provide proof of etttsen Lp, visa or alien registration
number after being hired: Yes, No,
Comments:
17. Have you had experience In the following:
401 Guying out oaring job situations Yes y- No
(b) M
l L
b
Y
X
anua
a
or
es
No
(c) OutsLde Work Ves_ c No
(d) Use of teneraL hand tools ^?er.
(e) Use and snatntenance of t
saws as -?ito?,
(f) O
rLvLnF truck Yes ? No
o
(gg) Operating amatt equ?nt Yas No
(
--
h) Had others work under your Lnstruc ons
Vex X No
(L) MlorkLng with others and the publle Yes-.?( No _ •
Comments on the above: r fwm 6A Some ekaf lM f 0 4 CM I? ll
CIS , V }? k 0,J14 6,,m --P
78. Have you been conv-Lc a or have yyou served - me n a oorrec ona 1
facLtLty withtn the past seven (7) yyaarik, for any crLme vhtch sntght
h
ave some beartnX en your gl.iatiftcatLon and fLtness to aces pt tM •.
elutLnes and res
onsLbLtLtLes of the
osttlon for slhtsh
o
l
p
p
y
u era app
y,
Lng1 Yes No_< !f yes, please *Lve details
79. PLEASE READ THE FOLLOWING AND SIGN BELOW:
k
1 certify that all statements above are true and to the best of a,y
knowLedge. 1 understand that false statements shalt, be sufficient
• cause for .'natL // '
t(je of AFL (? 7
:
lican cant-- a
?
na re
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pp
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l
form 100c
J
PRE-EMPLOYMENT APPLICATION /
Position Appli For
Jefferson County is an Equal Opportunity Employer and encourages
applications from all persons regardless of race, creed, color, vex,
national origin, marital status, age, or physical, sensory, or mental
disability unless based upon a bona fide occupational qualification. (State
Law: Chapter 49.60 RCT and WAC 162)
IMPORTANT: Complete all sections. Please use ink. Please PRINT. j
1. Name: MCEf//I 11/ Ke-u i7 Jf{ r'
(LAST) (First) (Middle)
2. Address: 13309 yr? STree7- Po,TToWaas-4 98.31 fF
(Street) (City) (State, ZIP)
3. Social Security No. s33 - 92 - 5103 6 4. Date of Birth: S^02 - 7
(Age will not be used to discriminate)
5. Home/Message Phone:385_-/9G7 0,1 3 SS' Opp( 5. Business Phone: //O/l e-
7. Education - Total years of pre-university schooling:
12 Circle year completed: 1 2 3 4 5 6 T 8 9 10 11
8. Have you passed the General Education Development (GED) Test in lieu of
High School graduation? NO YES Year
CJ /?oT /a P/?Cy
9. Colleges Attended Years From To Degree
?;1.5 year T ?i/f l?2/1 r (6r?mul? 'Til Go tz ,7ul7 e
10. REFERENCES: (Please do not list relatives)
I
I. R;61< ToCCeFSo,? 7 3 Z Yo T-0
2. _7; e,117 p e Tr /'S 3 S"/ 7 9 Z
5.
11. EMPLOYMENT HISTORY (beginning with latest employment):
To LC S?ar,K Cor?s'riucT%vrc
A. Company Name - Phone 7 3 Z ' YOYO
Address//-32 1):)A T!'oJrn X17. G d i?r%cum w a Sl _ `/ 8'3 2 s-
City State ZIP
Job Title /alnrer Immediate Superviso J2JCfKToCLrFt0
Dates Employed. Jac Noil4S SeP 8'6 Salary
From To Beginning Final
Specific Duties z yao[ To /JaT `iarnc wor!< v? c-?ori< Gcmr??T
I ?aI'JGC SG ???'L ?19G? GLCa?=+ Usk
i
ffff« itit« ««tff «tiss «sit«
Company NameGc%r/S l z??(SGa/? rv9 Phone__ ? S' ^/ 7 1?
Z
Address / 7o GaroC C orT TOcr/?S2lto( L7 S k Fq 368'
City State ZIP
i. r
Job Title Nc L/l ?/ Immediate Supervisor T%rrn gc Tr/-s'
Dates Employed ScI?TSS A/OV 5'S Salary
From To Beginning Final
Specific Duties T Hacc ro weed m? rPl9?C G Lcart c>y
II
tf«st «ttit «ii«f i«f if f«s«« - -
I
Company Name Phone
Address
City State ZIP'
Job Title Immediate Supervisor
Dates Employed Salary
From To Beginning Final
Specific Duties
sssrt ss«ss sssss «ss«s sssss -..
Company Name Phone
Address
City State ZIP
Job Title Immediate Supervisor
Dates Employed Salary
From To Beginning Final
Specific Duties
12. Talents or Special Skill sT%,? /noSiCy inTCr'erreeZ /i7 sa?rctizn:cS (r??
vrTG. m? l(and.S /.?h?L % ti?rd t,-?n!^Kcr.
13. Do you have any activities, commitments, or responsibilities that may
prevent you from meeting work attendance requirements? NO_? YES
Comments:- /,au2 SGInOL a Barn iyJ ieX?ebe's
14. Do you have any handicaps that may affect work performance which you `
feel should be taken into account in determining job placements?
L NO t? YES
If yes, please explain.
15. Do you have any problems becoming lawfully employed in this country
because of visa or immigration status? NO GC YES
Comments:
4 16. Can you provide proof of citizenship, visa, or alien registration
number after being hired? YES OL NO
Comments:
17. Have you had experience in the following:
(a) Carrying out varying job situations Yeses No
(b) Manual labor Yes oL No
(c) Outside work Yeses No
(d) Use of general hand tools Yesoe-
No
_
(e) Use and maintenance of power saws Yes oC No
(f) Driving truck Yes No?_
(g) Operating small equipment Yes C>1' No
(h) Had others work under your instruction Yes No-A--
(1) Working with others and the public Yes_ No oG
i
Comments on the above:
18. Have you been convicted, or have you served time in a correctional
facility within the past seven (?) years, for any crime which might -
have some bearing on your qualification and fitness to accept the
dutie and responsibilities of the position for which you are applying?
NO LK- YES
If yes, please give details.
19. PLEASE READ THE FOLLOWING AND SIGN BELOW:
I certify that all statements above are true and to the best of my
t knowledge. I understand that false statements shall be sufficient
cause for termination.
/
Signature of Applicant Date
At i
i '
11or1hwesl Services Council
. .: u; n•I'.,.,• ; .. 1H1.. . ;I PLC I, SUITE TEN i,P.O. Elox 7pYJ1 eELLINGHa•,:, :. .. ..
WORK ERPE1111NCE (Wr1C) TiLUNINO REE'OULALL
DATE I Ct `,_7
Dear Host Agency Site Superviuor,
I n ?'
This is to confirm that i (° ?t{, c? yLG,t
( S1314- ,?,}(r, - ?R - (D 111 } , has been certified as an eligible trainee for
t)Ilr 'rlork prr'ier1CC (4lErO curni,onent of the Youth Nmployment and Training
Pnigram. He/She has reviewed Lite job information you subrnitted.Rnd is
f
bo;n}; referr'cd for the position of Vegetation Management Crew
• I
Aftes• interviewing this young person, please contact Sue Wilson at
38j-5578 to indicate your- decision for accepting this young worker. A
rueetine For supervisoru ail'! need to be arranged once a start date is
set, fox' the trainee. This rneeLin., should include all persons who will
lI
1 be iuvulved in Lhc supervision of t;te trainee.
1
Sincerely,
Susan Wilson j
Coordinator
Wa ?Cp;J1;y Jefferson County Public Works
CONTACT 1•'rata!i;d Earl Wells or Carter Breskin
l,LU!ii 3:1 Jefferson County Courthouse, Port Townsend
1"r 110141; 385-0890 (Call for an appointment)
WAGE $4.85 HoI i!S v'.1 WEc1S 40
i .nsn, ri< ronks rnAIME PL VI
_ ,. ,9,r tOtb rr.-? vu tt'.% 0ar11 rorir:5. WA 98731
1
i
x c
PRE-EMPLOYMENT APPLICATION
?
?
V'o on Appl
r
L
Jefferson County is an Equal Opportunity Employer and encourages appLLca _
bons from aLL persons regardLess of
race, creed, coLor, sex, nationaL
origin, marital. status, age or physical, sensory or mental dLsabLLLty un-
less based upon a bona fid
e occupatLonaL qualification. (State Law:
Chapter 49.60 RCN' and K'AC 162),
IMPORTANT: Complete aLL sections. Please use ink. Print
name only,
1. Name:
Iy,?JI
_
%LaSt)
first T--TmLddLe f
2. Address: l fV
6,7- Jil?l rJ??-)VUJC?1141) !
street
city state Zip
3. Social. Security No.
4. Date of Birth
(Age wLLL not be used to discriminat
e
5. Home/Message phone: 6
B
i
.
us
ness phone:
7. Education - TotaL years of pre•-university schooLLng:
CircLe year completed: 1 2 3 4 5 6 7 8 9 10 11 12
'
8. Have you passed the General Education Development (GED) Test in Lieu of
High School Graduation. Yes
No
Year
9. CoL?L7ges
A)Attended Years
? F( om
To i
?
t y egree
?)Illil
f (44IAdlp 1 So
S(? ?<hn9 n7 r
s
w
cn
{
I
10. REFERENCES: (Please do not List relatives)
Name Address
Office/Home Phone
1 ? {lV1 ?
?
I
c
?
nyt ?? a c? ,? W • ?WANti-' ,?ol:`?'r.??.,f-?r?.??.,4 ?s?? --r29a?'
2. L7J/tee. l9??hlin o i
Q Ad
3. 1 P T, n ? cl !
?Y
s =c
y
k
o
4. Rw'r-14 f n c l
-I-
,II
,
n
i.
N
?ylckc ur,i ??1?
Ph
5-II kal rayi? ??,; T?? ,?,> ?53?? ?,? s?
I
?Orm'; 7 00a
i
I
i
1?
A-T
11. EMPLOYMENT HISTORY (begLnni
ng with Latest empLoyment)
n
A. Company Name: JFZ`? t? Phone:
Address: -A ? J.
CLty State ZLp
Job TLtLe: 040Immediate Spvsr•.: /? V'Crf-lI Clrnf??1
Dates Employed:l?)? ((l%? ' SaLary:- ?i i ' S (? L (1/ p
From To BeginnLng FLnaL Monthly M
SpecLfLc Duties: (?» t?,r f?0 s{?lnr?? Ir rVCi ??61"; it'f7G) (7??
B. Company Name ?( T? ?•t??C)i'CF_ ??OY'?J, Phone:?`;,`?
Address: __(_?-rr5 I,%JLAJA)<-ey b, ck)nn on
CLty State ZLp
Job TLtLe:_ 61xi2itiyd IQ.tc-o? Immediate pvsr.?QCfKS
Dates EmpLoyed:? c' npt?? Salary:,
roF m T
o
LlegLnnLng' FLnaL Monthly
/
"
SpecLfLc Duties: ?Ut?C?IYoa ?1^al)I r?I?
.. ••i•.•.....••....••..•......•..•............•. •..••...••... ••.•... •...e...
C. Company Name: Phone:
Address:
Lty State ZLp
Job TLtLe: Immediate Spvsr.: 4
Dates Employed Salary
From To Beginning Final MonthLy
SpecLfLc Duties:
D. Company Name: Phone:
Address:
L y State ZLp
Job TLtLe: Immediate Spvsr:
Dates EmpLoyed: Salary:
From To BeginnLng FLnaL MonthLy
j SpecLfLc DutLes:
•••...........• .................•...•....... •... •....... •....•.•...e. •..•.•
?Form 100b
t'
i
12. Talents or Special SkLLIs((? Tt 2?
?F? U.{,.VV?. ( Yr1lR k.? i'Xt9t',Eli? r?O,/ I_ , L-t L
13, Do you have any activities, commitments or responsibLL'LtLes that nay/
prevent you from meet Lng work attendance requirements: Yes' No y
Comments:
14. Do you have any hay?dicaps that may affect work performance which you
feel. should be taken Lnto account Ln determining job placements:
Yes No l/ If yes, please explain:
15. Do you have any problems Ln becoming Lawfully employe. d yrf thLs country
because of vLsa or LmmLgration status: Yes No V
16. Can you provLde proof of cLtizenshL , visa or aLLen registration
number after being hired: Yes No
Comments:
17. Have you had experience Ln the following:
(a) Carrying out varing j o sLtuations Yes No
(b) Manual Labor Yes !// No
(c) Outside Work Yes No /
(d) Use of general hand tooLs Yes V No /
(e) Use and maintenance of power ts'aws Yes_ Nov
(f) Driving truck Yes No i?/ i
(g) Operating small equipment Yes VNo
(h) Had others work under your Lnstruct'LOns ,Ves ? Nco
(L) Working with others and the pubLLc Yesp No
Comments on the above: ?SC7 (ill (eQal
V U
18. Have you been convLC a or have you served: Lme Ln a correctLona
facLLLty within the past seven (7) years, for any crime which mLght ?
have some bearing on your quaLLfication and fitness to accept the
dutLnes and responsLbLLjrtLes of the position for which you are apply-
Long? Yes No Lam/ If yes, please gLve detaLLs
19. PLEASE READ THE FOLLOV)ING AND SIGN BELOW:
I certify that aLL statements above are true and to the best of my I'
knowledge. 1 understand that false statements shaLL be sufficient
cause for ermLnatLon.
bLgnature 6f AppLLcant Date
form 300c
i
_ . .,
is