Chemetron Corporation application for truck driver employment - Howard Eugene Shirley

CHEMETRON CORPORATION APPLICATION FOR TRUCK DRIVER EMPLOYMENT BOTH SIDES MUST BE COMPLETED BEFORE ACCEPTANCE Birth Date: May 17, 1928

NAME OF COMPANY MAKING APPLICATION: Chem Trom Corp. - Orem Utah Sub 755 NAME (FIRST, MIDDLE, LAST): Howard Eugene Shirley PRESENT ADDRESS: Roberts Hotel, Provo, Room 77 Phone 373-3400 COUNTY: [blank] OWN: X PREVIOUS ADDRESS: 4843 Thunderbird, Eugene-Ore. COUNTY: Lane OWN: X PREVIOUS ADDRESS: 81820 N. Melody Ln. Creswell, Ore. COUNTY: Lane OWN: X SEX: [X] MALE [ ] FEMALE WEIGHT: 220 HEIGHT: 5'10" ARE YOU AT LEAST 21 YEARS OLD: [X] YES [ ] NO CAN YOU READ AND SPEAK THE ENGLISH LANGUAGE: [X] YES [ ] NO MARITAL STATUS: [ ] SINGLE [X] MARRIED [ ] DIVORCED [ ] SEPARATED [ ] REMARRIED NO OF DEP.: 6 AGES OF CHILDREN: 16-16-14-12-9 ARE YOU A U.S. CITIZEN: [X] YES [ ] NO IF YOU ARE NOT A U.S. CITIZEN, HAVE YOU THE LEGAL RIGHT TO REMAIN PERMANENTLY IN THIS COUNTRY: [ ] YES [ ] NO DO YOU NOW HAVE A VALID DRIVER'S OR CHAUFFEUR'S LICENSE: Yes IF SO, WHAT IS THE EXPIRATION DATE: May 17, 1974 STATE OF ISSUE: Oregon GIVE LICENSE NUMBER: 1485393 [partially legible] IN WHAT OTHER STATES HAVE YOU HELD A CHAUFFEUR, OPERATOR'S LICENSE: None NUMBER (IF KNOWN): [blank] NO. TIMES CHAUFFEUR OR OPERATOR'S LICENSE HAS BEEN REVOKED OR SUSPENDED: None WHY? (IN EACH CASE): [blank] JOB APPLYING FOR: Line haul driver YEARS EXPERIENCE: 18 1/2 WAREHOUSE DOCK: 2 ALL TYPES VEHICLES YEARS EXPERIENCE: 18 1/2 CITY VAN YR. EXP.: 2 TRACTOR TRAILER YR. EXP.: 16 1/2 DIESEL YR. EXP.: 16 1/2 [guess: 16 1/2] DUMP TRUCK YR. EXP.: [blank] NUMBER OF VEHICLE ACCIDENTS: 2 ARE YOU NOW EMPLOYED: No IF SO - WHY DO YOU WANT TO CHANGE?: [blank] HAVE YOU PREVIOUSLY BEEN EMPLOYED BY THIS COMPANY: [ ] Yes [X] No IF SO, PLEASE GIVE DATES: FROM [blank] TO [blank] NAME OF WIFE (OR HUSBAND): Carla T. Shirley OCCUPATION: Housewife COMPANY: [blank]

SCHOOLING TABLE: GRAMMAR OR HIGH SCHOOL: YEARS COMPLETED: 12 DEGREE REC'D & MAJOR SUB.: General NAME OF SCHOOL: Klamath Union High School LOCATION: Klamath Falls, Ore. DATE OF GRADUATION: 17 May 46 TRADE, BUS. OR CORRESPONDENCE: [blank] COLLEGE: [blank]

MILITARY RECORD: PRESENT DRAFT STATUS: P MEMBER OF RESERVE: [ ] YES [X] NO [ ] ACTIVE [ ] INACTIVE TYPE OF DISCHARGE: Honorable

LIST ALL VEHICLE ACCIDENTS INVOLVED IN DURING THE PAST THREE YEARS: Nature of accident: None Date: [blank] Any injury or fatalities: [blank] (annotation at right: "Sub 755") [second row] Nature of accident: [blank] Date: 164-816479 [guess: reference/case number, partially legible] Any injury or fatalities: [blank]

LIST ALL VIOLATIONS OF MOTOR VEHICLE LAWS OR ORDINANCES (OTHER THAN PARKING) LAST THREE YEARS: None

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SEARCHED ___ INDEXED ___ SERIALIZED ___ FILED ___ FEB 24 1975 FBI SEATTLE

DB COOPER-54266

EMPLOYMENT RECORD AT LEAST PAST THREE YEARS (START WITH MOST RECENT OR PRESENT EMPLOYER) [handwritten, partially overlapping header]: Turbo Cycle Co. 1756 Willamette Eugene, Or[e]...

NAME AND ADDRESS OF EMPLOYER (MOST RECENT) Turbo Cycle Co. 1756 Willamette Eugene, Ore. 97402 JOB TITLE AND DESCRIPTION OF DUTIES: Consultant & construction foreman HOW LONG EMPLOYED FROM: Jan 72 TO: Jan 73 SALARY OR HRLY. RATE $: 1,000.00 [guess] per mo

NAME AND ADDRESS OF EMPLOYER (FORMER) Public Resources Council of Ore. Inc. 1746 Willamette, Eugene, Ore. 97402 JOB TITLE AND DESCRIPTION OF DUTIES: Executive Director - Public relations & education HOW LONG EMPLOYED FROM: Mar. 71 TO: Jan. 72 SALARY OR HRLY. RATE $: 1,250.00 per mo

NAME AND ADDRESS OF EMPLOYER (FORMER) Pacific Motor Trucking Co. 1675 Prairie Rd. Eugene, Ore. 97402 JOB TITLE AND DESCRIPTION OF DUTIES: Line haul driver - driving units over the road HOW LONG EMPLOYED FROM: Sept. 53 TO: Mar. 71 SALARY OR HRLY. RATE $: 16,000.00 per yr.

Have you ever been discharged from a job? Yes Explain: I decked a store manager in 1952 for [illegible, possibly "calling me a S.O.B."] [it] was a test case over

Have you ever been indicted or convicted of a crime other than violation of motor vehicle laws or ordinances? Yes Give details: Forest service policies

Have you ever had a surety bond? Yes Cancelled? No Refused? No

From what employers? Pacific Motor Trucking, Eugene, Ore.

Have you ever been injured on a job? Yes

Do you have any physical disability? No If so, what: [blank]

Have you ever filed a claim for workman's compensation? Yes Been paid workman's compensation? Yes

What employers? Pacific Motor Trucking

[blank divider line]

Who should we call in case of emergency? Carle T. Shirley Phone No. 1-503 689-0500 [guess: last digits partially illegible]

Names, addresses of Doctors and Hospitals that have given Medical attention to you: [left blank] NAME OF DOCTOR OR HOSPITAL / ADDRESS [blank rows]

IMPORTANT "This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge." "I hereby authorize my former employers or references to furnish any information concerning my personal character, habits, past health history, or employment record and I hereby release all such persons from any liability or damages on account of having furnished this information, medical or otherwise." "I hereby agree that I am employed on a 3 [guess] months probationary basis and that I may be terminated during this 3 [guess] months period at the discretion of the company. I understand that should I be employed and later laid off, that at the end of _____ lay-off, I am permanently laid off." "I hereby agree to submit to a physical examination as required by the Company and the D.O.T." "If employed, I agree to abide by all present and subsequently issued policies, rules and regulations of the Company."

DATE: 7-13-73 SIGNATURE OF APPLICANT: Norman E. Shirley [guess, cursive signature difficult to read] SEAL WITNESS: [blank] SEAL

FORM #613

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( I.C.C. physical 4-30-7[illegible] Ore. b6 b7C

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DB COOPER-54267