Part 118, page 181

Transcript

The scan is the source; the transcript is machine-generated from it.

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