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Title
Box 1, Folder 22, Document 17
Text Item Type Metadata
Text
+ me
Have you ever applied CITY OF ATLANTA PERSONNEL BOARD Veteran ——____
for City of Atlanta APPLICATION FOR CIVIL SERVICE EXAMINATION Chauffeur ———____
_emplcyment?, —_+—— : : . ¢
* lf "TYes?’ check with Interviewer 260 CENTRAL AVENUE, Ss. W. Operator so ae
befcre completing this form. ATLANTA, GEORGIA 30303 es # ¢
OEE E28! Social Securicy Number? SES
POSITION APPLIED FOR DATE DATE OF EXAM : DO NOT USE THIS SPACE
Cc QL ee haan 29 4969 Discharge ——______ Medical
License Education
Court Record ——___. Experience
Trade Report ——_______. Past Emp.
/ Additional Remarks:
e/ GEE KZ LETC aT Vili? ECE Line se ee
Ms Jit (TEALAD 5s) LIL [ AL2 FOBT wal 2 BLE SS €.
Last at Firs st Middle | (or Maiden) “How long have you lived
Address AIEEE LYE SF bbb: [fofostosbipy “Go. SLY/ at this address?
Number Street Direction Apt. No. City State Zip Code
previews adios 5/51). L/S 167) A Llib pate sp MELEE UE
7 a & GY Y Exiats To
Telephone Number LEG 2b SY Place of Birth Lot. LL Le 2 Lapa
Alternate Number Are you a citizen of the United States? fe, SPE al
Height Sele eat Dan What is your husband’s or wife’s name? e :
Single f= Bivcced—— Widow —____—._ No. of children cS
Widower ——___ No. of dependents Sn
Check appropriate: White ——_— Male
Colored Female Z=_Masried
If answer to any question below is ‘'Yes’’, explain. (Ask for_extra sheet if needed).
Have you any disease, physical disability, or defect? b ‘
Have you ever been treated for a nervous or mental condition? SRD
Are you receiving disability compensation? ff ‘
Have you ever been sued on a debt? > D Have you ever had your wages garnisheed? ae
Separated
- Have you ever filed for or been awarded bankruptcy judgment? = 7p = Have you any past due debts? i ——
FORM 6-A-12 REV, 8/67
EXPLANATION:
Have you ever been arrested or given a traffic ticket? LFS <_.
If **YES’ list all crimes or misdemeanors, including traffic violations, with which you have been charged. Failure to admit any offense
regardless of when or where it occurred, may cause rejection of application. (Ask for extra sheet if necessary).
CHARGE WHEN CITY & STATE SENTENCE/FINE
List any machines or equipment that you can operate efficiently. Are you presently employed?__f7 4)
Have you ever worked for the City of ee i When
Jf) wa c
a V
LLLEPAL. ELLIS Tae Are you interested in permanent work?_. wo GRP aa
oe = Are you willing to accept remporary worl i
How many times were you in service? -
Pa
Have you had military service?
#5
Were all discharges ‘*Honorable
DO NOT WRITE BELOW THIS LINE
Branch of Service Service Duties J
Date enlisted , Discharge reviewed by = Form
Date separated . Reason for discharge :
Honorable
VA letter dared Per cence disabilicy _-__——EESSS——s« 3RReemarrksss
Serial or File No.
Last
. Year E ircle high
Educational Record Name of School & Location Attended | Graduate pile complecat 3
Elementary Ae Df, Jf, “h ‘GQ 7. Sg A, Ca 1-2+3-4- La;
be 3 Meee] = 7 LO Mle te Li le8 1 UT 27 | EX ee
High School r == Ui } : 5 Pl Yes fo oa xo)
LLL T4 thy R= Dye & VFL No oie 4 Ay
College, Univ. c Yes oe
No Degree & Major Subject
Post Graduate Yes
No
Trade SE Yes No. of months
Business School No attended
“EMPLOYMENT RECORD: Account for all time since school. Incomplete applications rejected. (Extra sheet may be obtained from interviewer).
Date Seared] Firm's Name (7 :
MA, VO 7 CLx hot Al 7 WW? cb Le Final Salary/75 2?
Date Left Mailing Address. LA > ea eee
ON 5B Mae "it, J 20 L502 Mil pilin ae) GUS
Reason fot Leaving Number Street Direction / City State Zip Code
Despribe Duties
AL Np Ay - ZB
UCL Ll Ll £3 2 bety AD! bez fzZ
Date Started ; hee “Firm’s Name L Ay AL ; pte =} Ly
Lhe LTAY (4, LG cag Le: Pe Lie O° Final Salary es
Date Left Mailing Address ae ee 95 %
ULE ah), [of tp Mt LOL LD Lil Soe Anda Pape
Reason for Leaving: Number “Street itection ‘City State Zip Code
yn fren Bay Le tier Describe Duties
Lyle AVAL Le Ltt ZG AGE ied 2 =
Dare Started : oo ” Firm? ‘Name : . A wv
te . i» 3 ed eis u- fee. ce et fr Awe é ¢ Pear ied Final Salary (fast Lt
ili ‘ ~ a aoe
eee ale a ee ee CEI ls FER
-Reagon for Leaving Number Street ~»* Direction - ‘City State Zip Code
NAA! th Describe Duties {/
* fe peg , 5 ff sf
ae ¢ s. ep AT agen Ae reta a LK fs Lt ttle /
/Date Started Je Firm’s Name ee A; Scar ;
é SZ = i7 Y Ke it LPP RAD pols gi Cy feats’ ¢}' Final Salary ( Ps
Date Left 6 Mailing Address _ 4 ea Z/ ‘4 Df Ra. FE
Cf ~ é zy / (ale Cite fee é ZL F 2/4 Ee Mth Lo 24 et /
Reason for Leaving _ Number * Street . Direction ° City “State Zip Code
Describe Duties
Aj Pk) J Lyf oe
dhe iy rok if be Ra A) the 2 KOE OC fa
Date’ Started | Firm’s Name vias ee f j
/- LAxCe Pee he 5 Final Salary
: : “ye # : j / ’ Zé
Date Left ‘ “f PURE Address POs : i oy pew
Reason for Leaving Number Street Direction 4), “City” 25 / State Zip Code
4 _ Describe Duties AE a Boks
40 Geta Lert ee. dO
! ed fp HAA bee :
2A Zot oe List names and complete addresses of three character references. Do not list relatives or former employers.
— - NAMES | ’ ADDRESS
IIT, LAtite 2D, os Lz21% DE tinZE, JIA LiL = 22 f= EBL
ff Numb “Street - . Direction City State Zip Code
Wye Lisle espacial CIDE 6 a Mite ATi herk Ca Pees
tis iy SORES Number Street’ 2 Direction LJ State Zip €ode
3 Spice Be be. Tot
Yl“ Vie, 27 Crt’ C25) C+ LD “Sohn. LL lever, ATe. Jeo Brey
= Ea Number Street Direction City State Zip Code
I do solemnly swear (or affirm) that the statements in this application are PI i *
i complere - the best of/my a and belie ee
a) phy Reviewed by
kpoate AD bo bga,
fs Rote
.
4
fy, /. sity
EXAMINATION: hie fs gibt Li} DATE a 2 ¢ ae
bs fae st a!
~ - rg
PLEASE PRINT 5 n
FULL NAME: Opphy're LA fe } OA FSS LE i // Lp, i)
(LAST NAME) ~ (FIRST NAME) (MIDDLE ant ‘
IF NONE PUT NMN)
ADDRESS : fZ 20 (Apaty Spd Sy LD ves AFL ff Ad 2TA
Number Street _ Direction “(Apt. ae ive State Zip
que,
I certify that I am the above individual taking this examination. I understand
that if it is later established that I have misrepresented myself, I and the
person being misrepresented will be permanently barred from City employment
and may be prosecuted by the courts. If either is already employed by the
City of Atlanta he may be subject to eee ee
r i
SIGNED; Ere Better Af ~~
Spay . CO SEEN. VY
Chk (flint Chin \
Have you ever applied CITY OF ATLANTA PERSONNEL BOARD Veteran ——____
for City of Atlanta APPLICATION FOR CIVIL SERVICE EXAMINATION Chauffeur ———____
_emplcyment?, —_+—— : : . ¢
* lf "TYes?’ check with Interviewer 260 CENTRAL AVENUE, Ss. W. Operator so ae
befcre completing this form. ATLANTA, GEORGIA 30303 es # ¢
OEE E28! Social Securicy Number? SES
POSITION APPLIED FOR DATE DATE OF EXAM : DO NOT USE THIS SPACE
Cc QL ee haan 29 4969 Discharge ——______ Medical
License Education
Court Record ——___. Experience
Trade Report ——_______. Past Emp.
/ Additional Remarks:
e/ GEE KZ LETC aT Vili? ECE Line se ee
Ms Jit (TEALAD 5s) LIL [ AL2 FOBT wal 2 BLE SS €.
Last at Firs st Middle | (or Maiden) “How long have you lived
Address AIEEE LYE SF bbb: [fofostosbipy “Go. SLY/ at this address?
Number Street Direction Apt. No. City State Zip Code
previews adios 5/51). L/S 167) A Llib pate sp MELEE UE
7 a & GY Y Exiats To
Telephone Number LEG 2b SY Place of Birth Lot. LL Le 2 Lapa
Alternate Number Are you a citizen of the United States? fe, SPE al
Height Sele eat Dan What is your husband’s or wife’s name? e :
Single f= Bivcced—— Widow —____—._ No. of children cS
Widower ——___ No. of dependents Sn
Check appropriate: White ——_— Male
Colored Female Z=_Masried
If answer to any question below is ‘'Yes’’, explain. (Ask for_extra sheet if needed).
Have you any disease, physical disability, or defect? b ‘
Have you ever been treated for a nervous or mental condition? SRD
Are you receiving disability compensation? ff ‘
Have you ever been sued on a debt? > D Have you ever had your wages garnisheed? ae
Separated
- Have you ever filed for or been awarded bankruptcy judgment? = 7p = Have you any past due debts? i ——
FORM 6-A-12 REV, 8/67
EXPLANATION:
Have you ever been arrested or given a traffic ticket? LFS <_.
If **YES’ list all crimes or misdemeanors, including traffic violations, with which you have been charged. Failure to admit any offense
regardless of when or where it occurred, may cause rejection of application. (Ask for extra sheet if necessary).
CHARGE WHEN CITY & STATE SENTENCE/FINE
List any machines or equipment that you can operate efficiently. Are you presently employed?__f7 4)
Have you ever worked for the City of ee i When
Jf) wa c
a V
LLLEPAL. ELLIS Tae Are you interested in permanent work?_. wo GRP aa
oe = Are you willing to accept remporary worl i
How many times were you in service? -
Pa
Have you had military service?
#5
Were all discharges ‘*Honorable
DO NOT WRITE BELOW THIS LINE
Branch of Service Service Duties J
Date enlisted , Discharge reviewed by = Form
Date separated . Reason for discharge :
Honorable
VA letter dared Per cence disabilicy _-__——EESSS——s« 3RReemarrksss
Serial or File No.
Last
. Year E ircle high
Educational Record Name of School & Location Attended | Graduate pile complecat 3
Elementary Ae Df, Jf, “h ‘GQ 7. Sg A, Ca 1-2+3-4- La;
be 3 Meee] = 7 LO Mle te Li le8 1 UT 27 | EX ee
High School r == Ui } : 5 Pl Yes fo oa xo)
LLL T4 thy R= Dye & VFL No oie 4 Ay
College, Univ. c Yes oe
No Degree & Major Subject
Post Graduate Yes
No
Trade SE Yes No. of months
Business School No attended
“EMPLOYMENT RECORD: Account for all time since school. Incomplete applications rejected. (Extra sheet may be obtained from interviewer).
Date Seared] Firm's Name (7 :
MA, VO 7 CLx hot Al 7 WW? cb Le Final Salary/75 2?
Date Left Mailing Address. LA > ea eee
ON 5B Mae "it, J 20 L502 Mil pilin ae) GUS
Reason fot Leaving Number Street Direction / City State Zip Code
Despribe Duties
AL Np Ay - ZB
UCL Ll Ll £3 2 bety AD! bez fzZ
Date Started ; hee “Firm’s Name L Ay AL ; pte =} Ly
Lhe LTAY (4, LG cag Le: Pe Lie O° Final Salary es
Date Left Mailing Address ae ee 95 %
ULE ah), [of tp Mt LOL LD Lil Soe Anda Pape
Reason for Leaving: Number “Street itection ‘City State Zip Code
yn fren Bay Le tier Describe Duties
Lyle AVAL Le Ltt ZG AGE ied 2 =
Dare Started : oo ” Firm? ‘Name : . A wv
te . i» 3 ed eis u- fee. ce et fr Awe é ¢ Pear ied Final Salary (fast Lt
ili ‘ ~ a aoe
eee ale a ee ee CEI ls FER
-Reagon for Leaving Number Street ~»* Direction - ‘City State Zip Code
NAA! th Describe Duties {/
* fe peg , 5 ff sf
ae ¢ s. ep AT agen Ae reta a LK fs Lt ttle /
/Date Started Je Firm’s Name ee A; Scar ;
é SZ = i7 Y Ke it LPP RAD pols gi Cy feats’ ¢}' Final Salary ( Ps
Date Left 6 Mailing Address _ 4 ea Z/ ‘4 Df Ra. FE
Cf ~ é zy / (ale Cite fee é ZL F 2/4 Ee Mth Lo 24 et /
Reason for Leaving _ Number * Street . Direction ° City “State Zip Code
Describe Duties
Aj Pk) J Lyf oe
dhe iy rok if be Ra A) the 2 KOE OC fa
Date’ Started | Firm’s Name vias ee f j
/- LAxCe Pee he 5 Final Salary
: : “ye # : j / ’ Zé
Date Left ‘ “f PURE Address POs : i oy pew
Reason for Leaving Number Street Direction 4), “City” 25 / State Zip Code
4 _ Describe Duties AE a Boks
40 Geta Lert ee. dO
! ed fp HAA bee :
2A Zot oe List names and complete addresses of three character references. Do not list relatives or former employers.
— - NAMES | ’ ADDRESS
IIT, LAtite 2D, os Lz21% DE tinZE, JIA LiL = 22 f= EBL
ff Numb “Street - . Direction City State Zip Code
Wye Lisle espacial CIDE 6 a Mite ATi herk Ca Pees
tis iy SORES Number Street’ 2 Direction LJ State Zip €ode
3 Spice Be be. Tot
Yl“ Vie, 27 Crt’ C25) C+ LD “Sohn. LL lever, ATe. Jeo Brey
= Ea Number Street Direction City State Zip Code
I do solemnly swear (or affirm) that the statements in this application are PI i *
i complere - the best of/my a and belie ee
a) phy Reviewed by
kpoate AD bo bga,
fs Rote
.
4
fy, /. sity
EXAMINATION: hie fs gibt Li} DATE a 2 ¢ ae
bs fae st a!
~ - rg
PLEASE PRINT 5 n
FULL NAME: Opphy're LA fe } OA FSS LE i // Lp, i)
(LAST NAME) ~ (FIRST NAME) (MIDDLE ant ‘
IF NONE PUT NMN)
ADDRESS : fZ 20 (Apaty Spd Sy LD ves AFL ff Ad 2TA
Number Street _ Direction “(Apt. ae ive State Zip
que,
I certify that I am the above individual taking this examination. I understand
that if it is later established that I have misrepresented myself, I and the
person being misrepresented will be permanently barred from City employment
and may be prosecuted by the courts. If either is already employed by the
City of Atlanta he may be subject to eee ee
r i
SIGNED; Ere Better Af ~~
Spay . CO SEEN. VY
Chk (flint Chin \
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