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I .MPLOYEAS NAME MAILING ADDRESS---`—_« 551 /yl'CODE <br />Maplewood Police Dept 1380 Frost AV U <br />H <br />Ve <br />FROM 1979 TO 1981 <br />.,Communications Center Supr„ <br />LASTSALARY FU LL TIME ja <br />PART TIME R <br />I1.I4III Runny <br />Prev. Coordinatorl Lt. Dalmo <br />011 LEAVING <br />8. returned tN— <br />EMPLOYER'S NAME MAILING ADURESS 71P .:JOT 111 lPlllllll 110 <br />_�aPlPlanod Poltte Depi.—�3@O�t�stJ1Y---_ _ _ • 55109 1y71.0191_..... <br />OSITION HELD DUTIES PERFORMED IMI•IlD IiUPl IIy110F <br />Patrol Su ervisor midnights Lt, Delmont <br />-�Dr-0eant�nve axe. -!! -(• -- ) - - - - - <br />MPLOYMENTCATE$ LAST SALARY FULL TIME HEASON F Oil I I AVJIII <br />• ROM 1978 TG 1919 __ __ PAlii 11MC (] (_.Promoted. to Admin(stritho-TOAtIM. <br />MPLOYER'S NAME <br />MAILINU AODnf SS .�« <br />FIP 1'llUf <br />65109 <br />1NIf NIION <br />777.01 <br />Maplewood Police <br />Dept 1380 Frost AV <br />•OSITION HELD <br />_ <br />DUTIES PLnFORMED <br />IMMIII Iu"M <br />Sot. Col <br />Patrolman <br />•RAPLOY''DATES <br />LASTFULL <br />TIME <br />III ABIrI f11 if nylnq <br />,ROM TO 1Q%n <br />8jjM_i`ar`PA1T11MEQn <br />—M <br />_ <br />_ . Promoted <br />to Sernganj.__._..�_ <br />'.:AY WE CONTACT YOUR PRESENT EMPLOYE II YES NO II Ilq P11 Asl 1 H'I. AIN <br />:THER EXPERIENCE/SKILLS <br />LIST ANY UNPAID Won S, VOLUNTEER EXPERIENCE, 011 AIILIIAnY DUTY NOT MLNTIOIIEO AROVL THAT MAY RLLATE 0 THE POSITION <br />FOR WHICH YOU ARE APPLYING. INDICATE TYPE OF ACTIVITY, YOUR 001", DATES INVOLVED HOURS PER W/EX, AND NAME DF <br />Ifni NAA CtAfPC NAvv 1961-65 honorable Discharge (Vietnam Service - 3 commendations) <br />Lions international, East Parks Lions (Board of Directors) (3rd Vice President) <br />OR EXPERIENCE WHICH RELATE TO Till$ POSITION <br />!riff Irlashinoton Co, 1969-70 (11ei <br />Forest Lake Police Dent. 1968.69 <br />UST THREE PERSONS W140 ARE NOT RELATED TO YOU AND WHO HAVE DEFINITE XNOWLEDGE OF YOUR QUALIFICATIONS AND FITNESS <br />FOR THE POSITION FOR W141CII YOU ARE APPLYING. DO HOT IIIPPAI NAMES OF EUPEnVISOnS AUOVE. ^ <br />FULL NAME AGORIII INCLUOINO CITY, STATE, EIP CODE BUSINESS Oft OCCUPATION <br />Kenneth Victor Collins 1380 Frost Av Maplewood 65109 Maplewood Chief of Pol <br />Robert Reistad 1544 Winchell St Paul 55106 Retired Contractor <br />Oren R. Durckhardt 1454 E Hoyt St Paul 55106 F.A.A. Engineer <br />I HEREBY CIRTIFY THAT ALL ANSWIRS TO TITS ABI)VE UUFBT1041 Alit TANS AND I AOH11 AND UNDERSTAND MAT ANY FALSE <br />STATEMENTS CONTAINED IN THIS APPLICATION MAY CAUSE REJECTION OF THIS APPLICATION On TERMINATION OP IMPLOVMINT <br />WITHOUT NOTICE OR 11NIFITI, <br />APPLICANT'S IIONATUIIE 1 tSevuaae�--..L--- DATEy <br />FDA INTIRVIIWIR'E UIE ONLY <br />`mow+ <br />