[180-10060-10463.pdf — page 23]
Describe Employment Experience On This Form. (A résumé is not a substitute for this form and will not be made a part of the application, if more than 2 pages.)29. PART-TIME And SUMMER Employment During The Last Three Years.| Name of Employer | Dates | Salary | Position and Duties || ---------------- | ----- | ------ | ------------------- |30. FULL-TIME Employment. (List Most Recent Experience First.)1. | Dates of employment (month, year) | Exact title of position | Annual Salary                      | Name of employer (firm, organization, etc.) and address (including ZIP Code, if known) || --------------------------------- | ----------------------- | ---------------------------------- | -------------------------------------------------------------------------------------- || From 3/75 TO PRESENT-TIME 6/75    | Supervisor              | mo. Starting $ 650. Present $ 810. | Foremost Insurance Company 100 Wiget Lane Walnut Creek, CA                             || Name of immediate supervisor | Area Code and Phone No., if known | May inquity be made of your present employer regarding your character, qualifications, and record of employment? | Yes ☑ No || ---------------------------- | --------------------------------- | ---------------------------------------------------------------------------------------------------------------- | -------- || Tom Edwards                  | 415/934-1400                      | Reason for wanting to leave                                                                                      |          || Description of work ||---||| Directed contract and licensing activities between Co. and its agents in 12 western states. Developed new filing and record keeping systems; wrote department manual. Supervised 5. |2. | Dates of employment (month, year) | Exact title of position | Annual Salary                      | Name of employer (firm, organization, etc.) and address (including ZIP Code, if known) || --------------------------------- | ----------------------- | ---------------------------------- | -------------------------------------------------------------------------------------- || From 5/72 To 2/73                 | Executive Secretary     | mo. Starting $ 600. Leaving $ 625. | Celestial Arts Publising 231 Adrian Road Wa Inut Creek, CA                             || Name of immediate supervisor | Area Code and Phone No., if known | Reason for leaving                                           |     || ---------------------------- | --------------------------------- | ------------------------------------------------------------ | --- || Harold Kramer, President     | 415/692-4500                      | moved from San Bruno to Moraga (approx. 35 miles from office |     || Description of work ||---||| Handled all correspondence for President/owner. Responsible for distribution of new products and product info. to national mktg. staff. Reviewed material submitted for pub. consideration. |3. | Dates of employment (month, ycar) | Exact title of position | Annual Salary                      | Name of employer (frm, qrganization, etc.) and address (including ZIP Code, if known) || --------------------------------- | ----------------------- | ---------------------------------- | ------------------------------------------------------------------------------------- || From 4/70 To 6/71                 | Legal Secretary         | mo. Starting $ 435. Leaving $ 500. | Fabian & Clendenind (law firm) 800 Continental Bank Building Salt Lake City, Utah     || Name of immediate supervisor   | Area Code and Phone No., if known | Reason for leaving            |     || ------------------------------ | --------------------------------- | ----------------------------- | --- || Sanford M. Stoddard (deceased) |                                   | moved from Utah to California |     || Description of work ||---||| Prepared legal documents and correspondence for senior partne Responsible for ordering all office supplies used by staff of 22. |4. | Dates of employment (month, year) | Exact title of position | Annual Salary                     | Name of employer (firm, organizanen, etc.) and address (including ZIP Code, if known) || --------------------------------- | ----------------------- | --------------------------------- | ------------------------------------------------------------------------------------- || From 1/65 To 1.69                 | Legal Secretary         | mo Starting $ 385. Leaving $ 425. | Office of the Attorney General Salt Lake City, Utah                                   || Name of immediate supervisor    | Area Code and Phone No., if known | Reason for leaving                 |     || ------------------------------- | --------------------------------- | ---------------------------------- | --- || Attorney General Phil L. Hansen |                                   | end of Mr. Hansen's term of office |     || Description of work ||---||| Assigned primarily to criminal division for preparation of pleadings, briefs and correspondence. Also substituted for receptioni and on telephone desk. |31. REFERENCES. List three persons who are NOT related to you and who have definite knowledge of your qualifications and fitness for the position for which you are applying. Do NOT repeat names of supervisors listed under Items 29 and 30.| FULL NAME             | PRESENT BUSINESS OR HOME ADDRESS (Number, Street, City, State, and ZIP Code) | BUSINESS OR OCCUPATION                    || --------------------- | ---------------------------------------------------------------------------- | ----------------------------------------- || Byron L. Fisher, Esq. | Fabian & Clendenin (see 3. above)                                            | Attorney                                  || David Hinds           | 763 Sixth Ave. Redwood City, CA 94163                                        | publishing                                || Robert L. Hartesty    | 601 Colorado Street Austin, TX 78701                                         | Asso. Deputy, hancellor. U. Texas, Austin || CERTIFICATION                                                                                                                                                                    | SIGNATURE (Sign in ink) | DATE SIGNED || -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------- | ----------- || I CERTIFY that all of the statements made in this form and in any attachment are true, complete, and correct to the hest of my knowledge and belief, and are made in good faith. | ![Sign]                 | 9/13/76     |