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CARL THOMAS MACY,
Plaintiff/Petitioner
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNlY, PENNSYLVANIA
v.
NO. 95. &- 7)
IN CUSTODY
CIVIL TERM
CARRIE ANDREA SNOKE,
Defendant/Respondent
AND now, this --.L -:l,'th day of -(-- (I.... , 1995, upon consideration of
the attached Motion, it~hereb"y directed that the parties and t eir respective coun~1 appear befQre
l=)L'" hP.t 'J...' b\\~/ t ';}'/. ,the conciliator, at LIth t:..1ODr Lv-Mh.
C-" ( 0.... (-\ho~' ~I' ,on the ? I S t day of (\/)...... r r.., ,
1995, at <;?"\<,u o'clock -4-. m. for a pre-hearing custody conference. At such conference,
an effort will be made to resolve the Issues In dispute; or If this cannot be accomplished, to define
and narrow the Issues to be heard by the court, and to enter Into a temporary order. All children
age five or older may/. also be present at the conference. Failure to appear at the conference
may provide grounds for entry of a temporary or permanent order.
For the Court,
By: -W,-~~(I-Y ~J~~~.
Custocy Conciliator ~
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A
LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH
BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Office of the Court Administrator
Courthouse, 4th Floor
Carlisle, Pennsylvania 17013
(717) 240-6200
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EXlnBIT "A"
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IN THE COURT OF COMMON PLEAS OF
CIVIL ACTION - CUSTODY
COUNTY, PENNSYLVANIA
10
, CARL THOMAS MACY . No.
.
Ii
vs. . Attorney I.D. No. 16532
Ii .
liCARRIE ANDREA MACY .
.
I,
i STIPULATION
Ii
II AND NOW, this day of , 1992,
it is hereby stipulated and agreed by and between Carl Thomas Macy,
,i
Plaintiff, and Carrie Andrea Macy, Defendant, as follows:
"
II 1. The parties shall have joint legal custody of their
!!
, two children: Carl T. Macy, II, who was born on January 30r 1985,
"and Mallory A. Macy, who was born on July 31, 1986.
I!
2.
Defendant, Carrie Andrea Macy, shall have primary
I
;: physical custody of the children.
II
3 Plaintiff, Carl Thomas Macy, shall have partial
I/PhYSiCal c~stodY of the children as follows:
1/
I!evening and ending on Sunday evening.
I
I
IChildren during each year which ends with an even number for the
entire Easter break (that time the children have off for Easter
livacatiOn), July 4 and Thanksgiving and Plaintiff having the
children during the years with an odd number for the entire
I,
"
I,Christmas break (that time the children have off for Christmas
,
I vacation)r Memorial Day and Labor Day.
I
(a)
Every other weekend commencing on Friday
(b)
Every other holiday with Plaintiff having the
"
Ii
I!
I
i~giving notice to the Defendant as to the six weeks he desires to
~: have the children at least three months in advance.
(c)
six weeks during the summer with plaintiff
4. Both parties agree to notify the other of any change
,in address or telephone numbers where the children may be reached.
I
I S. The parties agree that this stipulation shall be
lentered as a court Order and the Court then has jurisdiction over
, the custody matter by motion of either party.
I./A_q'L
iDZ~cI-
Witness
c.~~ ./
Cl!frl T1iomas~.ey
(SEAL)
, 4- /.f~t),~
Date
(./~ I/~
,w1tn:~' /--
vlJlJJi//') 1ii/A.IIl/ tma;!f
carrie An rea Macy (
(SEAL)
-2-
11
IN THE COURT OF CO~ION PLEAS
CUMBERLAND COUNTY, PENNA.
NO. 95 - CIVIL TEID1
IN CUSTODY
fEa 7 3 41 ;'11 '95
CARL THOMAS MACY,
Plaintiff/Petitioner
v;
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CARRIE ANDREA SNOKE,
Defendant/Respondent
PETITION FOR MODIFICATION
d-=t4' /9.s-?7
l;&::#- d::J. 6 J h
FLOWER, MORGENTHAL,
FLOWER &. LINDSAY
A PROFESSIONAL CORPORATION
ATTORNEYS AT LAW
11 EAST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
( ) JAMES D. FLOWER 06272
( ) ROGER M. MORGENTHAL 17143
( ) JAMES D. FLOWER, JR. 27742
IX ) CAROL J. LINDSAY 44693
,
CARL 'l'HOHAS HACY,
Plaintiff
: IN 'l'HE COUll'l' OF COMMON PLEAS OF
:CUMBERLAND COUN'l'Y, PENNSYLVANIA
:
:NO. 677 - CIVIL - 1995
:
v
CARRIE ANDREA SNOKE,
Defendant
.
.
:CIVIL ACTION - CUS'l'ODY
COt1R'l' ORDER
AND NOW, this 10 day of ~, 1995, upon consideration
of the attacheacustody Conci1.iation Report, it is ordered and
directed as follows:
1. 'l'he parties shall submit themselves and the minor children to
an evaluation performed by a professional agreed upon by legal
counsel for the parties. The Father, Carl Thomas Macy, shall
pay $500 towards the cost of this evaluation, with the Mother,
Carrie Andrea Snoke, paying the remainder of the cost. 'l'he
parties shall endeavor to have the Father's involvement in the
evaluation taken care of near the Easter holiday so that the
Father will have an opportunity to travel to Pennsylvania once
for the evaluation and also for visitation with the minor
children as set forth below. Upon conclusion of the evaluation
and if the parties are unable to reach an agreement on a
permanent Order at that time, counsel for either party may
contact the Custody Conciliator to again schedule a
Conciliation Conference. This Conference may be done by
telephone conference.
2. Pending further Order of this Court, the Mother, Carrie A.
Snoke, shall enjoy legal and primary physical custody of
Mallory A. Macy, born July 32, 1986, and Carl 'l'. Macy, II,
born January 30, 1985.
3. The Father shall have temporary physical custody of the minor
children as follows:
A. Over the Easter 1995 holiday while the Father is in
Pennsylvania. Father shall have temporary physical
custody from 9 A.M. each day until 8 P.M. This custody
shall be under a supervised arrangement. Father's
counsel shall suggest the names of a number of people
to Mother's counsel, which people will act as a third
party supervisor during the times of custody. In the
event Mother rejects all of these names, Mother shall
have the responsibility of affording to Father a third
party non-family member who shall provide supervision
4p,f
.. 5 1.995
.I,~
CARL THOMAS MACY,
Plaintiff
:IN THE COURT OF COMMON PLEAS OF
:CUMBERLAND COUNTY, PENNSYLVANIA
v
.
.
:NO. 677 - CIVIL - 1995
:
CARRIE ANDREA SNOKE,
Defendant
.
.
:CIVIL ACTION - CUSTODY
CONCILIATION CONFERENCE SUMMARY REPORT
IN ACCORDANCE WITH CUMBERLAND COUNTY CIVIL RULE OF PROCEDURE
1915.3-8(b), the undersigned Custody Conciliator submits the
following report:
1. The pertinent information pertaining to the children who are
the subject of this litigation is as follows:
Mallory Andrea Macy, born July 32, 1986, and Carl Thomas
Macy, II, born January 30, 1985.
2. A Conciliation Conference was held on March 31, 1995, with the
following individuals in attendance:
The Mother, Carrie Andrea Snoke, with her counsel, Taryn
Goldstein of the Family Law Clinic, and counsel for the
Father, Carol J. Lindsay, Esquire.
3. The Father resides in Tucson, Arizona. He hasn't seen the
children since Christmas of 1992. The parties agree that some
type of arrangement should be accomplished to have a custody
evaluation by a professional. There was an agreement with
respect to the cost on that issue.
4. The parties were unable to agree on how to handle some type of
temporary custody with the Father pending further Hearings in
this matter. The Conciliator recommends a custody arrangement
as set forth in the attached proposed Order which should
address the concerns of the Mother with respect to providing
supervision for the Father during custody.
t//5!lfr
DATE
I Judy Magray . ADDRESS CHANGE
Page 1
From:
To:
Date:
Subject:
Karen Hecox
JUdy Magray; Marla Leon
12/5/00 5:49PM
ADDRESS CHANGE
The following Is an address change for Carl Macy:
810 North Alvemon
Tuscan, AZ 85711
Ph: (520) 795-2918
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,'''',~ ."::.' .:~:t'~;~"~I~~~"~ \.\~~g~JI.tl:'~"t:~W \~~~},- .. .: ~~ .~;;'~~~.~--+..~I..:J'~;~~~r~.;~"if;-,: ,," ::'t:~~:"~~"'!;;.'.1
..JI'o,.:"'I" '~,"~~'::~iTi,.~~~ ,,~~j!'.itf ~.(~; ~~,;. ;;:-~....,.~~..,~.:t.~J.~:fi~'" . \0. ;!-rJ;~ ~;;....~'r~~~'~,;)~,,1;~ ..... /"r~:...;tSI~'. :::~. :':'.
'. ,.....,~ ~ l';-r'~'!~~~"""~l ~.Af;l~1.:~:'~~/,(5 1 l' f).~C{J'l.~"'i' '~~~~ENTE'" -~,,~l~~I':r;,....Bv~~t.P.:~";":\":~/r1"~;tt"'&;~'....; ~ r,: ,.,
..".' .";," ,.: ,.,;..~ ,,(".,.,,!'1,./,.,;'<_f;;~...,.,i'.,.,l ';...~i!") RED'SEP 2..9'1999,..,' I.'..,'~'.'" n
. ' !'" -T'".:~'~::."'.,;'.-;;,:';::~~:!"':.:.""..<,:-:;'~,M':'" ":':':';".\~~,'~:':;";' "~ " ':---'
IHI 101 "It... I~I''''
As of Pay CI.1iI'
Printed
ADP
10
4684
02119/99
oetl0/99
$ oyer GUA
FIT Hire
Dale
STATUS
Lo.
...,allon
Oale
Descrl lion
Accrual
Avail 311199-12131/99
Vae Days ~s
ACCR 00 Ava'lJ'-......
10.00
Days
Taken
Days
Remain
.': ~ ,~~~rf2.f} :$WiWt%~.
10,00
10,00
Acerual
M/\lWllltlll$k', lii$iirt'riIWi:
TOTAL
0.00
'" 'x' ,: .""\~t%~~t$$:#l ':~fhttitWl_ 'i~%~~fti~M%~ tW$0&hW#iMi tWMr'.'
10.00 10,00 0,00
"_'~_'''Y';;i,"Ji;W,*i'**~!li\'l'''''''''_''''''''''''~''''>%'''-'~''-''''4tl'lt~*ti\.'>''i",,s.-'
.....,: .m~~~~~~~''!4#,~~~,~~:H.it.::l.l:,..~~,*~~~l?~~~:;;-~;:~w.:.-....,~x~..,,~.~,:x:>>'m(::.m::m1$
Days
Taken
_;i\kWA", "''''W~;~~~~:~~:'il1%iM&tt~l!idmt;;;;';I~~i:7~~;~~\~tI1MCREW* wa:li~1~,f98!if
'".' :~J}t~~ ~tow~$;@ti$'~if4Mt"4*:$tk~: :: ?~, ;~.:':;"" ':rJ.#.U~:*$MKMtt~?-@%l&~Ji:m#'m$'" :.:" . :_"~:,:. ....:. .
~mfi1,_~ii$Rf@_r&l%illr;;j!fJifM%@_:, "."i",~:tM111..-.*#lMjHmW$1\~!tw~~
Dale Hours Hours Hours Hours
Descrlnllon ACCR 89 Avail Taken Remain
Accrual Avail 07/31-12131197 10,07 10,07
Accrual Avail 01101-12131198 24,00 34,07
SIL 1 1115$198 0,00 34,07
Accrual Avail 01101-12131199 14.00 14,00 48,07
SIL 5/1/99$
~itN* liijm>ioW~tJ%\$W*MW;iJNi~I!&W$I*MR% 4J;W1A\iWiiM\# '*ltM~ I~~
:;;t:.:__' ,.':0: "'<'__'" __' .n',__'" '
TOTAL I 14.00 48,07 0,00 48,07
mwl!l!ii1#1""'mwm'iWfmOOlOOtlWijNWiiW\m&Jllmi$fMJ\fw, " "~ilil-'.,$,_~
".'..,. .. ~,."4t~.>>;,:",<.~,,. . ,:, " ...,.",." ~". w~ ..t~,L:" :<,/~io .~., ,,' .' V,"_ .. ..
Dale Vac Days Days Days Days
DescriDllon ACCR 00 Avail Taken Remain
Accrual Avail 07131-12131197 5,85 5,85
Vae 10107-10119198 5,85 0,00
Accrual Avail 01101-12131/98 14,00 14,00
Accrual Avail 01101-12131/99 8.19 8,19 22,19
Final pav Resloned 7120199 22.19 0,00
w~t*:t:&Vih:'\~W fMeit:iOfttt#~~g;f~:f~Wt,'Ui%~~~:;hS~:~;,:Ki~li~.$.i ,$#4f.$MiM$?$ *}j~1HWif~~\htj: $iMttk$$~ m,'1M\%l'.***
TOTAL 8.19 28,04 28,04 0,00
~S@~]:~;~>:~"'i$*:ti~a~~%l~{@tW%]WW#.Yf.Pli\~jWCCAVE//:;OTHER@~$~@EM;'$1n*WM~1:1~~@:~@@1i#lli~.wjf.*'~~{t~.
',Y.-. ....'-"".".,~~%..~~.,.'" l.,W"w.-~<,."..A"J.""":''(.,,''''''''''<~'f;,.,,,. ',,',''', ,,__',''', ,,~,: ",,' ,,' ".,.,.""".(.:::.",..""..,,,,,*.,,..x._...~:-;,,.,~,,-:::,.,~..,,->>-,;-....,.,...,., B:.,.". w:.~~,.,,, ,;l.,."
Dale Days Hours
Descrlnllon Taken Taken
VLWOP 110119198 Ume used ~ ~ 4,80
.gW~~~:W.t..r$l%~
TOTAL 0,001 4,80
~~......
(G) POLAR AIR CARGO
......;I"JI?
.
PERSONNEL
CHANGE NOTICE
~ NEWt STATUS
SEPARATION INFORMATION
DEn CODE ,,,y CODE H[WHIRI:
....SE RAff; A[.KIRf
LOCATION RECAU. rAO"
FURLOUGH
JOB YlTlt
SALARYIRAt[
CHANGE
TIlANSfER
SICK LEAVE O""$lHOURS USED Sltll. UAV[ OAYS/HAS REMAINING
SICICLUVE
...ACA'ION O...'SMOURS USED VACAnON D"YS/ttRS REMAINING
VACATION
lASE "ATE
LOCATION
JOITlTU
DAYS HOTICE GIVEN
ELIGIBLE rOR REHIRE
R[ASO", rOA U.....UTlON
. NEW ADDRESS .
HV/olIIU AND "REET
PHONE HUNIER
TE....ORARY
LEAVE WIO ,...y
elll
STAt[
ZIP CODE
EUEHDED LEAVE
WIO'",
RETURN TO WORK
VOLUNTARY
TERM'NATION
DISCHARGE
fURLOUGH
REDUCTION
CHANGE or
ADDIlESS
OTHER
, ~ j .
0.... '-,' ~ . ~-;"""'_.II' .,-~... ....,v.......,-...-..~.....-. .~r....'. ~.--. ........ ..:"'. e....... .... .,."...... ...." .... ~.
F.ICE USE ONLY' '.' : ","'J ....; 0" ';!..'.'I' f. .?':'>-.l.....!t~ ~"';t"'.t:. t. :4; {,1 ;.t'~ \. .:. .~': "': ~.,\,\ .,....':.r..,,_.'/~~ ,... ,...., ~~ '--:i'\IO,,~";~\., r.l
'.. ;:.........1)..; '"",'. ...':,.....\'...tt;..4.."~1-~.r' .;"~.\,:;...,;-.'. ,-'. .4t' ...:,<;....~.,.... ~ I ;""I'~.\'~:"" ........".~~;" :~1..''"...<l...5''.
.....,' ',..l.(i'ol"l".~ '-. ..,.,.r~ "':.1.'':j:.,,~ Y':~~" '",'.'~~i::"'..,.:. ~;-.' .'f', J '. '..1' '.'~r.'" 10,',(' "'..':of '.4' ..~\. !. I I.!,,~f~'rl~"': r Y.l:,~", ~~. ~. .'.l........I':~:. "..u..~ .I.~~
",'.. ..'.:;. .." ..tHW....i"': ~ ...... ..,,".I'f'~"..J "'\:r~"'''l l...f. "..<'f'_ \......., ,.'t..-.; ,\~.r:..a'....("""
",t. .... '..' 't.;.c'~ .t~ ~l'l'lIo.. '.... .':"",'l-<:,\!...-,. t;.:" ',' . "'V.....-.I ~..... f " .: l..... ...,' --..., ... /.. '1' I., .t~ .. "'.01
..:0 ..,...." .~r,":,....,"',<..if.'i':....:.,','~"'..'(., ..~.'."'~ENTERE' ..' ,> 'D..."..A'Y..l.)l'1999..'" ;.<::i!t!:'!i.r'.:l
'. I .' .,' '..~ 1.l.,.'1"~~".'f"f..~!'~'_'..-I,'::lf~1f~:~ ..... ".4" In ,.' ,,' I. ... .~--!.'~..l:~,)~
. '.l ~. '. Of;,'. ,':;. . '., -- '.fi..., . . (, .' .....~} ~ '."
..,";i ..... >," ,'. . ..,. ~V ".,' ~:~!~.-.
Ilflfll.',At>' llf'J71
''','L'"
PERSONNEL
CHANGE NOTICE
~~........
(m) POLAR AIR CARGO
,,~I
.
,"LUS[ OPE OR "RINT)
I.....LQ.U NO.
.'.:k~y' "'Sl1t;1~L
STATUS EFr OATr.
HIW HlI'l
'r/yj'?
ME,HUII
LOCATION
LOCATION
IIECAlL '"0'"
'URlOUGH
JOI Tint
JOI1'lTLI
IAUIIMIATE
CHANGI
. SEPARATION INFORMATION
TIIAN!lru
DA.S HOTlCE GIVEN
EUGI8LE 'OR REHIRE
SICK LEAVE DA.S/HOURS USED
SICK lEAVE DA.s/HltS IIE...AINING
liCit lEAVE
RUSON 'OR U"AItATlON
VACATION DA.SlHOURS USED
VACATION OA.5fHRS RE...AINING
VACAfIO,.
NEW ADDRESS
NUMeu "'ND STREIET
"HOHE HUM,ER
u:.....OMA'n
LEAVE W/O "A.
en.
SIAn
II" CODE
(lTEHDED LE"'VE
w/O......
RElUAH 10 WORK
t4/.PfA e;./~ q;; :.?...../V/..-v (
VOlUNTAII.
TUMIN"'TlOH
,r.
..........)
-"":', .~
, \,.......
.. .
,I'.,
\....
OllCH"'''OE
'URlOUGIl
"',QuCllOH
3-1
CH"rtGt 0'
"DORUS
D"1I
owu
"ERSOHN[l
D"IE
FOR'ciF CE ~~j~~" \ ,,";~.~'-~~J;n;j~r.~~,):~lrr~.;'''''\~,'.-' f":~ ,;,I...~".,4 "':r-',...~:.,~~",, .">.~,:/: ,",.".. 'I "./~~f''''{~(,i..l(,
. tl . '.. \'j..~.~. l:"l ~",., '. . -',..~ {'( *,'" Ii" ~ ;.{.' '~.{ .,'!; .....
....,~~~. ;,~ 'I,,'. <,','" ~'~o~"":r~;!.." !.t~;,<o:-',;:(;: 1 C,:. 0..",7...r.~ '~"'".I\: "~"';i f!. tri"'~ .J'"Pt...J ".i1j'[.:~ W 4'
" ~(.~-r". + ~,'\~ll~~..tt:~:r~);j:t"'!f~.;:"~ ;.<)(,~~:,.~;:''': ". '.,:.':' i.: ;'''~~~'.'4h~ "1';-4*~1V., t...~~!~ "" ~:I.<!~::,~~~",,,,;, ,," t&l~\ r;'!1 '... I ("
.. '..'t-' k"#I(U,;.1 '~~'1'\'1""" ""'J~~'.;:J"'/jfttt,,;tWJf....,.l,"~f;t~"'f ..... .~ .:,,1 ~ /.,. ..-;.. ~A~~'M'.,,' '~'Y'...~\,,:,,/'.'... '1>''''' .",. if:.l)~-'''''');I~~'fi'~!I. 1.,1
.I-'(~ ).....~'i~~f;,..~I.:(~~...H~:. ,!.t;{:fwJff,':,!J;, :.!'''~r'''',,\'' "'~ AJ~t~I'>':" ,.\ ~,~ (', ~.,../"" . "lltJY~; ""v~.P,'.t\TI ~ l,;' .". .. .... . .jII,H f.. '\......t\',~1I: ~i
',' ',. .~t.....:....::,t'",~:, ~'.... '.,,'..,.~;'~""; '.,-~\. .. ... " ..':.. : .""1"1"" .,'" ',~ /", '
"'\I,~",,,,,v"""'~'''~'~I~'''''''(.''''::\~' ...:...... '. I" ',.\ ~.' ..," -- "f't' 1" ,,~~'"
:,\,. -.~"."';",j :J::';',' -: " ,:.-~:.~~~~..~;~~>' ....i~.':. . ". .. ,,:.: .. . 0 r, '.
., '0"" ..'
IIlIllll,"'''' 11'1"
P....on.. A1lowancos Worksheel (Keep lor your records.)
A Enler "1" fOt yourself if no one else can claim you as a dependenl . . . . . . . . . . . . .
{ . You are single and have only one Job; or }
B Enler "1" If: . You are married. have only ono job. and your spouse does not work: ot
. Your wages from a second job or your spouse's wages lor the toIaI of both) are $1.000 or less.
Center "1" fO/' your spouse. But. you may choose to enter -0- If you are married and have enher a worldng spouse or
more than one job. (Entering -0- may help you avoid having too li"le tax withheld.). . . . . . . . . . .
o Enter number of dependents (other than your spouse 0/' yourselO you will claim on your tax retum. . . . . .
E Enter '1' if you will me as head at household on your tax return (see conditions under Head of household above)
F Enter 'I' if you have at least $1,500 of child or dependent care expenses for which you plan to claim a credit
Q Child Tax Credit:
. If your total income will be between $18,000 and SSO.OOO ($23,000 and $63,000 if married), ent... "I" for each el
. If your total Income will be between $50,000 and $80,000 ($63,000 and $115.000 if married). enler "1"1f you 0
eligible children, enler "2" If you have three or four eligible children. ot enter "3" If you have fIVe or more eligible children. Q-
H Add lines A Uvaugh G and enter talal here. Note: This maybe diffetenl Irom fhe numberal exemptions yau claim 011 yo<1I'tax l1!/Um. ~ H_
. If you plan to Itemize or ctalm adjustments to Income and want to reduce your wllhholding. see the Deductions
and Adjustments Worksheet on page 2.
. If you are single, have more than one jab and your combined eamlngs from all lobs exceed $34,000, OR If you
are married and have a working spouse or mare than one jab and the combined earnings from a1t jobs exceed
$60.000. see the Twa.EamerlTwa.Jab Worksheet on page 2 to avoid having too Ii"'e tax withheld.
. If neither of the above siluatlons applies, stop here and enter the number from line H an line 5 of Farm W-4 belew.
Form W-4 (2000)
Purpo... Camplell Form W-4 10 your employer
can witIlhold the eooect Federal income tax
lrom your pay. !leuuse 'fO'J' tax situalion may
chang., you may wanlto ..r'lluro your
witIlholding oacl1 yoar,
Ex.mpllon from withholding. II you are
..omp~ complet. only lines 1. 2, 3. 4. and 7.
and sign the tonn to validate it. Yovt exemption
lor 2000 ..pites F.bruary 16. 2001.
Nate: You e.",.,' claim exemption from
-11 It fl} your Income ..coed, S700 IlId
/nclIdoO mono ftwI S2SO 01 unearned ..,eom.
(..11.. Int""''' _ dMdondsJ _ (2) IlIIOlhor
penon can elalm you .. . depenclenr OIIlh.1r
tOJI rwlUnl.
Betic Inltrucdan.. tf you are not exempt.
complete the Penonaf Allowance. Workshut
below. Tho works/lHts on page 2 adjust your
witIlholdlng a1lowanc.. based 011 homlzed
For accuracy,
complele all
wor1<sheets
that apply.
dod_, ad~ 10 Incamo. or
_ltM>-jab IilualionL ~let. all
warkshools that apply. 7hoy wII help you figure
1M ....- alwi1hhald1ng aJIawsnc.. you ora
entitled 10 claim. However, you may dalm
1._ (or zero) a1lowanc...
Child laX lInd higher education crwdlb. For
d.teils on adjusting witIlholdlng for 111_ and
other c:rodits. ... Pub. gIg. How Do I Adjust
My Tax Withholding?
H." 01 household. Generally. you may claim
head.ol household filing status 011 your tax
r.lum only W you are uMWried and pay more
than SO,. 01 the costs of keeping up . home lor
yourse~ _ your dopondenl(s' or ather
qualifying individuals. See Ilno E below.
Honwage Income. If you hI.~ . large ImOUf1t
of nonwage income. such .. interest or
dividends. you should considor maldng
estimated tax payments using Form I040-ES,
estimated Tax for Individuals. 0lheIw1so, you
may OWl additional taJc.
.... .omonItwo Job.. If you have I wort<i1Q" '
__ or mare than .... jab. fIgwo Ihe Ialal
number 01 aIIowlllCOl you arl entltlod to elUft ';
on all jabe using -. fram only one .
Form W-4. Ywr witIlholdlng usually wi. be ~
aceural. _ all _anc:" .... c_ on
the Form W-4 proparod la' the hlghosl paying
job and ."" .lIowances are elalmed lor tho
others.
Check your withholding. Mil your Farm W~
lakes ."eel. use Pub. 9,9 10 ... how the dolor
amount you ora having wllhheld comi>aros 10
your prajoclod loW lax for 2000. Gel Pub. 919
..poc:laIIy H you used tha Twa-EamerlTwo-.lob
Wurkshotl an page 2 and your MmIngs
oxeotd SISO,ooo (Single' ot $200.000 (Maniodl.
ROC:lnt name eh_.? II your name an line 1
diffors lrom that shawn on your IOdaIlICurity
card. call 1.800-772-1213 lor. now soclaI
security card.
. -A
B
C
D
Cut herw Ind give Fonn W-4 to your .mplaye,. Keep the top plrt lor your record..
Employee's Withholding Allowance Certificate
Fonn W-4 I
0IIl_1o._4 olIN r,....,
...... ....... SoNa ~ Far Privacy Act .nd Paperwork Roductlan Act N lice.... pa
I ' TYI'! or print your /ltst NmO and _ Ir'OlIa/
and~l or nnI?,AI'
~". Slal.."..,ZIP.-
,q~.f)q!/ ;Z,
5 Talal numb... 01 allowances you are claiming (from line H above OR from the applicable worksheet on page 2)
6 Additional amount, H any. you want withheld from each paycheck. . . . . . . . . . . . .. 6
7 t claim exemption from withholding for 2000, and I certify that I meet BOTH of the following conditions fO/' exemption:
. Last year I had a right to a refund of ALL Federal income tax withheld because I had NO tax liability AND
. This year I expect a refund of ALL Federal income lax withheld because' expect 10 have NO tax lIabill .
If ou meet bolh condilions. write 'EXEMPT" here. . . . . . . . . . . . . . ~ 7
Under penalties of perjury. I Certlfy tN.t I am entitl~pr lhe~bef W\thho&ding al'owaN:es daim8d an this cenrrlClle. Of I am entided 10 claim exempt stiluS.
Employee'. signature ~, /-1~,
(Form is not valid L_ /
unless you . n ~l ~
a Employe(' "'"" and Id<nss (Employer. Campi ,. ""es 8 0I1d 10 only ;1 send;"g to "'" IRS)
Dat. ..
g Oftice code
(opllo....,
Cat. No. 102200
~~"
{~, POL.AR AIR CARGO
-...;.:..l
AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS
Please read this form carefully and write clearly.'
If this is a new account, you must:
1. Already have the account set up at your bank.
2. Find out if they accept direct deposits. Verify bank's transit number and your account number
(including dashes).
3, Notify the bank that you are going to set up direct deposit through Payroll. Make sure that there
is not anything special you need to do as far as Ihey are concerned.
Please check the action and fill out form below:
o Canceling account (complete item C below). Do not close account unless you cancel it
through Payroll first
o Direct deposit already set up, Changing S amount only (complete C through E below).
o A new account (complete A Ihrough E below),
o A new account to replace a direct deposit already set up (complete A through E below).
Which account are you replacing?
o An additional account for direct deposit, ie: one account for partial, second one for net
(complete A through E below)
A. Bank Name tcJE'/k ;Z:;;-R-bt"'J
B. Bank TransiURouting # for direct deposits: 000000000
C, Bank Account #: ~!lIrz;) all B1BH3Il!IlIDlII 000 DO 0
D B" Checking 0 Savings
E, 0 Full Net Deposits 0 Partial Deposit (amount per payroli - not %)
. Please relurn to the Payroll Department with a voided check from vour checklnQ account
or a deposit form from your savings account.
. The process of establiShing a direct deposit takes two (2) pay periods,
. I authorize Polar Air Cargo and the bank listed above to deposit my net payor portion thereof
as indicated above into my account each payday.
. If funds to which I am not entitled are deposited to my account. I authorize Polar Air Cargo to
direct the bank to return said funds,
. I acknowledge and understand that Polar Air Cargo cannot guarantee the date on which my
paycheck will be credited to my account. I am responsible for verifying with my bank. the date
and time of ACH transfer credits, I am aware that funds are wired the day before each pay
day and that it could lake one (1) to tree (3) business days for my account to be credited.
/? ~
\..s~...~
~ -.2. <2- 99
Olle
tOOC-:C"1"~!. I"" '.:10' + L:I".. 1(';",:4 lC,~C: U i' .. r(~ ""!, "J~'."~l .. '.I, ''54:. ")4.11J] + ,,~. '1':;"""_,,
OfC-OI-1III al141PM
PROlI-
r"" TO
O"'j
T-114 p.aal/aal
~e~ 6 z. 4 -z:r::rr
rom
~< It::
J~'
(~)
~~
POLA.R A.lR <:ARGo
AUTHORIZA TION AGReEMENT FOR AUTOMATIC DEPOSITS
.
Plea.. rud Illis lorm cllfllrully and wrtte clearly.
1/ rhllllll a new accolln!. YOII mllst
, Already have me 'ccount let up Bl yOur bank.
2. Find eM if 1hll'/lICCept direct dopOcits. Verily bank', Inn,il numbsr and your aCcount number
(/ncluolng daenllll).
3. NotiIY the bank IIW you are going 10 set lip direct depclitlhrough Payrall. 1.I1Ika Iura lhallhcra
la not aflylhlng apedal YOII nced ta do u C::Ir 11$ IIllly are conclmed.
- -
Plaa.. chick tho action and 1111 0111 10m
-.'. . . -.-
f!.~ nur u;-
1tL<v #- tJ 7 Rl{J"s 1175'5' lie" )'QU ClII1Ce/ it
Itf/IIJ I Pl./ () (J(J ~<;/ I' lrough e below).
S-hw. PI! C?i'of' ,lhrough Ebelow).
b.Puf ?t j) j) Jew.. iCOnd one ler nat
a
o
o
.Q
CI
Canceling account (compfets ilsm
through Payrolllir1t
O~ d.pclllit already Ht up, eIlar
A new Qccollnt (c:omplela A lhroug
A new account to replace a direct c
Which aCCOunl are you rep/aelnll?
Mac!dlllOn.' account lor direct de,
(COmplata A through e belOw)
A. Bank Name W IE' 1/ (' r:-.;, P. g t!:>
a, BankTranait/RoutingIHordlreCldapoGlts: lD~jZlGJl!JriJ~ra~ I 7.. { 1) 't>(n_-I-~
C, BankAcc:ount#: f'lJri!]lm~l!Z1~ImIi9~mOD(JD[JO O;Z:Pof-8~~rS-s-
D. :8 Cne':~ing D SavinSI
e, :J Full Nel DepoSIts 0 Partial Depoall
(amollnl per payroll, not %)
· P:eas~ I'tllim ta me PlI'Jf~1 Deperwr.enl wftI1 a yarded chIck rrom "'our checklno accou"l
or 8 c!e~ca)llerrn frcr.. yOUr savln~ aCCOunt
. The precess 01 astabliahlng ;a dlract oeposlt takes NlC (2) pay periods.
· Ilulherize Po/;ar Air Cargo 1In<llllt IlIInk listed abQ1'8 to deposlt my nat plly or portion Ihete<ll
as Inaicatad abQve fnta my IIc:counteach payday.
. It funds to which I am not entilled are doposillld ta rrrl ac:::ount , authorize Polar Air Cargo ta
c/l'eCllt1o bank to retum aald funds.
. I acknowledge and onders:and that Polar Air Cargo ear.roOt guarancae lhe dale on which my
payelllCk Will be credited ta my account' am respons/t't (or verll')'/ng WIth my bank. IIle dais
.".0 tInoe o( ACH lransfer credits. '1m aware lIlat funds lira wIred the day t:efota eaclI pay
dB'1 ;ar.d lI:allt CO\lI<l taka one (1) to :ree (3) bullinass ceys for my account ta be credIted.
C/~~
8.~ra.... ~
r:",,~ L 'H4,.4.v
p.o."r ~~~ /
/2/ P/9.p
elll
f'
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.
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toa acc..c..... i.,. ,..,.,. ... "'''~ II.:., CA 'lno: liS" + fn. .t",. ......,..., ... '''' _,.,. 4J'.UJ) + I". ta..u#lQ
Form W-4 (1999)
deductions. adjustments Co income. or
l'NO-eamerllwo-job IllllationS. Compleee all
wCtl<sh.... IhatIllPIy. They will help you lIllure
the number of withnoldlno IIlowancttS you ar,
entitled Co ct.am. How..,.r_ you mlY claim
,'W" IlIow.nclL
Child lax .nd hl;h.r educltion eredl... For
details on adjusting witht10lding ler these and
other credits. see Pub. 819, Is My Withholding
Correel fer 1999?
Held at hausehold. Generally, you may claim
h..d ef hou.""eld mitl; .lalU. en your lax
retum only it )'Ou lie unmarried and pay mer.
Ch.n 50% ef Che co... 01 k..pin; up . home for
youmlllnd your dependent(., or eCher
qu.llfy1n; itldIvtdUal', See line E below,
Nonwag. Incom.. It you have I large amount
0' nonwage income. SUCh as incereSI or
dividends, you Should consider making
eseunlted lax p.ymen.. usln; Ferm 104D-ES.
Otherwise. you may owe additional tax.
Two lImen/two lobs. II you ha.. I working
spous. or more Chin one job, lIllure Che telal
number er allowances you ere entitled 10 claim
en all job. usitl; workshee" lrom only en.
Form W,.. Your wllhholdln; WIll usually b. moll
accurate when III allowances 1111 dalmed on
Ch. Form W.. prepared for Che hl;hes' poy!n;
job and zero allowance. II. clllmed fer Ch.
ct!lenl.
Ch.ek your wlthholdln;. After your Form W.4
takes .IIeel, use Pub. 919to see how Che dollet
amounl you lie havln; wiChheld comperes to
your estimlled lolalInnuallax. Get Pub. 919
especially II you usod Che Two-EamorlTwo-Job
Workshoellnd your oamitl;. e'Ceed S150,000
(Single) or 5200,000 (M1Ir1ed).
Roc.nt ""m. chin;.? II your nam. en line 1
dill.... lrom IIlat shown on your soclal socul1ly
Card. call 1,800-772.1213 for I new social
security card.
Pvtpo... Complete Form W.4 10 your employer
can wIthhold the COf'recl FederaJ income t&.1
from your pay. Because your tax situation may
ctwlge. you may want to rer~ur. your
withholding each year.
exlmptlon fram withholding. II you are
...mpl. complete only litles 1,2.3, '. Ind 1.
and sign the lonn to validaee il Your exemption
for 1999 ..pires F.bruary 18. 2000.
Noll: You cannal cJ~m ~empfjon from
wifMolding il (7) your income UCee<l. $700 Ind
incilK1eJ more INn 5250 el unel/l1fld income
(..g., 1r11.....,1nd rJlvldondsJ I1ld I2J anolller
person ..n claim you IS . dependenl on //lei,
tax filum.
Ballc In.truc:tlana. II you are noe exempr.
compleee the Pel'SOnal Allowances Wotksheer.
Th. workshee.s en PI;' 2 Idjust your
withholding allowanc.s based on Itemized
Personal Allowanc:e. Worklh..t
A Enler "I" tor yourself It no one el.e can claim you as a dependenl .
{ · You are .Ingle and have only on. lob; or }
B Enler "I" If: . You are married. have onfy one lob, and your .pou.e does not work; or
· Yeur wages lrom I second lob or your e?Ouse's wage. (or lhe Iotal at bolh) 87e $1,000 or I....
C Enler "I" tor your spouse. Bul, you may choo.e to anter -0- Ir you are married and have either a working spouse or
mar. than one lob. (This may help you avoid having 100 IIltle lax withheld.). . . . . . . . . .
o Enter number at dependenls (olher Chan your spouse or you....elQ you will claim on your tax return . ....
E Enler "I" It you will file as head 01 hous.hold on your lax retum (.ee conditions under H.ed ot household above)
F Enler "I" il you have alleasl $1,500 at child or depend.nt car. expenses tor which you plan 10 claim a credit
G Child Tax Crldlt · It yourtolaJ income WIll be between 520.000 and SSO.OOO (523.000 and 563.000 il married), enter "I" tor each
eligible child. 0 It your 10lal Incom. will be between 550.000 and 580.000 (563,000 and 5115,000" mllr1ed), enler "1"lt you have
two ellglbl. children, enter "2" it you have lhree or four elig'ble children, or enter "3" It you have fIVe er more eligible children. a
H Add lines A Chrough G and enter total here. Hot.: This amounl may be dilleren' from lIle number 01 exemptions you claim en your reeurn, .. H I
· It you plan to 11emlze or claim adjustments to Income and want to reduce your wllhholdlng. see the Oeduellons
and Adjustmenls Worksheet on page 2.
· It you are single, have more than one job and your combined earnings trom all jobs exceed 532,000, OR it you
are married and have a working spou.e or mar. than one jab and the combined earnings trom all jobs exceed
555,000, see lhe Two-Eamerrrwo-Job Worksheel on page 2 10 avoid having 100 IIltle tax wllhheld.
· It neither of lhe above situatlen. aoolles, .top here and enler Che number 'rom line H on IIn. 5 or Form W-4 below.
A
B -1-
c
o t
E -L-
F
For accuracy,
complete all
worksheets
Chae apply,
......................... Cut here and ;ivethe certificate to yeur .mployer. Keep Chelep part loryeur reconl.. ,........................
Form W-4
Otoanment of en. Truar.rt
""""" - ....... .. For PrivICY Act and Paperwork Reductfon Aet Notice, lee po;e 2-
1 T. Of pnnt )'Cut finl naml and ~ inibll Last name
Employee's Withholding Allowance Certificate
OMa No, 1545-1Xll0
~@99
v"'" soeJaJ .oeunty numbot
4i~/i 1S4,:L
3 5,nvlo 0 arried 0 Memed. but w;lhllCld .t hi;hor Sln;1e _.
H.lo:1.._Il<irJogxfll~or_.._..c/Iodrlllo~lla<
4 lt)'Our lat name dlfflrs from tN.t on your sociat lecunty card, check
"er,. You musl cad 1.8OO.772.12f3 fer a new card ...
5 Total number of allowances you lie claiming (from line H above or from Che werl<sheets en page 2 it Chey apply) .
8 Addieional amounl, it any, you want withheld 'rom each paycheck. . . . . .
7 I claim ..emption from wiChholdlng for 1999, and I certify lhall meet eOTH 01 Che (onowing COndition. tor exemption:
· Lasl year I had a righllo a refund 0' ALL Federal income lax wllhheld becau.e I had NO tax liability AND
· Thi. year I e.pecl a refund at ALL Federal Income lax withheld because I expect to hay. NO lax IIabill .
If au meet bot" conditions. write "EXEMPT" here. . . ... 7
U(I(i!tt Pen<ies or pel)Uty. I Cll'tlty that I am entltled 10 number~' Nltht1old~ allowances cla,med on tros certltlcale. or I am .ntltled to cl&lm ..empt statui.
Employee'l sl,onaturet2.
(Form II notvaJld . A
unless '(au '1<3" II) ... . Dale" G" Z ~- -
I Employ.,'S ".1m' and ad"'". (Etnptoo,oer. Com g OtrlCe code 10 Emptoyw idtntJ1lc.aUon number
(o~hon&l)
C.lI. No. 102200
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Cllr"~.:~ WELLS FARGO BANK
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CARL T. IIACY
PH. ~sr.B47B
TBIlS H. "'OIlA LISA, NO. 1204
TUCSON, AZ 15741
IIDIlIID
I: & ~ BO & &1'1&1:0773 0 7 ~8 ....S30Sh.
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2438 E. 23rd Street
Tucson, AZ 85713
(520) 292-9758 home
(888) 502-5633 pager
Carl T. Macy
OBJECfIVE
Professional Flight Engineer
4,500 hours 00 \~ \019
\,\ ./\
..........." /
L-188, L-382, DC-8, B-727, B-747
FLIGHT TIME
AIRCRAFf FLOWN
CERTIFICATES
TRAINING
Flight Engineer B-747
Flight Engineer DC-8
Flight Engineer L.382
Flight Engineer B-727
Flight Engineer B-188
PROFESSIONAL
EXPERIENCE
09/95 to 09/98:
Flight engineer for Southern Air Transport. Served on the L-382,
DC-8, and B-747.
07/77 to 09/95:
Flight engineer for U.S. Navy, active duty and reserve. Flewanti-
submarine warfare, drug interdiction, and fleet support missions.
02/93 to 09/95:
A&P Mechanic/Contmctor for Tucson Aerospace, Lockheed,
Dynair Tech, McDonnell Douglas
PERSONAL
Excellent health, willing to relocate, available immediately
I.~""""
\.~) POL.AR AIR CARGO
~........
!?LEASE PAINT)
Polar Air Cargo
AlJtJlication for Employmerll
DATE OF APPLICATION
"ersonal Data: 0 Position not available (HR onl,/)
,ame: Lasl ~c..V FirSI eA~L -......liddle;~.J.f4~5SociaISecurity#~.f.1/I.f?~ Z
7 ,lUluvA "'KZO'f-
'ddress: Slreet -;Z:r?~ A..&'~ ~/S.# City -r-;.It"!.5dd Slale and Zip Code ~ ~~4:/
"~Iephone: (Check which preferred) ~Home: (52D) 5'3 I c:z,1+(o 0 Business: ( )
')SIUon Preference: .F I E ~me I Part.Time I Other (Circle One)
Availability: Number of Hours: IJ.PF/f) Tlmes:O?eA/
_ate: 2. ~ 2 C(l''1 'J Salary/Compensallon Desired: A/ ~ /or
Referral Source: 0 Employment Agency ~a'k"n Applicant
o Employee Referral
., Government Employment Agency
(NaIM)
. 0 Newspaper Ad
o School/College
o Other IN....".......'
'Nam. 01 -'g.nqol
(....I~
Have you e_er been employed by Polar Air Cargo before?
DYes
lH.ameJ
~NO
yes. when? Which facility? In what position?
hal interests you about Polar Air Cargo? Fh5/-r/lo'E (At..K. Alhrrr fO~
:? you know anyone who works for or has in the past worked for Polar Air Cargo? 0 Ye~ ~
': les. please identify: Name:
~'" you currenUy employed?
~s
Facility:
Position:
o No
Educational Data
School
Prlnt Full Name. City. and
State for each School
~~S F:L/AM~S
~ 1I tt..t..1fi C-.II.
Number of
Years Com leled
Degree
Major Courses of
Stud
I b~J(C'~
GPA/Scholasllc
Honors
n Igo School
1'2-
fII" P )?'
Z.r
,~oUege
tV
.:Jraduate School
7rade. Business.
,ighlor
~orrespondence
Jther Training
" Educalion (Incl.
Iilitary Exp.)
AI
",-HI( ;I'/.>t:/tevt-
p. ~ ,e-/~
;./- "2- ~t14P
'5.<6
Employment History
. the following spaces, give a complete record or of your employment for the lasl len years, Including periods of unemploymenl and
lell,employment. It any, Begin with your most recent employment and work backwards. II additional space Is needed. anach a supplementary
~eel.
Company: Z:;;6'.e..~6J
Address: 7uC!.sl'IrJ A?:
Stan,ng Position: J... € Ail 7fi-"",J."
Other Positions Held: "./>f?Vy
Name and Title of Supervisor In Last PosWon Held: -r I/A.. J
Stanlng Salery: "3 r K
Reason tor Leaving: ;tI/ .e e-}.,
Employed Fr~ /-1.7- 9 9 Mo,tyr. to ~<;'F.,p-Mo,tyr,
Telephone: (S-20')' .
-
Last POSllion: / ~A'A ,e. / EC/-'
Of <;" /E',.)
":?.s- /<;
Final Salary:
13)/
FbLAR--
2.
.
Company: Ai>. ~~?~.,--Z-;;;~r
Address: L" T7'2F ~v ,,4 .e.
Slar1Jng Position: /~.II".Y ~/1'I..Ir" t: E:P
Other Positions Held: " )/7><...71<
Mo,tyr.
Employed From: ~ Mo.tyr. to / - 7'?
Telephone: f?",..,., z c;<Y' Z.8-(-~i{)'
Last Position: <;;' "'" rl4t::
.
Name end Title of Supervisor In Last Position Held:
Stanlng Salary: ~ 1Z 1<'
Reason lor Leaving: --111 e en
Oh'IHb ~9"..A'17~E
Final Salary: "'? "7 IC..
EVtE"e~R.tP€A.J
'j) I.e.~cro/:; I/":-Ao/ I'IA
~y
,
3.
Company: ~1r-11gp ILl
Address: ('~L ~"'n<St.l..
Slanlng Position: F /6""
Other Posillons Held: t: / IE'
~R- .
01-1.
c::; -/ sO
hc..-1f
.
Mo,tyr,
Employed From: <? /9..r Mo,tyr. to .:; /9 g'
Telephone: ~QO +2.J no';f-
Last Posilion: r /.tE a r~:r
~ "'''',v >?n. ,.oVl'. /?, JulF F
Final Salar/: ~ k...
1'91:-11 0 F B uk /1..7 ~s
i1LcJ-I-
.
Name and Tille of Supervisor In Last Position Held:
Staning Salary: '2..s- k
Reason lor Leaving: CtJ 1'Z1.,P"~V
,
4.
Company: ~""? I L 1ihJ /t~ 111171) J
Address: r;:; e {' b7o.l A 7!.
Stanlng Position: ;; .,t-p .n-1"ECA
.
Other Positions Held: 67 t'.. /,v S:PFC17) It'..
Name and Tille ot Supervisor in Last Position Held: ~K~ h~A'S"f'".::: ~A,PEL/.J/S'/!).e-
Staning Salary: ./,/. eN p,l! ~~ Final Salary: / 3 .p~- /h'...
Reason lor Leaving: M!? ,,0~11 Lr,V' S'br...lrH&..v 1l"R-
Mo,tyr. to I -ef 5
+-~+g I
Mob':.
Telephone:
Last Position: ~ S,-v~E
,
Company: L-/.s: /1/;/v,l Employed From: 7~.;z: Mo,tyr.to 7' /9f-
Address: ,,1/4 <; /4/''I.L,01toJ (,R-OVlr Telephone: /~A.JKA/~~
Stanlng Position: A'f-? ,n-fFO-A , Last Position: r:. r r c;:
Other Positions Held: /(J(', /,OS'pIF"t".7CiJC-.
Name anc Title ef Su~er/isor In Lasl Pesiticn Held: ~/ L /. #4 ~ELve:V
Staning Salary: f k Final Salary: "'C..s- /<"
.
Reason for Leaving: E-v,{J ~rr t'!~rl~A~
Mo,fYr.
..~) POI.AR AIR CARGO
..~.
(;>LEASE PRINT)
Polar Air Cargo
A~tllicatjon for Employmerll:
DATE OF APPLICATION
'ersonal Data: 0 Position not available (HR only)
,ame: Last ~c..V First eAl'L-L ,.Middle'~.H4~>SociaISecurity#~4-1//Jt Z
7 /H'M~A ~~G) ~
'jdress: Street ;Z::~t:- A..,{,'~ L.I!:.# City -r;~S.d~ Slate and Zip Code ~ ~~r?/
;~Iephone: (Cheek which pre/erred) u,t'Home: (52D) 5'3 I ""/.1+(0. 0 Business: ( )
. Jsillon Preference: ,r / E ~me I Part.Time I Other (Circle One)
Availability: Number of Hours: ;P':-...) T1mes:Of'€AI
- ate: 2. - :2 1(" 99 Salary/Compensation Desired: A/ ~ "r
Referral Source: 0 Employment Agency ~a1k'ln Applicant
o Employee Referral
Government Employment Agency
'_I
. 0 Newspaper Ad
o SchooVColiege
o Other IN....." ......,
(Name 01 "'gel'C'II
IN.*.~
,..;ave you ever been employed by Polar Air Cargo before?
DYes
INMMI
~o
yes. when?
Which facility7
hat inlerests you about Polar Air Cargo?
Ph.:; 1 nilE (AL/C
In what position?
Albrrr .FO~
o Ye~ ~
." you know anyone who works for or has in lhe past worked for Polar Air Cargo?
: /es, please identily: Name:
,.. you currenlly employed?
~s
Facility:
Position:
o No
Educational Data
School Print Full Name, City. and Number 0/ Degree Major Courses of GPA/Scholastlc
Stale lor each School Years Com reted Stud Honors
'''gh School '/",fS F7/AM~S
',t!.b {.I tL. t. ~ C-//. 1'2- nI" P j? bE/llte'~ 2. f{
,:;oliege
tV
Jraduate School
7rade. Business.
.ighlor
~orrespondence
Jlher Training
j( Educalion (Incl.
lilitary Exp,)
,A/
;( rH 1/ It ./ .>t:./rrA:J l.-
p. ~ F'/~
;./-"3. ~MP
5.<[
Employment History
. Che lollowlng spaces. give a complele record or 01 your employment for Ihe last len years. Including periods of unemployment and
lell.employment. II any. Begin wllh your most recenl employment and work backwards. If additional space Is needed. anach a supplementary
neel.
Company: 66R..&!JO&}
-
Address: lut'!..SI'I,v A%!:
Staning Position: J.. t5 A r. 7Fi-r."
Other Positions Held: "./A?\/jI'
Name and Tille of Supervisor In Last Posillon Held: -r.-, / A.. }
Slarting Salary: ':s r K
Reason for Laaving: hI/)?e-}., If)/ R,LAR-
.
.. Company: AI'. ~ ~'pb;(!"- ~r
Address: L I '77'Zi- ~" A /1.
Starting Position: /-M..IO,Y ~ IIVI t:: rs p
OCher Posillons Held: ")/h</~
Employed Fro~ /-1.7-99 Mo.tyr.to ~<:"E'~MO.('fr.
Telephone: C$-20')' .
-
Last PosItion: / II""-,,}j ,D.. I E'er-.
OI<:'#JA)
~.s- k;
Final Salary:
Employed From: ~ Mo.tyr. 10 / - 7' '1
Telephone: J?;,.17? Z ~ z8-t-/o '9 -
Last Position: <;' ^' rl<1E
Mo.tyr.
.
Name and Title of Supervisor In Last PosUlon Held:
Slanlng Salary: ~ '7 I~
Reason lor Leaving: --111 e !f"/)
O.#o/l:~ ;:;kS"t"..A'~g
Final Salary: "?7Z K
EV.€e/7R.t9t<#
]) II!.-~Crot:.- I*~l/f I'U
BY
,
3.
Company: ~..rr1lEP,u
Address: {'~L ,.ouSU~
Startlng Posillon: .fC' / C
Other Positions Held: ~ / IJf"
~~.
0(-/.
~ -/ sO
h~-g>"
.
Employed From:? /9 r Mo.tyr.to 9/~f:r'
Telephone: <;<-UO +2:1' fX6o:+-
Lasl Position: r/,tF IX -r-f-::r
Mo.tyr.
Name and Tille of Supervisor In Last Position Held:
Slartlng Salary: '2 S- K
Reason for Leaving: (2(J fflP"~V
. ,
~A'''''.,v ~"u/V/.., ~~flIFF
Final Salar/: ~ k.-
f?tA."'I t:'J F B uK- N /R:'S
'i1L.cJ1-
.
4.
Company: ~"':'IL 1it;J /t~ll1f7n~
Address: r;; e ~ h7Il /1 ~
Startlng Position: ;f ,t-p .n~EC.A
Other Positions Held: 6? t'.. I A/ ~ P FC7'7J A?-
Name and Title of Supervisor in Last Position Held: ~R~ h~A'Se/i: <:>"b(PELI.J/<;,aL-
Startlng Salary: ./ /: tH P,I!. /,,, Final Salary: /:5 ,p,e, /u,.
Reason for Leaving: ~ ,,0~/J J:ry S"uumtfL. -v IIlIe_
Mo.tyr. 10 I -'1 J
+--::s+C I
Mo.-Yr.
Company: dS' /l/JllI,'I Employed From: '7#.;z: Mo.tyr.to 7' /p.f-
Address: .01/4 ~ /A-hl.t.t:tr-J /"/l-otJti' Telephone: /..//UKA/uz-J~
Slaning Position: .A 'f-,P J1-1Ft.J.,t, . Last Position: r:- T r- ,!('
Other Posillons Held: If' (' / A.J SOP.€I". ~
Name and Title ct Super/isor in Last Position Held: ,.t> / ./. /. #4. ~ &' L (.I u::V
Slaning Salary: f k Final Salary: "Z. f-' k'
Reason lor Leaving: r.: p /) ,rr ~-'1.n-,e~
Mo.tyr.
1.8 Any messages or information sent by an emplo>'ee to one or more individuals via an
..Iectronic network (e.g., bulletin board, on-line service, or [ntemet) are statements identiliable
and attributable to our company. While some users include personal "disclaimers" in electronic
messages, it should be noted that there would still be a connection with the company, and the
statement might still be legally imputed to the company. All communications sent by employees
via a network must comply with this and other company policies, and may not disclose any
conlidential or proprietary company information. Failure to adhere to this policy may result in
disciplinary action up to and inClUding termination.
2.9 Network services and World Wide Web sites can and do monitor access and usage and can
identify at least which company.. and often which specilic individual _. is accessing their
services. Thus accessing a particular bulletin board or Website leaves compan>'-identiliable
electronic "tracks" even if the employee merely reviews or downloads the material and does not
post any message.
The company strongly discourages the storage of large numbers of non-business critical
electronic media (e.g.. e-mail, voice mail, spreadsheets, documents). Excessive storage of this
media may cause system performance issues as well as incremental costs for storage.
Any employee found to be abusing the privilege of company-facilitated access to electronic
media or services will be subject to corrective action andlor risk having the privilege removed
for himlherself and possibly other employees.
x. - . . - - - . - . - - - . - . - . . - . . - . . - . . . . . . . . . - . . . _ . _ . _ . _ . _ . _ . _ . _ . _ . _ X
Please cut on the doned line and return this portion to:
Human Resources
AUn. Sonia DeLuna
Acknowledgment
I acknowledge that I have read and \\;11 abide by the company's policies regarding
electronic media and services.
Dated: Z. 2. ~ -99
Name (please print):
Signature:
7. Olher Aareements. The Employee represents and warrants that he/she has no
olher agreements or commitments that would hinder his/her performance of
obligations under this Agreement. other than those that he/she has disclosed in
advance to Company and that he/she will not enter into any others.
8. No Solicitation. During. and for a period of one (1) year after termination from the
employment of the Company. the Employee will not directly or indirectly attempt to
call on. solicit or take away suppliers. customers. employees or consultants of
Company for Employee's own or for anyone else's benefit.
9. Disclosure of this Aareement. Before or after termination of the Employee.
Company may disclose the substance and supply copies of this Agreement to any
person. including any actual and prospective future employers of Employee and its
employees. consultants and contractors.
10. Severabilitv. If a court finds any provision of this Agreement invalid or
unenforceable, that provision shall be enforced to the maximum extent permitted
by law. and the other provisions of this Agreement will remain in full force and
effect.
I
11. Governina Law. This Agreement will be governed by and construed in accordance
with the laws of the State of California without regard to or application of choice of
law rules or principles.
12. Assianment: Successor and Assians. This Agreement may be assigned by
Company and will inure to the benefit of any successor or assign of Company.
13. Entire Aareement. This Agreement represents the entire agreement between the
parties with respect to the subject matter hereof, and no changes or deletions may
be made except in writing bearing the authorized signatures of both parties to this
Agreement.
IN WITNESS WHEREOF. the parties hereto have caused this Agreement to be
executed in duplicate by their signatures as of the day and year first written above.
POLAR AIR CARGO, INC,
By; ~. ~1MnvL
Name;~n,a De.-LuV\t1
Title: U.R.- AV"..;rt"":
EMPLOYE~
~~~e~ ~ L "fIt'll
Title:
~eturn this page to the Human Resources Department
(c) has been rightfully received by Employee from a third party not under obligation
of confidentiality to Company and without breach of this Agreement; or (d) is
independently developed by Employee without use of or access to any
Confidential Information of Company.
4. Reoresentations and Warranties with Resoectto Tainted Information.
(a) For purposes of this Section 4, "Tainted Information" shall mean any trade
secret or other nonpublic technical or business information of any kind of a
third party, including but not limited to designs, computer programs,
techniques, interfaces, protocols, file structures, marketing plans, product
plans, business strategies. financial information, forecasts. personnel
informatinn, customer lists and information relating to research. design.
development, manufacturing or pricing, which such third party has not
intentionally made generally and publicly available or disclosed through
official announcement or disclosure.
(b) Employee represents and warrants that he/she has not or will not:
(i) use. rely upon or obtain any benefit from any Tainted Information in
rendering services to Company;
(Ii) provide or disclose to Company any information which Employee
believes or has reason to believe may be Tainted Information; and
(ili) induce any other persons to use. rely upon or disclose to Company
Tainted Information in rendering services to Company.
(c) Employee represents and warrants that he/she shall maintain and exert
hislher best efforts to enforce such company policies and procedures as are
reasonably necessary and appropriate to ensure he/she comply with the
obJ:gations and warranties set forth in Section 4(b) above.
5. Related Richts. To the extent that Employee has copyrights ( including audiovisual
copyrights). patent rights. mask work rights. trade secret rights, or other rights
related to the work to be performed under this Agreement (coUectively, "Related
Richts") and that might otherwise be infringed by Company's use in any manner of
any of such work or the results thereof, Employee grants or will cause to be
granted to Company, and to Company's parent. subsidiaries and customers, a
royalty-free. irrevocable, worldwide. nonexclusive license to make, have made.
sell. use. disclose. reproduce, modify. distribute, perform and display such Related
Rights.
6. Return of Comeanv Materials. Upon termination of the employment by the
Company, Employee will promptly return to Company. and will not take or use, all
items of any nature that belong to the Company and all records (in any form, format
or medium) containing or relating to Innovations or Confidential Information
belonging to Company.
I."~
\.~, POL.A R A I R CARGO
~.-I')
Employee Intellectual Property and Non-Compete Agreement of Polar
Air Cargo, Inc,
Employee: r?..4'~L. T ~~y ,
Address: -;r.59~..J #/~I/ 1. I!:"A pi- %20+ 1"i:dJSIM./ lie i s-'l-4(
This Agreement is entered into and made effective as of this _ day of , 19
_ by and between the" mployee" identified above and Polar Air Cargo, Inc., a
corporation with offices at ca ("Company.). In consideration
of being paid a salary for the rendering of se ices to Company and for access to
confidential information of Company in connection with the rendering of such services,
Employee and Company agree as follows:
1. Term and Terms of Service. Employee will use best efforts to render for Company
the services described in hislher job descriptions. performance objectives and/or
addendum job description to which the parties may from time to time mutually
agree. However, at any time and in its sole discretion, Company may elect to
terminate the rendering of services by employee at-will, for any reason or for no
reason. The provisions and obligations of Section 2 through 13 of this Agreement
will survive any termination of the Employee. During the period Employee is
rendering services to Company, Employee will be paid in accordance with the
terms of his/her original offer lelter or as amended on a duly authorized and signed
Company .Personnel Change Notice",
2. Innovations. In rendering services to the Company, Employee may create or
develop technical, and/or business innovations.
(a) Employee will disclose in writing to Company all inventions, improvements,
works of authorship, and other innovations of any kind that Employee may
make, conceive. develop or reduce to practice, alone or jointly with others, in
the course of performing work for Company or as a result of that work,
whether or not they are eligible for patent, copyright, trademark, trade secret,
or other legal protection ("'nnovations.). Examples of Innovations include but
are not limited to: original works of authorship, formulas. processes,
databases, mechanical and electrical hardware, electronic components,
computers and their parts, computer languages, computer programs and
their documentation, user interfaces, encoding techniques, marketing and
new product plans, production processes, advertising, packaging and
marketing techniques, books. manuals, documentation. and improvements to
anything.
,.
(b) Employee acknowledges that all Innovations will be the sole and exclusive
property of Company and hereby transfers and assigns to Company all rights
in the Innovations and in all related patents. patent applications, copyrights,
mask work rights. trademarks, trade secrets. rights of priority. and other
proprietary rights. At Company's request and expense, during and after the
period during which Employee is rendering services to Company. Employee
will assist and cooperate with Company in all respects and will execute
documents, give testimony, and take such further acts reasonably requested
by Company to acquire, transfer, maintain, perfect. and enforce patent,
copyright, trademark, mask work, trade secret, and other legal protection for
the Innovations.
(c) Employee also hereby. irrevocably transfers and assigns to Company, and
waives and agrees never to assert. any and all "Moral Rights" (as defined
below) he/she may have in or respect to any Innovation. even after
termination of Employee's work on behalf of Company. "Moral Riohts"
means any rights to claim authorship of an Innovation, to object to or prevent
any modification of any Innovation, to withdraw from circulation or control the
publication or distribution of any Innovation. and any similar right. existing
under Judicial or statutory law of any country in the world, or under any treaty,
regardless of whether of not such right is called or generally referred to as a
"moral right."
3, Confidential Information. Employee's rendering of services to Company creates a
relationship of confidence and trust between Company and its Employees. During
and after Employee's rendering of services to Company, Employee will not use or
disclose or allow anyone else to use or disclose any "Confidential Information" (as
defined below) relating to Company, its products. suppliers, or customers except
as may be necessary in the performance of services for the benefit of Company or
as may be authorized in writing and in advance by appropriate officials of
Company. Employee represents and warrants that he/she will restrict disclosure
of Confidential Information to those of the Company's employees, consultants and
contractors with a need to know to render services as contemplated hereunder
and who have agreed to be bound by the restrictions set forth in this Section, and
that he/she will not reproduce any Confidential Information other than as needed
for such purpose. "Confidential Information" includes innovations, marketing
plans. product plans, business strategies. financial information, forecasts,
personnel information. customer lists. trade secrets and any other nonpublic
technical or business information. whether in writing or given to Employee orally,
which Employee knows or has reason to know Company would like to treat as
confidential for any purpose. such as maintaining a competitive advantage or
avoiding undesirable publicity, Employee will keep Confidential Information secret
and will not allow any unauthorized use of the same whether or not any document
containing it is marked as confidential. These restrictions, however, will not apply
to any information which (a) was already rightfully known to Employee prior to the
time that it is. disclosed to Employee hereunder: (b) is in or has entered the public
domain through no breach of this Agreement or other wrongful act of Employee;
.
I."'~
l~) POI.A R AIR CARGO
'f;;...I ,
Polar Air Cargo (liThe Company") Employee Confidential Information
1. Confidential Information. As used in this Agreement, the term "Confidential
Information" Includes the Company's trade secrets. marketing strategies, account
and financial information, present and prospective customer lists and' files, any
other Company information regarding its customers (including. without limitation,
customer purchasing preferences and requirements, credit terms and status,
promotional programs, pricing policies, sales totals and sales allowances and
discounts) and any other Company information that is not generally known or
available to third parties as part of the business operations of the Company.
Employee agrees that during the term of employment and at all times thereafter,
Employee will not in any way, directly or indirectly, divulge, disclose or
communicate to any person, firm or corporation (other than the Company or any
persons employed or designated by the Company), or use for the benefit of any
party other than the Company, any such Confidential Information. Employee
understands and agrees that all such Confidential Information is and shall remain
the sole property of the Company, and upon any termination of employment,
Employee will not in any way make, copy or retain records or summaries of such
Confidenliallnformation.
2. Breach b'l Emolo'lee. The Company and the Employee recognize and agree that a
breach by Employee of this Agreement will cause the Company great and
irreparable injury and damage. Employee therefore expressly agrees that in the
event of any breach or threatened breach of this Agreement by Employee, the
Company shall be entitled, if it so elects, to the remedies of injunction and specific
performance. as well as to all other available legal and equitable remedies
(including. without limitation, damages and reasonable attorneys' fees). .
3. Waiver. No delay or failure on the part of the Company or the Employee to
exercise any right. power or privilege as specified in the Agreement shall operate
as a waiver, nor shall any waiver on the part of the Company or the Employee of
any right. power or privilege, as specified, operate as a waiver of any other right,
power or privilege as specified in this Agreement. No delay or failure on the part of
the Company or the Employee in regards to a single or partial exercise of any right.
power or privilege as specified preclude any other or further exercise of those rights
or the exercise of any other right. power or privilege as specified in this Agreement.
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I.,....~
\~, POLAR AIR CARGO
~_/I
NEW HIRE CHECKLIST
(
Today's Date: z.-Z 9-99
Employee Name: L3A'....e L- 7jb; .I'U'~.s ~ y
Social Security #: 5"'~+ .::r / - / .5Z-? Department:
Hire Date:
Employee #:
Reporting To:
Pre-employment Drug Screen Results Date:
CONTENTS:
Personnel RequlsitlonlPelSonnel Change NoUce
Maintenance Required Documents
Applicallon
D Previous Training Records"
D A&P License"
D Repalnnan's Certificate"
D Restricted or General Radio license"
D FCC Radio Licenses (Class 1 Etc.)"
D Previous Run-upfTaxl Authorization"
D A&P License Verification Fonn'
Resume
Applicant Data Survey (10 be filed)
Offer Letter (signed)
W.4 Form
I-g Fonn and Copy or Identification (original 10 be filed)
IT-2104 (NY only)
Employee Inronnation Sheet
Operations Required Documents
Mandatory Business Practices
D 5 Year Background'"
D Customs Appl/callon""
D 'Badge Lener-
D Customs Lette""
Confidentiality Agreement
Inlelleclual Property Agreemenl
Electronic Media Policy Acknowledgment (signed)
Inronnatian Systems Access Request Fonn
Other
Telecommunications Access Raquest Fonn
D
D
D
D
D
D
Anti-Crug/Alcohol Program Papers
D NADE Enrollment Form"
D Drug and Alcohol Quiz"
D Drug and Alcohol Receipt"
D Consent Release"
D Pre. Employment Drug Screen Date"
. Onglnals to manage, ""Inte~nce tralnrngoCQptes ta be "led '" emplOyee "Ie
.. These Ilems to be "led In contldenlial d"'9 I'll.
... If Agplic.able