CITY OF CHICAGO eurcaoa. AX DEPARTMERNT OF AVIATION HUMAN RESOURCES nee STANDARD OPERATING PROCEDURES. ACKNOWLEDGEMENT OF RECEIPT 1. ACKNOWLEDGEMENT OF RECEIPT A. Lacknowledge that lave received the Chicago Department of Aviation Human Resources Standard Operating Procedures. —_ TINIE i o. an PRINT NAME * Ifthe employee refuses to sign, the supervisor must sian the form “employee refuse to aign” 1. FORMS, DOCUMENTS & RESOURCES A. Additional information and guidance may he obtained by contacting the following CDA-HR personne! 1. Robert May, CDA-HR, Office: 773-686-3458, Bmail: Robert may@eityotebicago.ore 1, COMPLIANCE A. Compliance with the rules and procedures of'all SOPs is mandatory for all CDA employees. Failure to comply with all SOPs may resuit in disciplinary action pursuant to an in accordance with DHR Personne} Rules, CDA policies and procedures and any applicable collective bargaining agreement. Diselaimar: If any ofthe rules or procedures tet fadh inthe SOPs confit with eating Lv, Cie polices or callctive bargaining. ‘agreements, the provisions of such laws, policies or agreeutanis shal suzersede te applicable provisions ef the SOPs, Page tofDEPARTMENT OF HUMAN RESOURCES CITY OF CHICAGO MEMORANDUM 72012015 TO: Personnel Director 085-4800 SECURITY OPERATIONS PROM: Department of Human Resources City of Chicago Re: JAMES LONG ‘The above employee has attained Career Service status as 7/20/2015 in the title of AVIATION SECURITY OFFICER S00 CHOI COMMISSIONER 12] NORTT LASALLE STREET, ROOM 1100, CHICAGO, ILLINOIS 60602EFFECTIVE DATE: DEPT: NAME: EMPLOYEE NUMBER: SOURCES DEPARTMENT OF HUMAN CITY OF CHICAGO MEMORANDUM PERSONNEL ACTION REPORT 7120/2015 085. DEPARTMENT OF AVIATION LONG, JAMES ACTION: 23-0 STATUS CHANGE FROM: 0 - PROBATIONARY CAREER SERVICE, TO: 1 - CAREER SERVICE APPROVED/UPDATED: DATE: 20150720_¢115721_csc.pdf 121 NORTH LASALLE STREET, ROOM 1100, CHICAGO, ILLINOIS 60602DEPARTM! T OF HUMAN RESOURCES “ITY OF CHICAGO MEMORANDUM 7720/2015 FROM: Department of Human Resources City of Chicago Congratulations. You have attained Career Service status as of 7/20/2015. $00 CHOI COMMISSIONER 121 NORTH LASALLE STREET, ROOM 1100, CHICAGO, ILLINOIS 60602CHY OF GHIGAGO DEPARTMENT OF HUMAN RESOURCE ACKMOWLEDGEMENT OF RECEIPT FORM The following policies and Personnel Rules book are to be distributed to new employees during orientation, These policies are also available on the department of Human Resources intranet site, _X_ PERSONNEL RULES _Z_ victims’ ECONOMIC SECURITY AND SECURITY AGT (VESSA) _~_ wocorepness poucy __X_ executive ORDER OF anaes ann NOTICE OF aries 7 CHILD SUPPORT POLICY, aah x GENERAL HIRING PROCESS AS DESGRISED IN THE ACCORD A OUTSIDE EMPLOYMENT POLICY X ALLIANCE TO END REPRESSION NOTICE AND OROER OF 22/01, _____MIOLENCE IN THE WorKeLAcE Pouey | _”_eTMes NOTICE AND RULES __ SEXUAL HARASSMENT POLICY fi —__ INFORMATION MANAGEMENT POUCY £E0 POLICY __ EMERGENCY EVACUATION PLAN (GITY HALL ONLY) % DOMESTIC PARTNERS ORDINANCE __X_prus TestING PoLicY X _ PERSONNEL S”PE POLICY Title Cade Department __Sticage Boparimant of Aviation I hereby acknowledge receipt of the above Human Resources and Bthies Policies and the Personnel Rules book iia —t Q) - Qe = As DATE > SE T TaeCuicaco DEPARTMENT OF AVIATION CITY OF CHICAGO ion Security Officers and Agreement Regarding Repayment of Training Costs in accordance Section 18.5 of the City’s collective bargaining agreement with the Public Safety Employees Union ("Unit II}, effective October 6, 2005, employees hired as Aviation Security Officers ‘who leave this position within two (2) years of attaining Career Services shall reimburse the City for the ‘cost of their inital training at the academy. w me & 2.0.5}... hove read the above statement, and understand (Print Name} and agree to the requirement that, If | leave my Aviation Security Officer position within two (2) years of attaining Carcer Services, | will reimburse the City for the cost of my intial training at the academy. Ol Qor ofh (Date) (Signature)Cuicaco DEPARTMENT oF AVIATION CITY OF CHICAGO LEDGEMENT OF RECEIPT have been advised of my available medical plan as an employee with the City of Chicago. 1 am waiving City of Chicago Health Benefits L | accept full responsibility for providing all necessary applications and documentations to the Benefits management Office at 333 5. State Street, Room 400 within 30 days of employment to ensure proper medical coverage for myself, my spouse, and dependents if applicable. et IS ite Sa \ ___oate; OI RO~ Qo LF enscaca 19610 WEST ZEMEE ROAD. P.O. HOX 66142, CHICAGO, ILLINOIS 6066CHICAGO DEPARTMENT OF AVIATION crry OF CHICAGO ACKNOWLEDGEMENT OF RECEIPT (have been advised of my Prudential Life insurance, as an employee with the City of Chicago. ‘The City pays $25,000 benefits to all active fulltime employees in the event of your death, benefits will be paid to the Preferential Beneficiary affidavit. + Surviving spouse ‘@ Surviving children (in equal shares) ‘+ Surviving parents * Surviving siblings (in equal shares} + Estate L { accept full responsibility in maiting my application to Prudential Financial Group Life Record Keeping, P.O. Box 13676, Philadelphia, PA 19176. Print Name: KS aN Signature: Seong date:_G I> Qo~ Aa cureaco vt GOA DEPARTMENT OF AVIATION ¢, 10510 WEST GEMEP ROAD, 1.0, BOX Ger42, CHICAGO, ILLINOIS cocesCITY OF CHICAGO. DEPARTMENT OF HUMAN RESOURCES, OUTSIDE EMPLOYMENT FORM z Oo \ Depart oo on 5 Tob Ti Wig d Barer ; Work Phone: Work Sit L To you now have ordo you an cipate having a job in addition o your present employment with tne Cily OF Chi YES (No Ave ya ve Spy or have any anes ner wr ato Sod DAT aes ate I yen does this involve ny ey, stat ol ton? Oyes Bio yes, state the (ype and registration number: _ fe in, ta repr at City Enaployment Swen Wednesday Fy thatthe abo information i real complete aid wathorie my oul empyema ave eCity of Chicago wat ny zkliionalfovpation pertaining 1 my employment. Should ie above & ately and eonyplte a new Quis Frplaynvent Foe sutborid eanation change, | wil sotify em Rue, fu {subnet Mave read the City's hiss Ordinance and Fors poyee Relations, Section 3-Outsde Employer that [have no gquftict of interests and tat any falsification ofthis report willbe eause for ditciplinary action —V Same = Pe on Gly QO QO) ate APPROVALS: Elves Oxo Division Head: tl Byes EINo Bureau Head: wu Oyes Ono Department Head, wave PeRI3s Pant FawnCITY OF CHICAGO. DEPARTMENT OF HUMAN RESOURCES PERSONNEL FILE PART IL HIRING PAPERWORK CHECKLIST Residency Affidavit Hire Certification Form (New Hires Only) (New Hires onty) (New and Current Hires) I X__ Commitment to Follow the City of Ethics Pladgo |_» EEO Policy Chicago's Code of Conduct Acknowledgement —GRIMINAL BACKGROUND DISCLOSURE RELEASE FORM - CLEARED _x_YES We [ (Now Hires & Rocalls/Rohires over 00 Days) EMPLOYEE STATUS i (orcs (DES __2)Provisionat @iExempt by Ordinance _— 6)SES @)Exemot Program _. (Emergency (8) Exempt Confidential (Exempt Seasonal Education“ __Reference ___Indebtedness __Criminal Background _____ HR Records Specialist Recruiter —_Effective Date: inate inane IFRITFG Ex-Employee FINAL ~IFRITFC Date Ts Trials Tats PLEASE RETURN THIS FORM ALONG WITH THE REQUIRED PAPERWORK TO: DEPARTMENT OF HUMAN RESOURCES Employment Services 121 Nomh LaSalle Stet Room 1100 CChicaao. tina's 90602 9/07/2014Tog WS TI pep eT] TREN Tad — SBE) ‘ONOT Sahtyr ARS eS | I Buyeany snsuasuog ul paredoned [EJ] a]epIpueD pemanuawUy sega Eq] fujoay snsuasuog peyewoes TL} 181 feuspey paieaig” ET] seuoeswwoy— FJ] swueorddy pauses Eq] 0 perong aus 199424 Koyod agar eum pasado paxoteays 0 USER gg) seo] 80 wees ewsorfST] wessosenT] tur sf] 6s ovzy enema Loc-stoz-s80 YS914I0 ALINOAS NOLLWIAY HU dor ONo1 SAW he ne stent sian cner eon on 2 aR onCITY OF CHICAGO DEPARTMENT OF HUMAN RESOURCES EMPLOYEE RESIDENCY AFFIDAVIT Se Te _Bareau: Department: BS none: Lom ee Song. ———— Position Title: _ ui atian OEE cee Employee Number: ‘understand and acknowledge thal as a condition of employment with the City of Chicago 1 must be an actual resident ofthe City of Chicago My address a Tunderstand that the falsification of this statement of address shall constitute grounds for discharge from the City Servi Tanderstand end acknowledge that I must report any change of acaress immediately to sy department head and to the Department of Human Resourtes and that failure to provide such eration shall constitute grounds for discharge from the City Service. By signing this residency affidavit, acknowledge andl represen that Phave fully read and a a aend both the front and reverse sides ofthis resideney allidavit, ‘and further certify that {he information which f have provided herein is true and correct. se NOTE: the new employen must provide proof of adress in the form of 68 NOTE Ae tgaae statarient, or bankestatement,or water bill ost department. Complete and sign tr0 copies. First copy to department fle ‘Second vopy to Department of Huiman Resources fre 60 290083low the City of Chicago's Code of Conduct Asa condition and in considoration of my employment by the City of Chicago, | hereby commit myself to follow the City’s Code of Conduct, pursuant to §2-158-008 of the Municipal Cade of Chicago: () The code of conduct sat fort inthis soction shall be oepirational and shall guide the conduct ef every official and employee of tie Giy, AS an employee ofthe Cty, | shall (1) ramamber that fam 2 public servant who must place loyalty to the federal and Illinois constitutions, laws, and ethical principtes above my private gain or interest, 2) give a full day's work for 2 full day's pay (8) put forth honest effortin the performance of my duties, (treat members of tne public with respect and be responsive and forticoming in meeting thelr requests for information, (9) act impartially in the performance of my dulies, so that no private oxganization or individual is given preferential treatment, (8) refrain from making any unauthorized promises purporting to bind the City (7) never use any nonpublic Information obtained through the performance of Clty work for private gain. (8) engage in no business or financial transaction with any individual, organization or business that is inconsistent with the performance of my City duties (9) protect and conserve City pro authorized purposes or activives. ly and resources, and use Cily property and resources only for (10) disclose waste, fraud, abuse, and corruption to the appropriate authorities (11) adhere to all applicable laws and regulations that provide equal opportunity for sli persons regardtess of race, color. religion, gender. national ongin, age, sexual orientation, or handicap. | understand! that this document is not intended to,.and does not, create any right or benefit, substantive or procedural, enforceable at few or eguily, by any party against the City, ts departments, agencies, entities, officers, employees or agents, or any offer person | Seams teres i Signature iH pes PO OA Bd Heo TEAC Brnted Name DateETHICS PLEDGE PURSUANT TO §2-156-105 OF THE GOVERNMENTAL ETHICS: ORDINANCE As a condition, and in consideration, of my employment or appointment by the City of Chicago in @ position invested with the public trust, | shall, upon leaving government employment or appointment, comply with the applicable requirements of Section 2156-105" of the Chicago Municipal Code imposing restrictions upon lobbying by former government employees, which 1 understand are binding on me and are enforceable under law. | acknowledge that Section 2-156-105" of the Chicago Municipal Code, which 1 have read before signing this pledge, imposes restrictions upon former government employees and appointees and sets forth the methods for enforcing them, | expressly accept the applicable provisions of Section 2-156-105* of the Chicago Municipal Code as part of this agreement and as binding on me. | understand that the terms of this pledge are in addition to any statutory or other legal restrictions applicable to me by virlue of government service. * 2.156.105. Post-employment Restrictions on Lobbying (@) Any person who serves as (}) a non-clerical employee of the Office of the Mayor, or (i) a department head, shall be prohibited from lobbying the City of Chicago or any city department, board of other city agency for a period of two years after leaving that position (b) Any employee who holds an exempt position in a City department, board or other city agency on or after May 16, 2011, other than a person described in subsection (a) of this section, shall be prohibited from lobbying the department, board or agency in which he or she was employed for a period of two years after that employment ends. (©) Any person who is appointed by the Mayor to the board of any board, commission, authority or agency, on or after May 16, 2011, shat! be prohibited from’ lobbying that board, commission, authority or ageney for a period of two years after the date on which his or her service on the board ends (@) The prohibitions on tobbying set forth in this section shall not apply to any person who (i) ‘occupied the position before May 16, 2017, and (l) resigned from that position before November 18, 2011. Nothing in this section shall be construed to prohibit @ person from lobbying on behalf of, and while employed by, another government agency. | \ Signature Spee lege wre SS O\= do-2oLS Date aia Printed Name Print FoonCITY OF CHICAGO. DEPARTMENT OF HUMAN RESOURCES DIVERSITY AND EQUAL EMPLOYMENT OPPORTUNITY DIVISION Diversity and Equal Employment Opportunity Polic: Acknowledgement of Receipt | acknowledge that | received a copy of the City’s Diversity and Equal Employment Opportunity Policy on the date listed below. Print Name: SS Os fis BOS, ME Employee 1D number: Department: __j Signature: a Bin, al ne Date: LA ese SIMI TIE IMI NOTE: If you have questions about the Diversity and Equal Employment Opportunity Policy,"or wish to file a complaint, please contact the Department of Human Resources. at 312-744-4224 or eeadiversity@cityofchicago.oraCITY OF CHICAGO CRIMINAL BACKGROUND DISCLOSURE RELEASE FORM MALE FEMALE Date of Birth: Hawaiian or otvor Pacific ita ‘American tadlan or Alaskan Native fasion _—_ Two or ore Races social Socurty # regent Addres: Please list all your past address for the lest seven years. nooded, ploase Hist addreesas on the back of the shoot and sign) ‘ravious Addressee: _— (Dates) a (ate) (Dates). a (oates) lome Phone: E-mail: ‘you were/are known by or use a name other than the name IIstec! above, please provide that name In the space below: TASTY FIRST) Wi otice to Applicant: Pursuant to the ilinais Criminal Identification Act, 20 ILCS 2630/12 you are not obligated to discfose scaled or xpunged records of conviction er acrost and the city will not ask you whether you hava had any such records expunged or sealed. dave you ever been convicted of any crime(s}? ves NO ifyes, list datas and nature of each conviction bel DATE NATURE OF CONVICTION 'Fyou have more than 3, ave you ever been employed by the CITY OF CHICAGO?_YES NO_ Ityes, please complots the information below. vom: Tot, Titles Dept: To: Tile: Dopt: ve you ever boon discharged or resigned in lou of discharge from the CITY OF CHICAGO? ___YES yes, please complete the Information below. EMPLOYER JOB TITLE ‘TERMINATION REASON J INCIDENT iffirm that the foregoing statements by me are true and complete and that any falsification or omission may be punishable as perjury ‘well ag. violation of the Municipal Code of Chicago 2-74-090, which provides a fino fer up to $500 and ei months impriconmiont, | tirm that any faisifications or omissions may result in a rejected application oF termination of employment. Additions, 1 knowledge roceint of the City of Chicago Statement of Purpose for the Collection of Sweial Security Numbers. aaypames Leng a : INI oa er aE siehavORE DATE Finger-Prints Cleared YES. No TE R= Critninal History Analyst (Signature) RES,Employment Eligibility Verification uscis y Form 1-9 Department of Homeland Security (OMB No, 1615-0047 . Citizenship and Sruenigration Service expos 03/31/2016 (START HERE. Road instructions carefully bofore comploting thie form. Tho inatruetions must bo available during completion ofthis form. ANTLOISCRIMINATION NOTICE: Its legal to discriminate against work-authorized individuals. Emplayars CANNOT specty which document(s) thay wil ccopt from an employee, The refusal ts hire an indvidual because the documentation prasanted hae a future expiration date may also constitute legal discrimination. Section 1. Employee Information and Attestation (Employees must complale and sign Section 1 of Farm FO nolaler than te ts day of employment, bul nol elare acoeptng a job ote.) { {ast Name (Famiy Name) Fisiame (Given Name) ‘nal nti | ther Names Used (ny) | a AGES Netepnone Number {fam aware that federat law provides for imprisonment andor fines for falso statemonts or use of false documents in connection with the completion of this form. Td cnzon ttn Und Sues [1] A nonctizon national a the United States (Sco inatwations) (7 A taut permanent resent (tien Registration NumperMUSGIS Number). 7] Anaten authorized to work until (expiration date, f applicable, mnlddlyyyy) (See instructions) For alions authorized to work, provide your Alion Registration Number/ISCIS Number OR Form 1-94 Admission Number Some alone may write "NIA in thi eld | ‘bo Not waite In This Space | 4. Alion Regiatcation Number/USCIS Number: OR 2. Form 1:04 Admission Number; Ifyou obtained your acimission numbar from CBP in ennnection with your aval inthe United States, include the folowing: Foreign Passport Number. County of ssuance: Some aliens may wie "WA" onthe Foreign Pasebort Number nel Country of issuance fs. (Soe msructons) eer Spe deg Stim galas Proparer andior Translator Certification (To be completed and signed if Section 1 is propared by 2 parson other than tho ‘attest, under nenalty of perury. that | have assisted in the completion of this form and that to the best of my Kknowlodge the information ia true and correct. [Stonature of Preparer or Translator Bate Grminnrd tH aa [Cast Name (Famine) ist Name (ain Name) P or Tews BD Fmnpioyer comprcies Next rage orm £9 0/08/13. N Page 7 0f9Section 2 Employer or Authorized Representative Review and Verification {Einployes other rte mpreseinate st compte an ign Seca 2 wit 3 uses days of te eles el day of seston You Ist ys exarue one darren fom Ut 3.08 xan a sana abion a aro Sacoment torn Ust Bad ane durant fo List © as Seon {ie "iste of tacoptabte Oacamantsran the nek page ti fre For each ocumonl yas fevksw zor ee otoutng formation: eeeument Hs ‘aaiog othory, document number, and oxpton sot 9) Enon athons Fstion tate tntonseaea Cg mee | aa Lista “OR ists AND List G (Gcamentine ‘Beni Ahan ecuclty Admin [pian Ba [Doaamant Te rag A \Bacimant Nimber lesan Date ar anion 3-0 Barcode (do Not Hirt in Ths Spaco sing Aoi Certification J attest, under penalty of perjury, that (1) | have examined the document(s) presented by the above-named employee, (2) the above-listed documontis) appaar to be genuine and to rolata to the amployee named, and (3) to the best of my knowlodigo the employee Is authorized to work in the United States, The employee's frst day of employment (mndaryyyy) — lure af ripioyer or Aula Reprenanesiwe aie nmiacryw {Sce instructions for exemptions} j@ of Employer or Autnonzea eprasoutaive WHOA pent Ge, 01/09/2025 [student Tater ame (rey one het an (Sa ae) ears Business or Grganzabon Name ‘honwa-vnekeon Ramon Department of Aviation Sate Fat ua Jee a ecclesia gem of amoayran nares ax, prove ho worn fare dosunsr rom Ui Aart poe ro (a esol ce wergojeesaabonzaa Gu space pote Use Docent Tite Decument Numbor | attest, under penalty of perjury, that o the best of my knowledge, this employes fa authorized to work in the United Stateo, and if ‘he empayer presented documents), the docarent{s) Rave exaztined! appear to be genuine andto reat to tein Page 8009acreAunou Annwone BSwDY yevesees, TTT DEA CBN TK 7 TT cuts 6 2) 0 Heh Aizu td SOK OH eua ‘Ssezppy eHoH, — eampubis SNOT Ca diysiaquiay 10j uonesyddy 9999-282 (ZL€), 22-0909 11 OBEO14 . ODF AUNS . “OA JeIUSY NOS ODE EZ [e207 YOUN jeuoteUa3UY saaA0jdwg a2IA—5| iF 9 | OF weeilite : hi Cheek One) FQ New Participant oO | g | {1 change to Bxisting Direct Deposit R LY cancer | : I | »posit Payroll Program + sof Chicago announces the Direct Deposit Payroll Programs for layers. i » pram utilizes eloctronic-fonds wansfor to provide you with a timely, i NZ and convenient method of depositing your fands o fH stomated Payment, you can climinate the hassle of mail delays and late S| | y | :, Direct Deposit Payroll offers you: | a Assurance of Timely Payments ! i i ht (71. Convenient Payment Method i F i 5 ik [1 simple and Easy Sign-up Q Employees choosing the Disect Deposit Payroll plan ensure the necessary funds are available for use, ‘Your deposits are-made directly to your cecount, eliminating time-consuming, ivi] delays, waiting in line at the bimk. and Waiting for funds avaitabiliy. Direct Deposit Payroll plon gives you the reliability and safety aclvantages of Knowing your finds are deposited, even if you are ou of town, & Instractions: Complete the form helow and attach an unsigned and woidesl che Hed “The City” to vitae ert entes to my checking sezpunt indicated below wn the istitsion "to deposit tthe sae suc aceon "to jutne dette to my ecco osovcat any emer and “Triton” tite ny such conection tomy soar a ey is remit in il force ant ees vu “Tie Cy" ang “TnaGioton” have resived weitenaeiesin from me oF is account he an in ach mans bord “Dae Ca” ad “Tasiation’”areasonhie opportnty osc mips to dosing fief iomploy te Address] Iuployee Number ] ] tank Rowing [ account ((.assist in verifying date, 1 audhosize TheCity of Chicugo hereafter ca named below, befeinafter called “Busitation,” 3 further authorize “i seating soe) tm Work Phone Number: TL seme sce fer 91-28-15 cca e Be Be Be Fe Fe e BeCemermoEEE 500 PLEASE COMPLETE AND RETURN TO: MUNICIPAL EMPLOYEES’ ANNUITY AND BENEFIT FUND OF CHICAGO 321 N. Clark Street ~ Room 700 Chicago, Mlinois 60684 Phone: (312) 236-4700 MEMBERSHIP RECORD INSTRUCTIONS: Each member or applicant for membership is required to complete this form. The form must be completed in ink. ‘This is a permanent record and must be delivered in good condition. You should notify the FUND promptly of any change in your beneficiary. Hottie OFF icer sepepatment Vee on Pa Ratt 5. Give date when you FIRST entered the service of the City or Board of Baueation_O | ~ Qo > ‘do | Gently Bey Yeas ‘wonth Day a NOTE: You must give the correct date of your birth if you wish to receive proper benefits from this Funtl If in doubt, consult records, Please enclose a copy.of your birth certifi 8. Where were you born?. Coaico3a. a 9, Give name of parents (Living or Deceased): Father's Name, ul Mother's (Maiden) Neme_| REV 1/08,MARITAL STATUS 10, Current marital st (please circle current status): CURRENT MARRIAGE: Ifyou are fegally married (including legally separated from your spouse}, you must complete questions 11 thra 14. PREVIOUS MARRIAGES: 15. For each of your previous legal marriages, please complete all of the following; FULL NAME AGE ~BIVORSE BNCLIDE MAIDEN NAME} S| Location | BATE [LOCATION HH [Gity, Statey | mafed/y | (City, State) (City, State) CHILDREN 17. Ifyour answer to Question 16 is *YES", give nemes and dates of birth of ALL children of your blood, Name Social Security Number Date of Birth 18. Have you any eet adopt cniren; Ye ¥10, Ifyour answer to Question 18 is “VES”, give names, dates of birdh, and date and Court where adoption occurred. SERVICE PRIOR TO MEMBERSHIP 20. Twas employed by the City of Chicago or Board of Education of the City of Chicage as follows: FROM 0 TITLE DEPARTMENT. ‘You have the right, in most cases, to elect to pay for this past service and receive credit for annuity purposes, remept systems that may be consitlered under the Mlinois 21. Do you have eredits in any of the following, .awer is "YES", indicate which system or Retirement Systeme Reciprocal Act? (Vee or No) [VOU It systems. County Employees’ Annuity & Benefit Fund Jaborers’ Annuity & Benefit Fund Bark Employees’ Annuity & Benefit Fund Metropolitan Water Reclamation Fund Chicago Teachers’ Pension Fund Forest Preserve District B. A. & Benefit Rand 2 State Bmployces’ Retirement System 1D State Teachers’ Retirement System 1D State Universitics Retirement System (0 TMlinois Municipal Retirement Fmd 1 Judges Retirement System 1D. General Assembly Retirement System ogpess 22. Give telephone number at which you can be reached if tl should be nccessamy to communicate with you Work: ( Vee —— Home: Enel Address: [hereby certify that the answers to the foregoing questions ars true and correct to the best of my knowledge, information and belief, Furthermore. if an application m writing is required to enable mic to participate in the Fund this constitutes ity application for membership. NOTE: I UNDERSTAND THAT I CANNOT WITHDRAW FROM THE FUND UNLESS 1 BECOME SEPARATED FROM THE SERVICE YOR NOT LE9S THAN 80 DAYS. pac _ O17 Ad ALS. {Siga herd.BENEFICIARY DESIGNATION A member can, SUBJECT TO PRIOR RIGHT OP SPOUSE OR MINOR CHILDREN TO ANNUITY, designate s beneficiary to receive any amount which may become refundable in the event of death a beueficiaty to reneive any amount refundable upon date of death the law bbe paid as follows: Unless a member designate provides that such refund sh: 1. To your children in equal parts to each. 2, To the executor or administrator of yeur estate. 3. To your heirs. Members who wish to name @ beneficiary{ies) should complete the form below. INSTRUCTIONS: You may designate one person or as many persons as you wish. ‘Two or more persona will receive equal shares ‘The form MUST BE NOTARIZED to be valid, "The most recent beneficiary form Gled with the Pund Office will take precedence over all other forras on fite. (MUST BE NOTARIZED) DESIGNATION OF BENEFICIARY FOR REFUND In accordance with the provisions of the Act governing thio und, Article 8, Section 8-170, L hereby designate the following named person(s) as my beneficiary (ies) Of any amount which may become refundable upon my death to be paid in equal shares to cach: SRICIARY DESIGNATIONS THAT I HAVE MADE ARG HEREBY REVOKED. ALL PRIOR BI eoxne oF n11vo1s} County ef S. Gubseribed and sworn to before me, a Notary Public in and for the County and State aforesaid, by the aboveNew COC Employee Appointm E-Business Suite:APSPROD $F Navigator 4 Favorites Effective Date 20-Jan-2015 Employee Name LONG, JAMES Manager PATTERSON, DOTSY Department 085-4800 SECURITY OPERATIONS Review your changes and, if needed, attach supporting documents. © jngestes Changed stems, Assignment Current Department 085-4800 SECURITY OPERATIONS Job 4210] AVIATION SECURITY OFFICER LOC Worker is a Manager No (085|0740|4800]4210| AVIATION ‘SECURITY OFFICER 7A Location 085-4800 SECURITY OPERATIONS Payroll Name EMPLOYEE STATUS EMPLOYEE SUFFIX 00 FLSA CODE ACTUAL JOB CODE/PAID AS BARGAINING UNIT UNION DUES DEDUCTION ‘CODE Position Name LOCAL COMMENTS PENSION Pension Tier 2 GRANT Assignment Status Active Assignment Change Reason Salary Basis Work Hours 35 Assignment Category Home Worker No Union Member No Probation Period 6 Probation Unit Months http:i/de0 1 finps4.cityofehicago.org:8000/0A_JTTMLIOA jsp?_n and L'T Reinstatements: Review Review Cancel | | Back | | Save For tater | | Organization Email Address Page 1 of 3 Home Logout Preferences Help Job 4210] AVIATION SECURITY OFFICER Proposed (085-4800 SECURITY OPERATIONS 4210|AVIATION SECURITY OFFICER, No (085|0740}4800|4210] AVIATION SECURITY OFFICER|7A (085-4800 SECURITY OPERATIONS PAYO? Go 00 No 42106 O20 Ho PUBLIC SAFETY - UNIT 2//SE1U.FULL TIME MEMERSHIP > to 2 ‘CORPORATES Active Assignment Appointment ~ New Hire 6 SALARY © 35 Fullime-Regular ¢ No No 6 Months Cora ele TOP_SS& si... 1/26/2015TOTS TTD, er Probation End Date 19-Jul-2015 19-Jul-2015 Primary Assignment Yes Yes Pay Rate i Current Proposed Appointment - New Hire 3,888.00 USD Pay Rate 0.00 USD 3,888.00 USDG Pay Rate ( Annual 0.00 USD 46,656.00 USD. Equivalent ) Salary Effective Date Comments 20-Jan-2015 Extra Information Type PAVROLL_NUM Proposed PAYROLL SUB GROUP 3908 PAYROLL BATTALION 00 PAYROLL UNIT NUMBER 001 PAYROLL SEQUENCE 0000 NUMBER PAYROLL DEPARTMENT 085-Aviation PAYROLL DIVISION Department of Aviation PAYROLL DIVISION HEAD Michael D, Boland PAYROLL DIVISION HEAD Acting Commissioner TITLE Additional Information Attachments ‘To help approvers understand the request, you can attach supporting documents, images, or links to this action, None_Add | Approvers Details Line No Approver Approver Type Order No Category Status Delete Show 1 MANNING, ANGELA HR People 1 Approver & |Add Adhoc Appraver http://dc0 | finps4 city ofchicago.org:8000/0.A_HTMLIOA jsp? re=HR_ EIT TOP_SS& Fi... 1/26/2015New COC Employee Appointm: and LT Reins Page 3 of 3 ‘Comments to Approver James Long-ASO; Eff 01/20/2015; AForm ##085-2015-004; Vaci# 4210-0001-2015; ME cancel | sack | Save For tater | Print | | submit | Home Logout Preferences Help Gopyigrt () 2000, Oxale, Al ghs reserved, hupy//de0 I finpsd.cityofehicago.org:$000/0A_HTML/OA jsp?_r IR_FIt_TOP_S eri... 1/26/2015Notification Details Q Pe Page 1 of 1 C5, Nou Ckoarpe Cr lis72 essustoes sutsaPseR00 ~P UST Navigator 3 Favortes: Home Logout Preferences Help COraele Applications Home Page > Wekcist > 22 Information ‘This notification dows not requice 2 response 025 - EVA: Taleo New Hire LONG, JAMES Applicant No. 41459 {Back | step 51 of 22 ! From SYSADMIN ‘To. HR_OFFICE DISPLAY Sent 16-Jan-2015 18:35:15 1 ga3se4e3 Pease revew the folowing opcan record fr camletaress and curacy Fal Name: LONG, 205 Pessoa 1a : 100190 ‘Aeplicont Humber: 1416 Peauision Name : 085, acaey 1D : 268872 Vacancy Name : 4210-0001-2015 tire Date: 20-38N-2015 ‘Once racer e reieued and eompleted, kindly refoam hie action as n hire date inated and assign suneriser. Subsequent. Hob ‘eleva ntermstion to concemad OD Inter twa peforning 3 PGR Ls appear the amgloycein SSH. enum te works, |Back | ston 31 of 22 { Next} Home Logout Preferences Help enya (06, One A ceed VENTFDETAILSPNP... 1/20/2015 http://de0 1 fmps4.cityofchicago.org:800/0A_1ITML/OA jsp?_10Suspensions, LOAs and Short-Term Reinstatements: Review COC-HR Oper Dept Self Service B Navigator {33 Favoritos Page 1 of 2 Home Logout Preferences Help “Cancel | Back | | SaveForLater | Print | Submit Effective Date 01-Apr-2017 Employee Name LONG, JAMES Employee nunbe Manager PATTERSON, DOTSY — Organization Email Address: Department 085-4800 SECURITY OPERATIONS Review your changes and, if needed, attach supporting documents. Dindeates Cronged ame | Assignment Current LOC Worker is a Manager No Position Name’ EMPLOYEE STATUS { EMPLOYEE SUFFIX 00 FLSA CODEN ACTUAL JOB CODE/PAID 4210 aS BARGAINING UNIT 02 UNION DUES DEDUCTION 14 ‘CODE LOCAL COMMENTS: PENSION 1 Pension Tier 2 ‘GRANT CORPORATE Assignment Status DISCIPLINARY SUSPENSION ‘Change Reason Disciplinary Suspension Home Worker No Union Member No Probation Period 6 Probation Unit Months Probation End Date 19-Jul-2015 Primary Assignment Yes | Additional Information Attachments _ (085}0740}480014210/ AVIATION SECURITY OFFICER|7A PUBLIC SAFETY - UNIT 2//SEIU.FULL ‘TIME MEMERSHIP Job 4210| AVIATION SECURITY OFFICER Proposed No {085|0740}4800[4210] AVIATION SECURITY OFFICER|ZA A 00 N 4210 02 14 PUBLIC SAFETY - UNIT 2//SETU.FULL TIME MEMERSHIP 4 2 CORPORATE ‘Active Assignment :> Reinstatement No No 6 ‘Months 19-Ju-2015 Yes To help approvers understand the request, you can attach supporting documents, images, ar links to this action, None. Add | http://dc0 I fmps4.cityofchicago.org:8000/OA_LTML/OA.jsp?_re=HR_ASSIGNMENT_T... 4/10/2017POPE TEEPTTTE TAPE Teer Page Sala Approvers Details Line No Approver ‘Approver Type Order No Category ‘Status Delete “)Show 1 MAY, ROBERT “HR People 4 ‘Approver «eikdd Adhoc Approver Comments to Approver “James Long (Aviation Security Officer) reinstate, <> Cancel | Back | Save For Later | Print | _ Submit Home Logout Preferences Help ‘Copyeght 6} 2006, Oracle. ARights rosa. htipy/ele0 I Impsd.cityofehicago.org:8000/0A. HTMLIOA jsp? re“HR_ASSIGNMENT_T.... 4/10/2017EERE Progeted Start Actual Stat 27-2007 Authorised by Ropleced by Betance Inforation Associated Etement Rning Tot In Curent Year Tyae SUSPENSION Rveson EE Ooourence 1 Date Nottied O1-APK2017 Date ae | i Category Umatt End End a1.6lAR- 2007 oe ews No Bale ta Conti Praeted BetasGarcia, Annabel To: CROWDER, PRISCILLA ce Garcia, Annabel inp sp ‘Hi Priscila, Here is the seraen shot of this employee on suspension. ThanksMi scciosaice SADROZIAPUELIC SAFETY - UIT 28 HOSDICAMIATON SECUEITY OF Beet R Posiian 28540 Payal FAVE? Leemion 5200 ECURAY OPERATORS Skis DSUPERARY SISERSION 4 Assonnan this Caen Asmat f na Cates Emon Cage _ Stans Coences Seis inornoten FARRER. Speci Sing Fropetnimaian Spee Later qi wernt ansiess | + Bemay Edt Ressen Ciscisinay Busarsen ‘Aanaeat | propces assignment Ene l ! | ect Dats From 27-MaQ2ia? To AMARQOIT en Uh AN We il gy | 1 suas | aetvamaten io iHfine Gan ew ot BS “vgansaiateeaeuuc SAFETY (IMT AEC TIL sEREAEICAMITION SECURTY 0 LES Gove Job SPiAMATI! SECUERY T Position Grnce M9 Payea Pave? 286.1935 SECURITY ORERATI Biatus dese Ae Coltectva Agreement alt Enolayee Category ‘Assignment Nurr Assgnmsat Catagory _ Stanene CocainonsStotweery iornawon PieeeaR@aue! Soocsi Cony Puject imation Gea iadese incr acres ¥ ines ; Reson wee © Prasctes Ascignmen Ene tat Dates From CbAPR2et? te 4 Lene sen | Sau ttecry | Ets tveraion | toni Aloeors st itae tyr SEEM category Unis Sasson Ciseghnan: Susiension ecweancs 6 Oate Notice SEAPRINT Ting Dete Tine Preset Start Ene Days Hows Acjual Stat 2TSIAR2OI7 End SEMARQGIT Duration § susoviaas by Number Restaced by Rober Balance information Agseeiatet Element Running Tot Gren Year Hours bee + regevsnes fo Gori Proycted Dates Best Regards Erika Nolfi Information Services Human Resources Records Specialist Department of Human ResourcesGity of Chicago 121 N Lasalle Street, Room 1100 Chicago, It, 6060; Direct 312-744-9707 Fax 312-744-1521 Enika.Nolfi@cltyofchicagg.org From: CROWDER, PRISCILLA Sent: Wednesday, April 12, 2017 9:31 AM To: Nolfi, Erika Cc: Garcia, Annabel Subject: James Long emp\. “I Good morning Erika, We are seeking a print screen for Mr. James Long suspension this morning. | was unable to locate his printout the day | printed it If you can help us that would be great. Thank you. Priscila A. Crowder Administrative Services Officer Il/Hurnan Resources Chicago Department of Aviation 10510 W. Zemke Biva Chicago, linois 60666 Office: (773) 686-7088 Fax: (773) 834-6901 Ema: cronder@citvofchicego.ora This e-mail, and any attachments thereto, is intended only for use by the addressees) named herein and may contain legally privileged and/or confidential information. If you ate not the intended recipient of this e-mail (or the person responsible for delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying of this e-mail, and any attachment thereto. is strictly prohibited. f you have reocived this ¢-mail in error, please respond to the individual sending the message, and permanently delete the original and any copy of any ¢-mail and printout thereof.SITY OF CHICAGO NOTICE OF PROGRESSIVE DISCIPLINE. AIL Employe0% Hares Empoyee's Tie: Long, James Avation Secury Offeor (4210) ‘Supervisors Ware: suporvgors The! Mattox, Robinete Auation Security Sergeant (4208), DivitonBureauibent: Date offside January 29, 2017 ‘tier nedent Bata omar ecg mints azedng te rover fA at he Cy oC Per Rn ston ot sutstton|s): 48, 90, 38,38, 28 1 vert counting Dato ot Verbal Counselina: __ Novbal Coinieting dos not require sinploy e's tgneiuts and ts not placed in the smploje's petschl fe older 1 otc of keprane B21 Worcs of Suapension Number of daya of eunperelon: O om 1D wrten tfoctive Date: 98272017 Return te work date; OwvoT/Z0N7. Date ot Repeia Ettoctve Time: 1330 RetuntgworkThne: 19.90 TCriina or imoropor Conduct EL misepresentton BRI Vian oF city Potiy or Rul T_Teratnese or Atssenteetam TE conduct inating Job Pestormence or Substandard Work Performance ehoIncident Description and Supporting Detalls - incite te totowing datas: Oxe of Occurence Tio ean bitario, mpc of ation Ons ne rand chong enpected tha ansayes, ya dal lar flew, W neva, en Fob 23, 2077, «weds most was he fer P10 Long Cn 4m, 2077 PO Lng whit weting eval on tho twit Ge to cer tom SST Pusoush to block rranco gts wh Pits async tio oot love veugh Port tt hats Seth atin to Pot IO Lang nl nd ooned chide ora og ho awit tg craonges 20 ah HO Le ORIGIN, iA faund ben vats Ne Vil par 28 389, AE an 80, for mdocOnon PO oa chy a ceteris nd ae gra sessersion, Gaur tctons oso ili he sae eaogay of te Cy 2 Gres Paul Rl joo wl be aoa pager dncbtna 4 acinowedge rcept of tie nbc. | understand tet «copy oft ntce wil oe inuded in my persone! recor. Signature of Superisor laguna Nice: Righte of Appeal: Crear Service Employees we ar ten (10) ays or fos may raquest i wreng 9 oview oto stociotinary acon by thelr Department Head. Wee poriod of suspension fs for more than ten (10) but less than ryan (34) ays {risa aocond suspension na sk month period, the zigpension may ba appealed in writing tothe Oly Humen Resources Board, ‘Any auch regiests must he made wthis 3 working days of te nottioation ofthe alsciplinary action. Employees covered by. F Copy toemotoves Copy tounion I Cony to auparviain I” Copy te departmental Huiman Resources representative Stora yb oad iwc a Feat Rel ta etn, Conn ie iran elects arcing ere epCuicaco DEPARTMENT OF AVIATION CITY OF CHICAGO April 10, 2017 To: James Long Aviation Security Officer Ce. J. Redding Deputy Commissioner From: rover ma 1 Director of Administration RE: Administrative Leave Please accept this memorandum as the Chicago Department of Aviation (CDA) notification that you are being placed on paid administrative leave effective today. The Administrative Leave willbe in effect until you receive notification from CDA of a change. If you have any questions please feel free to contact me at (773) 686-3458. 10510 WEST ZEMKE ROAD, P.O. BOX 66142, CHICAGO, ILLINOIS 60666