ML20071K909
| ML20071K909 | |
| Person / Time | |
|---|---|
| Site: | Hope Creek  |
| Issue date: | 07/25/1994 |
| From: | Miltenberger S Public Service Enterprise Group |
| To: | NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM) |
| Shared Package | |
| ML19304C423 | List: |
| References | |
| NLR-N94124, NUDOCS 9408020078 | |
| Download: ML20071K909 (66) | |
Text
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1 Pubhc Service Electnc and Gas Company Staven E. Mittenberger Public Service Electric and Gas Company P.O. Box 236. Hancocks Ondge. NJ 08038 609-3391100 JUL 2 5 1994 vo %- oa c==~ u'-
NLR-N94124 United States Nuclear Regulatory Commission Document Control Desk 1
Washington, DC 20555 r
Gentlemen:
l NRC REQUEST FOR INFORMATION REGARDING LICENSED OPERATOR APPLICATION MATERIALS t
HOPE CREEK GENERATING STATION i
DOCKET NO. 50-354 In response to the Nuclear Regulatory Commission's Letter dated June 15, 1994, Public Service Electric and Gas Co. (PSE&G) hereby provides the investigation results regarding allegations that the individua3 provided false information on an application for a i
Senior Reactor Operator license.
Since the individual did not have a bachelor's degree, and had not met the experience requirement to have held a Reactor Operator's license and been i
involved in the performance of licensed activities for at least f
one year, the individual was not qualified for a Senior Reactor Operator (SRO) position.
The individual had also not met the Technical Specification requirements to serve in the dual role capacity as Nuclear Shift Supervisor (NSS)/ Shift Technical l
Advisor (STA) since the individual had not obtained either a i
Professional Engineer's License or a bachelor's degree.
l The attached documentation contains personnel information, the disclosure of which would constitute a clearly unwarranted l
invasion of personal privacy of the individual investigated.
Information that would allow identification of the individual has been redacted.
This information has been held in confidence by PSE&G and its distribution has been controlled and limited.
Therefore, in accordance with 10CFR2.790(a) (6), PSE&G requests that the material identified by brackets in Attachment 1 be withheld from public disclosure.
A redacted copy of the investigation results is enclosed as Attachment 2 for release to l
the Public Document Room.
l l
p h,I/
ATTACEMENT CONTAINSINFORMATION EXEMPT FROM f
PUBLIC DISCLOSURE PURSUANT TO 10CFR2.790 Q
Q3L j
9408020078 940725 jdh
{DR ADOCK 05000354 I
1 f
JUL 2 5 1994 Document Control Desk 2
NLR-N94124 In addition, certain correspondence related to the individuals medical condition which was part of the investigative report but unrelated to the findings are being withheld in their entirety.
This material will be made available for your review upon request.
If there are any questions regarding the information provided in the attacnments, please contact me.
Sincerely, f
Sl~bky
' %6 Attachments (2)
C Mr.
T.
T. Martin, Administrator - Region I U.
S.
Nuclear Regulatory Commission 475 Allendale Road King of Prussia, PA
'9406 Mr.
J.
C.
Stone, Licent,'ng Project Manager - Hope Creek U.
S.
Nuclear Regulatory-Commission One White Flint North 11555 Rockville Pike Rockville, MD 20852 Mr.
C. Marschall (SO9)
USNRC Senior Resident Inspector Mr.
K.
Tosch, Manager, IV NJ Department of Environmental Protection Division of Environmental Quality Bureau of Nuclear Engineering CN 415 Trenton, NJ 08625 i
ATTACRMENT CONTAINS INFORMATION EXEMPT FROM PUBLIC DISCLOSURE PURSUANT TO 10CFR2.790
SENIOR ST A rF ENGINEER EMERGENCY PREPAREDNESS-NUCLEAR SUPPORT & SERVICES HIRE DATE - JULY 16,1982 Behrroimd
[
]',6hployed on July 16, 1982 as a ShiA Technical Advisor (STA).[" ~
~] submitted his Application for Employment on May 18,1982 and a resume, both indicated currently attending and the expectatiqn of receiving a Bachelor of Science Degree in Mechanical Engineering from
[
]Sy June 1982. (Append.a N Between 1982 and 1985,[
]
~
attended various training courses and spent time ia other Nuclear Facilities enabling him to obtain the necessary requirements to become a Senior Reactor Operator at the Hope Creek Generating Station for its Start-up program in late 1985. During 1985,[
] pt for and passed his Senior Reactor Operator exam and became a Nuclear Shin Supervisor. (Appendice F)[
] was placed on a two (2) year rotational assignment to the Emergency Department in January 1991.
Dunng January 1991 through September 1991b
]was absent from work due to illnest When {,,,,,,, ] returned in September, the Medical Review Officer (MRO) determined tha(
] dkl not meet the requirements for medical qualifications as described by ANSI /ANS 3.41983 (Medical Certification and Monitoring of Personnel Requiring Operator Licenses for Nuclear Power Plants). With this recomnendstior(.g
( ] was removed from his SRO duties and a job search began on [
]
behalf While in the Emergency Preparedness Department, he performed satisfactorily and eventually secured a permanent position in that department in late 1992. (Appendice G)
{
s I
The Mnat R-nt Evente
[
] unescorted site access was terminated on January 31,1992 due to the expiration of required training. On November 8,1993,[
] applied for site access by, in part, completing a Personnel Access Questionnaire.[
_, ]was l
l granted temporsry access (180 days) on November 9,1993. During the 180 days a
{
routine background check is required. This background check resulted in several j
disu%. des surrounding his driver's licence (_
_.,] stated during an interview with site & cess on November 9,1993 that his driver's license was suspended for a three (3) month period in 1986. The background check revealed that [
.am.
] license is f
y currently suspended and has been since April 1988. (Appendice L) Other areas of l
t discrepancies between the background check and[
] interview with the l
Company's psychologist include his financial position and his education. As a result of I
these discrepancies his unescorted access was suspended at i1:30 am on March 17,1994.
I A further review of this matter reveals [
] indicated on his Personnel Access l
Questionnaire that he had attended [
, ]but did not graduate. During his l
interview with the Company's psychologist he stated that he did have a degree. A search of[
] personnel file and application indicated he had graduated from((M]in June 1982 as noted on both his employment application, resume and during an interview with the hiring manager. (Appendice D)[
]yanscript reveals he had j
completed 135 credits and was dropped for poor scholarship in December 17,1981. A j
further investigation determined that 192 credits would have been required to graduate with a degree in BSME.
l A fact finding was held on March 18,1994 with[
] at which time he admitted that he did not currently possess a drivers license nor had he ever obtained a degree.
When asked to explain the discrepancy between his Application for Employment and his transcript, he said he had planned to graduate by June of 1982. However, when asked
how he planned to obtain the additional 57 credits required to graduate he indicated some credits were missing and that he was enrolled and attending in 1982. He also admitted that he had never come forward to notify anyone in the Company that he had never obtained his degree.
Since the fact finding, a further review of the record reveals that f
] completed NRC form 398 on July 31,1985 stating he had a BSME. (Appendice E) This form was submitted to the NRC, a violation of 10CFR50.9 (Appendice E)[
] role as an STA required that he have an Engineering Degree or a Professional Engineer's license.
Since[,
] gid not have a degree the Company is in violation ofits Technical Specifications, section 6 " Administrative Controls." These Technical Specifications allow the Company to obtain and maintain its license to operate these facilities. During 1986, l
I several documents exist certifying [
] qualifications to be a Shift Technical Advisor. (Appendice G) The Company remained in violation of the Technical Specification from 1985 through 1991.
As a result of the two violations (Technical Specifications and 10CFR50.9) the Company "self-reported" these findings to the NRC on Monday, Marca. 21,1994. That same day an
)
internal investigation headed by the General Manager-QA/ Nuclear Safety Review was initiated.
A second fact finding was held witt[
~"] ion Friday, March 25,1994. During the discussion,[
}erified the information provided and his signature on NRC form Jhlso admitted to driving Company vehicles on a suspended license.
398.
(Appendice L) At the conclusion of this meeting [,,
]was placed on an Administrative suspension pending an evaluation of his employment status.
Summarv and Recommendation
[
] employment and qualifications as an STA were based solely upon the Company's belief that he had a degree (.._,,_ ] continued by deceiving the Company regarding his suspended license and knowingly obtained and driving Company vehicles on a suspended license His continual falsification of his education from 1985 through 1991 in holding a position that required a degree placed the Company in violation ofit's Technical' Specifications.[
. ]tontinued to falsify information specifically, NRC form 398 in 1985. For those reasons, it is recommended that[
,] employment with Public Service Electric and Gas Company be terminated.
l i
[
]
Senior Staff Engineer Hired:
July 16, 1982 i
CHRONOLOGY OF EVENTS I
Thursday, March 17, 1994 Notification about some discrepancies during a background t
check.
Notification from R. Fisher (Site Access) to S.
Phillips (Client Consultant),
C. Connor (GM-NS&S) and T.
i DiGuiseppi (Nuclear Emergency Prep Manager, the employees i
manager) a R. Fisher had previously spoke with((~~ _
']about his driving record.
The discrepancies included prior moving violations, when the driver's license was suspended, and a possible altered driver's license.
Previous discussions between Site Access and the Psycholog~ist indicated a concern over his trustworthiness.
(i. e.[ _.) ' " ~] told Site Access he did not have a degree anf. the transcript substantiated this information, however( F
] told a Psychologist that he did have a degree./
3 Access was suspended at 11:30 am A search of['
) personnel file was conducted.
His i
employment application indicated a BSME 6/82.
The application was completed 5/82. [
] resume
~~
indicated a BSME from[
]
Friday, March 18, 1994 Notification to the GM-NS&S about the discrepancies (driving record and degree information)
Discussion with Bill O'Malley about the potential impact on f
He obtained information about[
Speci*ically, the Company's belief that[]
the station.
qualifications.
{
3had a degree and his qualification to be an STA was based on this belief.
l Discussion with Greg Mecchi about retrieving NRC form 398 the application to sit for the SRO exam.
This information determined that[
]had falsified this document that was sent to the NRC (1985)
Joe Hagan and Stan LaBruna were updated by C.
Connor It was decided that this employee posed no threat to the Company and could continue to work in his present capacity, therefore he was not suspended.
The belief was that we wanted this employee available for fact finders and the termination, if any.
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Afactfindingwasdonewithh 3at11:30am.Q
]
f_,
3had difficulty explaining the discrepancies.
Monday, March 21,'1994 C. Connor and R. Hovey "self reported" this information to 1
the NRC hqqgg 7
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..,, J 12/17/81 Dropped from[
]for poor scholarship transcript (12/93) 4/20/82
(
] letter to PSE&G (Tom Brown) indicates he has taken
Graduate Courses" 5/18/82 Application for employment and resume indicates BShE 6/82 Interview guide "BSME" (GCC)
I 5/25/82 Offer made for a Shift Technical Adviser, based on degree I
7/31/85 NRC Form 398 BSME (GCC) (Application to sit for exam) l 2/5/86 Shift Technical Adviser Qualification signed i
i 12/9/85 NRC letter - license obtained l
1/91 -
Medicalissues and a long absence 9/91 12/16/91 NRC letter failure to meet ANSI 3.1, license expired l
l l
11/5/93 PAQ lists "no degree" l
Dr. Boston interview - says he has a degree 3/17/94 11:30 am Access suspended - multiple discrepancies 3/18/94' Notification to GM-NS&S of findings Interview with employee Notification letter to employee that states no driving Company or personal vehicles First Fact Finding 3/25/94 Second Fact Finding, resulting in an Administrative Suspension l
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ROUTE ONLY IN ti.cea 4 s..
SEALED ENVELOPE cas,,
ICOamrNDADOM x DISCIPLINARY ACDON ONCLUDING DISCHARGE)
DISCONTINUANCE MERE EMPLOYEE IS NOT ENTTTLED TO PENSION JOB CLASSFICATION DATE WTO CLASSF6 CAT 10N r-TI Sr. Staff Engineer 05/10/93 DATE EMPLOYED LOCATION Emergency Preparednese DATE PREPARED 07/18/82 03/24/94 ACTION REfflMh88CER DIocherge REASON POOR ATTUWANCE OLLMSS ASSENCE, TARDWESS. ETU POOR WORK PERFORMANCE MISCOE3UCT (SPECFYk FAILED TO QUALIFY DURING PROBATIONARY PERl00
@0TER Felsified Company Documente STATEMENT OF PROBLEM PROVIDE TE DETAILS OF TE PR0sLEM WHICH REQU4RES DICIPLINE OR DISCONTINUANCE. F ECESSARY, CONTNJE ON ADDITIONAL SEET. ATTACH BACK-UP MATERIAt. WERE APPROPRIATEk i Attached O *oa"At C0uNSEtiNa All PtiOs CMCTNE etSCIPtiM MTTACA -
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O PSIKi Pubhc Service Electric and Gas Company P.O. Box 236 Hancocks Bndge, New Jersey 08038 Nuclear Department April 6,1994 Dear [.
3 On November 8,1993, as a requirement to regain Unescorted Access on the Island, you completed a Personnel Access Questionnaire. The questionnaire and a resultant background check showed inconsistencies with information you previsously supplied to the Company. Specifically, your employment application indicated that you were to receive a BS Degree fron{
]by June 1982. Subsequently, you indicated on an NRC 398 form that you had obtained such degree. Your previous representations to the Company and to the NRC regarding your degree status were false. Not only did you not receive a degree by the date you first promised - and never informing the Company of same - but later in 1985 you supplied information on the NRC398 form you still had not
[{eceived a degree. On the contrary, you knew all along that you w
~
credits for degree completion.
In addition, your drivers license has been suspended since 1988. From that time, to the present, you have driven Company vehicles without a license subjecting the Company to serious liability and violating state law, as well as Company rules. You have also driven your personal car on Company property during the time your license was suspended.
Again, you knew that you needed a license to fulfill the requirements ofyour job and that you were ot'igated to inform the Company as soon as you lost your license. As a result, fact findings vere held with you on March 18 and 25,1994 to address the Company's concerns You admitted that you did not come forward at any time during your employment to notify the Company you had not obtained a degree or that you lost your driver's license You were hired to fill a position that under the Company's Technical Specifications required an Engineering Degree or a Professional Engineers License. It has been determined that you falsified documents, placing the Company in violation of Technical Specifications, section 6 " Administrative Controls" and 10CFR 50.9 by providing such false information when submitting form 398 to the NRC.
.. i,,,, a m,.......,
l l
Page 2 Also, you were hired in a position which requires you to drive and possess a valid driver's license. it has been determined that while employed you obtained and drove Company vehicles while your license was suspended, in violation of the law and Company policy.
Because of your initial fabrications and your continual falsification as aforementioned, you placed the Company in violation ofits Technical Specifications for the period of 1985 i
through 1991 and your failure to disclose your drivers license status subjected the i
Company to needless risk and undue liability. Therefore, your employment with Public i
Service Electric and Gas is terminated effective the first day ofyour suspension,
~
March 25 f*>4.
Sincerely,
(
fP' 1
Thomas DiGuiseppi Nuclear Emergency Preparedness Manager i
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O MaoOLEsEx COUNTY 106)
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O suRLiNaTON/cAMoEN COUNTIES (07)
O MANUALTRAOES O senosN/NUOsON CoVNTIEs lost O MEaCsR COUNTY 40s)
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O ALL LOCATIONS (101 pATg DO YOU HAYE A FEAR OF HEIGHTS 7 Jtit0 '
ARE YOU WILLING TO WORK OVERTIME AS REOUIRED7 O NO E*YES twOT RELATED To ALL JOssi' O YES O NO ARE YOU WILLING TO WORK DAY. EVENING OR NIGHT SHIFTS AND SATURDAYS. SUNDAYS AND HOLIDAYS 7.JFYES DO YOU HAVE ANY PHYSICAL CONDITION WHICH COULD AFFECT THE KIND OF WORK YOU D07
,5FNO O YES - EXPLAIN DO YOU HAVE A VALID DRIVER'S LICENSE 7 -
mEOuiRED FOM sOME ros:TIONei O NO MYES HAS YOUR DRIVER'S LICENSE BEEN SUSPENDED OR
,3040 0 YES - EXPLAIN IN DETAIL As TO DATE, PLACE.
REVOKED IN THE LAST TWO YEAR $7 V'OLATION AND OtsPOSITlON ON NEXT LINE HAVE YOU EVER BEEN CONVICTED OF ANY VIOLATtON OF LAW OTHER THAN MINOR TR AF FIC VIOLATIONS SINCE YOUR 16TH BIRTHD AY 7 JFNO O YES-EXPLAIN FULLY 4AN AFFIRMATIVE ANSWEA IS NOT AN AUTOMAT 4C BAR TO EMPLOYMENT)
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.1YOU EVER BEEN INTERVIEWED FOR A POSITIO*1 AT PSE&G BEFORE?
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(.*4 We AFFWIMATivt AfeSIfEN IS NOT AN AUT0edATec S AA TO EMPLOYMENTJ -
WHERE: 4/erue d /4/J V _.*_
pl5 EIAPLOYIAENT LIST PRESENT OR MOST RECENT JO8 FIRST i
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i la prosessing the application PSESiG may otnaen en *irwestigative ccnemer report" as defined in the Fair Credit Reporting Act s
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n Title VI of Putdic Laur 96-508. Further information on the nature ano scope of such a report. if one is made, is avaitelds to you upon written aquest.
AUTHORIZATION:
. suthoriae investigeuen of all statements contemed in this applicstion i
LFFIRAIATION:
fa Wie host of my linowbdpe, all information on this applice.
If I am considered for employment and hereby authorite pr6vsous op lon is true and eerfect. I understand any fe6es statemena, ployers, or my other person or persons to whom the Company #ney l
speesentatiers, or teilure to endose pertinent intnrmation refer to give any and all iedermetion regarding rny _..-ti unt or ney be considered asfhosent cause ter dameseal from the scholastic standne togefier'.wHh any other information, personal or i
otherwise, she; mer or mov nee be en,sheir records.
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Location.
DATE POSITION gg l
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10MPANY LOCATION AT WHICH WPL9 CANT ORIGINALLY APPLIED.
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,1 PERSONAL:(
)
BORN (
]
f
~
f' di
{j EDUCATIDN [ ichelor of Solence~
]
B in Mechanical 5ngineering, June 1982
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)AWAMOS:
,a EXPERIENCE:
1 December 1979
{
]
l Technical Assistent et to
[ W et[
June 1980
] Test Engin-sering, plant support, instrumentation esin-tenance, calculation and logging of verlous plant date, predist raver flee, plot actual flee on Hydrographic Chart, seeist in prepare-tion of station production report and lose of f'.
energy' report during spill.
i
[
,t E.
)
Oecember 1978 Technical Assistant et(
g.
] Test Engin-June 197g seeing, monitoring of Rodoeste and Condensate Filter Deelneralizer Systees, plant support, surveillance and routine testing, photography, coloulation and logging of plant date, updating piping and instrument disgrene, respons ible
.I for proper ing Monthly Production Report sent to the Nuclear Reguistor y Coesission.
E.
.)
March 1978 Co-op in PLhlic Works Engineering.
Assist in piens for r enovation of escisting[
.]
l g.
gun,gg7g Facilities including project design and silt ef ting of piping and electr-ical drosings.
',Ja.,,
-** rwynew qv:,:;,::n
... i J Septoeber 1977 Maintenance Group for air compr essor-Plant g.
manuf actur et,
Assisted staff in trothle-January 1978 shooting and in effecting minor electrical r opeir e.
Communicated with vendosas and
'w %
customer e shile sor-king in per-te division.
f t.g
f 3
Participated in High
'N+.
BACKGROUNO:
I._.....
Student Gover-neont, Nationel' Honor-
,j School sporate, gp Society, Concer t Band, Stege Band and Choeel Groups.
Worked es en Assistent Pro et a golf resor t.
I CDs.LEGIATE 2
ACTIVITIES:
Mondaar of Tau Koppe Epsilon Fraternity have held offices of House Meneger, Social Dir octora and Rush o
2 Dimirman.
Competed on the Rifle Team and one Team J
- }j f
Captain in 1979 and in 1980.
Served me Ameistent L
Editor on the[
] Technical Journal Staff.
f Participated in Frsehsen Orientation on the I
g Drientation Committee and as en Advisor *.
W 4
Also par-ticipated in and helped or genize outinge e
for the Selling Club and the ski Cith.
INTERESTS:
Enjoy all spor te, especially selling, skiing, canoeing, r unning and r ocquetball.
Also enjoy camping, photogtsphy, motor cycles, hor-ticultur e and music.
j PROFESSIONAL MEMBERSHIPS: American Society of Mechanical Engineer e and the Amer-ican Society of Hosting, Reft-iger etion end Air -Conditioning Engineer e REFERENCES :
Will be furnished upon t equest.
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v 7ph.11'20, 1982
)
l Mr. Tom Brown Public Service Electric and Gas Esployment and Placement P.O. Box B Bancocks Bridge, NJ 08038
Dear Mr. Brown,
as I indicated durin6 our phone conversation today, I wonld like' to inquire about employment with PSE&G at Sales or Hope Creek.
My interest in Electrical Production began during Coop Assignments in Nuclear, Pump Storage, and Hydroelectric Generation.
Baving worked with plant support Eroups, I l
obtained practical experience in many areas.
A few of these include: system trend analysis; preventive main-tenance procedures; post-maintenance checks; writing and performing Surveillance Tests and Routine Tests; data calculations for various systems; and mechanical and electrical trouble-shooting.
At the Nuclear Plant I was also responsible for the Oil Usage Report and the Monthly Production Report sent to the N.R.C' I have worked during both generation and extensive outage periods and am familiar with Health Thysics practices.
My course work while at[
]has focused upon Power Generation with such topics as Power Plant Design, Heat Transfer, Thkrsodynamic Analysis, and Heating, Ventilation and Air Conditioning.
I have also taken graduate courses in Nuclear Engineering I & II, Nuclear Reactor Safety Systems and the Building as.an Energy System.
My qualifications are further outlined:intthe enclosed resume which'.you requested.
I look forward to further discussing with you opportunities at PSE&G.ed at' the. above address or by telephone a I ca re da k
.'3Thank you very much for your recent, assistance.
w
. Sprely yours, M
RED. NO:
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d REASON FOR APPLYING TO PSEtG: S b v1 oD ctdh es lo < o 4 'ou PatsENT OR usi SAMAY: $ dM -OP
/ YEAR LDOKING FOR: $
/ YEAR
[w 6EOGRAPHIC RESTRICTIONS (jNITIAL OR EVENTUAL):
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Ava:LAntLITY TO sEGIN WITn 'SE!,G - (DATE):
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R EVA!!!ATION Frerttrwr h
P'a n c t N A L IYPE AND AMOUNT OF EXPERIENCE Pens 0NAL IMPACT AS PCTENTiiL LEADER s ]NTERE5T IN THE PO$tTION Low TURN 0vtR PRQsAs LITY C,FNEDAL CD'O'INTS J
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REviEwEnYh 2
ATE:
sat ARY OFFER PRCM'FNDR1 sk n
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BAstD ON:
YEAAS RELATED sullMESS EXPERIENCE AND/0R YEARS MILITARY EXPERIENCE OTHER FACTOR $:
3" RtcomExcEn sV:
BATE:
REvtEwtn sY:
DATE4
.i 03y J_ Pp0VL3a8 EPPLOY"FNT AND SALARY OF Fi h
$,0l BY:
DATE:
... o s
' s.. ; '
MIEh
i k.
Pubiec Service Etectoc an:s Gas Company P.O Br.,a E hancocks Booge, New Jersey 08038 s
Salem Genersting Station May 25,1982 i
(
L
.w @
Dear [
]
We are pleased to of fer you the position of Shift Technical Advisor in the Nuclear Department.
Your starting salary will bel
]per year.
If you accept employment with our Company, you will be assigned as indicated in your discussion withMr. 'S; LaBruna on the day of your interview.
Your employment is contingent upon
.4 satisfactory reference in-i vestigation and successful completion of the Company's customary medical examination. Iflyou. accept our offer, please fill out the enclosed Medical and Physical Record Form and bring it with you on the day of your physical examination.
Do not fill in the
" Physical Examinat2 on section on the oppsite side of the medical form.
I would appreciate a reply from you as soon as possible, but not Should you decide to accept our later than June 7,1982 offer, a mutually convenient starting date and a date for your physical examination will be subsequently arranged.
I am quite sure if you accept, you will be very satisfied with your decision to come with Public Service Electric and Gas Company.
We feel that the opportunities available within our Company will enable you to fully demonstrate your abilities and maximize your potential.
We look forward to hearing from you.
Please do not hesitate to call (609) 935-8580. if you have any questions regarding this of fer. (609) 935-8150.
Sincerely yours, d,
Thomas A. Brown Personnel Coordinator Employment and Placement-Salem Enclosures m
TAE :;a r.
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pre startup dutf es.
12.7 Training j
Scheduled for Pre-Itcense Examination Testing and Training from 7/22 to 10/11,1985 consisting of:
Fundamentals Peview (4 weeks) 5faulator Operation /Cle:sroom Preparation b 50/50) (7 weeks)
Written ari Oral Exams (1 week)
This training is structured to be the equivalent of a simulator Cold Certification Program.
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v v
a UNITED STATES g
NUCLEAR REGUI.ATORY COMMIS$10N I
REGION I 1
531 PANS AVENut
\\**...
Elmo OF PnueS&A.Pf MNSYLVANLA 194o8 DEC 161985 f**k**"*;b
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%;g 2.
_-M_,
Pursuant to the Atonio Fnergy Act of 1954, as amended, the Fnergy Reorganiration Act of 1974 (Public law 93 438), and subject to the conditions and limitations incorporated herein, the Nuclear Regulatory Commission hereby licensen you to direct the Ifeensed estivities of Ileensed operators at, and to manipulate. sis controls of the Hope Creek Generating Station, Unit No.
I.
Your License No. I'm[
] The Docket No. is [
' 3 The effective date im December 9, 1985.
This licenne is subject to the provisions of Section 55.31 of the U.S. Nuclear Regulatory Commission's regulations, Title to, Code of Federal Reguistions, Chapter 1,
Part 55, with.the some force and effect as if fully set forth herein.
In directing the licensed activities of licensed operators and in manipulating the controls of the above facility you shall observe the operating proceduren and other conditions specified in the facility licenne which authortres operation of the facility, and shall comply with the following condition:
You shall wear corrective lenses while performing the activition for which you are floenned.
The issuance of this license in based upon examinstton of your quellfications, including the representationn and information con-tained in your application for licence filed under the docket number indicated above.
Unless sooner terminated, this license shall expire two years from the effective date.
A copy of this license has been made available to the facility licensee.
For t Nuc1
/ ulato(y Cqmmission P
1 1
Id Richard W.
Starostocki, Director Division of Reactor P oj ects cc: Public Service F.loct ric and Gas Company ATTN:
Plant Manager Hope Creek Gener at ing Station P.
O.
Box A Hancocks Bridge, NJ 08038
O PSIEG
- .c.; 5er.,te E'ectnc ana Gas C:s.com 244 C-E'**
i> w.
T E F 3
- W W M E6' Nuclear Training Center January 27, 1986 To the Operations Manager - Hope Creek CERTIF'.C.4 TION OF COMPLETION OF TRAINING
^
This is to certify that['
3 has completed the Senior Reactor Operator training program outlined in TP-304HC and meets the training and experience requirements established in ANSI /ANS 3.1-1981, Section 4.3.1.2 for Senior Reactor Operators.
In addition, he has completed the plant observation training outlined in FSAR Section 13.2, Appendix 13K,Section II and meets the training and experience requirements established in ANSI /ANS 3.1-1981, Section 4.3.1.1 for Shift Supervisors.
The following waivers to the training program were made:
None
(
Monald E cha r
Assistant Manager -
Operations Training SK:ja C
PTS - HC Ops NTC Records & Reports Group
+5:-
SA-AP.22-004(;
ATDGBENT 1 NGEDgGut AM) APPOINDEstr OF S'DLTICBI QUM.IFIED REVIDER 1.
In accordance with SA-AP.22-004(O), b m E ) of the
%1,
O 04 det (SA.5 is nominated to serve as a Station Qualified i
(Department or Organization)
Reviewer (SOR) in the discipline (s) indicated.
Plant Operations Preoperational Testing-Mechanical /Pipiry i Electrical Maintenance Preeperational Testing-HVAC Mechanical Maintenance Preoperational Testing-IEC I&C Maintenance Nuclear Engineering Refueling Operations Mechanical Engineering Security Plan Electrical Engineering Envirormental Controls I&C Engineering Emergency Plan Nondestructive Exmination Chemistry and Radiochenistry Meta.1,lurgy Piping Codes ( ASME/ ANSI)
Radiation Protection Training Adminstrative controls Startup ( Pcwr Ascension) Testing Quality Assurance Practices Preoperational Testing-Electrical 2.
I certify that the indivital listed above meets or exceeds the qualifications of Section 4.4 of ANSI /ANS 3.1-1981 and doctanentation is on file. I have verified that the above listed indivicbal has adequate experience and familiarity with licensing, regulatory, safety, 'and other H(LS requirements associated with the disciplines for which nominated.
hb D
' Department Manager
/ Date 3.
The above listed indivi&al is hereby appointed a Station Qualified Reviewer (SOR) fo:
the indicated discipline (s).
Effective Date: )/ l k{
Expiration Date:
A
)/2/R
[Soit& airman' Date
S A-A P. 2 Z-014 (;
ATTACBMEltT 1 Form SA-AP.II-014-1 verification of Qualification for Position Hope Creek Operations Employee Nam &
F TMkM UMMW51dy#dhikis(
3 Oopartment CA74/kn oxj s ANS,3.1 1981 2 ara Reference L/.4.R Functional Level ST4 A brief summary of the basis used for determining Qualification for Position shall be listed below.
Education SGS 4--A c e Experience scce
. k m.56 L
Training AM 4 r-r4easb The qualifications of the above named employee are verified to be in accordance with the indicated reference.
NM 2/S/lK Signature Date i
k SA-A P.23-014 (0 )
i i
A'tTACEMENT 1 Form SA-AP.22-014-1 Verification of Qualification for Position Hope Creek Operations t
]
Employee No.b
]
Employee Name 1
Dapaetment OPGd/> r ios3 s FunctionalLevelhS.S f
ANr '.'l 1981 Para Reference u. t;/.t A brief summary of the basis used for determining Qualification for Position shall be listed below.
Education SGs 4L- - A c.m-6 i
^
Experience mm
/,, AcA d t
i Training 25&&
A, -rnen3h The qualifications of the above named employee are verified to be in accordance with the indicated reference.
WWj ffb cate signature A ttachment 1
- o.,
OP-AP.ZZ-014(Q)
ATTACHMENT 3 Certification of Qualification for Position:
SHIPT SUPERVISOR Name
)
VERIFIED BY QUALIFICATION SOURCE OF REQUIREMENT SIGNATURE /DATE Education - High ANS-3. l ( 1981 ),
4.3.!.2.a.
School diploma plus May be waived per 4.1.
equivalent of 30 10-'f semester hours d
/) I college Experience - 3 yrs.
ANS-3.1 ( 1981 ),
4.3.1.2.b.
power plant, 2 of which are nuclear.
During 2 yrs.
participation (reactor operations activities) at a large operating plant (BWR):
- a. 6 mo. on-shift Mcpe Creek SER 13.1.2.1.
participation, May be waived if the including S/U and Senior Shift Supervisor S/D, or (assigned to that shift) has completed this requirement.
/
b.
6 weeks on-shift ANS-3.1(1981),
4.3.1.2.b.
participation,
\\
above 20% power ru.L
/1 Training -
NOTE-Waived training requires G.M.
approval 1
- a. Nuclear Reacter ANS-3.1(1981),
5.2.1.1.
Fundamentals (TP-May be waived per 5.2 and 304 HC, item A)
FSAR, 13.2.1.1.1.1.
3-
/ /0 di OU b.
Reacter Startup ANS-3.1(1981),
5.2.1.1.
Experience (TP-May be waived per 5.2 and
/ /
304 HC, item D)
FSAR, 13.2.1.1.1.1.
/ i/7/ af
/
//
- c. Advanced Technical ANS-3. l ( 1981 ),
5.2.1.6.
Training (TP-304 May be waived per 5.2 and g/
[2 HC, item B)
FSAR, 13.2.1.1.1.1.
UM '
/ / #/ MI yV d.
Pre-Cert System FSAR, 13.2.1.1.1.1.
May Training (TP-304 waived per 13.2.1.1.1.
p
/
HC, item E) jus
/ r /A r
/N OP-AP.ZZ-014(Q) 1 of 3 Rev. 1
OP-AP.22-014(0)
ATTACHMENT 3 Certification of Qualification for Position:
SHIFT SUPERVISOR
~o VERIFIED BY QUALIFICATION SOURCE OF REQUIREMENT SIGNATURE /DATE Training continued -
e.
BWR Cold Cert ANS-3.1 ( 1981 ),
5.2.1.3.2.
Training (TP-304 May be waived per 5.2 and HC, item F)
FSAR, 13.2.1.1.1.1.
O
/ I 3/
f.
In-plant Training ANS-3.1 ( 1981), 5.2.1.2.2, (TP-304 HC, items 5.2.1.3 and 5.2.1.4.
May H and K) be waived per 5.2 and 4
/
FSAR, 13.2.1.1.1.1.
4/4
/ / h/((
q.
Hope Creek Systems ANS-3. l ( 1981),
5.2.1.6.
/
Training (TP-304 Per E SAR, 13.2.1.1.1.1,
//,n
/////
HC, item G) must not be waived.
h.
Pre-license exam ANS-3. l ( 1981), 5.2.1.5.
and training (TP-May be waived per 5.2 0
C, item J,L, and FSAR, 13.2.1.1.1.1.
- i. Trans. Anal /Mit.
SER, 13.2.1.4.
FSAR Core Damage (TP-future rev.
/,f 304 HC, item I)
//J/
f//
- j. Plant Observation / FSAR, Appx. 13K. Pcrtions Experience may waived per 13K.
/
Training
/
of
)
y0 1
k.
NRC Examination TP-304 HC, item 0)
/
// 4 0/
- 1. TSSP Supervisory ANS-3. l ( 19 81),
5.2.1.8.
)
Skills (TP-304 HC, Per PSE&G ccmmitment, item C and TP-901 program must not be HC) waived.
Personnel may be exempt from specific
_O portions.
BM
/} i Y 0'
- m. Gen. Employee ANS-3. l ( 1981), 5.4 m
/
f(,
Indoctrinatien 00' t
- n. Rad Worker FSAR, 13.2.1.1.7.
/
Training ow'
/ k
00 OP-AP.ZZ-014(O) 2 of 3 Rev. 1
~
OP-AP.72-014(0)
ATTACHMENT 3 Certification of Oualification for Position:
SHIPT SUPERVISOR 1
Name
=
VERIFIED BY QUALIFICATION SOURCE OF REQUIREMENT SIGNATURE /DATE Training continued -
- c. Respirator FSAR, 13.2.1.1.7.
Training May be waived at I
f/
discretion of Operations Q Manager M Wlh h
/Als/4
!\\ U l
Certification of ANS-3.l(1981), 4.3.1.1.d.
Competency -
- a. Corporate Security
>W S%6 Clearance
- b. Corporate health examination; includes drug and psychological screening AlTJ'eM 2/Cf(b u u
- c. Employee annual evaluations; dlh / 3/C/E analyzed for:
- I (1) dependability (2) stability (3) trustworthi-ness (4) demonstrated abilities (5) apparent health (i.e.,
sick time)
NRC Senior Operator License #,
SOP -
,h c9/dK6 Operations Ka?.ager Date OP-AP.Z2-014(Q) 3 of 3 Rev. 1
OP-AP.ZZ-014(0)
ATTACHMENT 4 Certification of Qualification for Position:
- k'
~W Name VERIFIED BY QUALIFICATION SOURCE OF REQUIREMENT SIGNATURE /DATE Education - Bachelor HCGS Tech Specs, 6.2.3.
degree or equivalent in a sciertific or Engineering i
discipline **
OO 6
/ hy N7 no Experience - 1 year ANS-3.1( 1981),
4.4.8.a.
nuclear power plant, b,
/ A !Ib 6 months onsite.
Ud
'f Training -
NOTE-Waived training Overall references requires G.M. approval TP-303 HC
- a. Advanced Technical ANS-3. l( 1981),
5.2.1.6.
Training May be waived per 5.2 and FSAR, 13.2.1.1.1.1.
. 2lud 7]s7s c,
,,/
b.
In-plant Training ANS-3. l ( 1981 ),
5.2.1.2.2, 5.2.1.3 and 5.2.1.4.
May be waived per 5.2 and FSAR, 13.2.1.1.1.1.
/
Mf/rd,
~ ~ ~ _ '
- c. Trans. Anal /Mit.
SER, 13.2.1.4.
FSAR pg Core Damage future rev.
N 'nr d b 2/(//4
'-- ~~_J
( i
- d. TSSP Supervisory Per PSE&G commitment, Skills (TP-303 HC program must not ce
(
MV/kL and TP-901 HC) waived.
Personnel may be t-__
' /
exempt from specific portions.
- e. Gen. Employee ANS-3.1 ( 1981),
5.4.
Indoctrination N i n, k
/ i b !S$
Qf
- f. Rad Worker FSAR, 13.2.1.1.7.
Training b db
/ 2I 6 ou
- Qualifications described here apply only to the position of SIA.
If the individual whose name appears above is to be SRO j
licensed, the additional requirements of Attachment 3 also apply.
Degree must be from an accredited institution, for the STA to assume a dual role of STA/NSS.
i I
OP-AP.ZZ-014(Q) 1 of 2 Rev. 1
OP-AP.ZZ-014(Q)
ATTACHMENT 4 Certification of Qualification for Position:
SHIPT TECHNICAL ADVISOR Name VERIFIED BY QUALIFICATION SOURCE OF REQUIREMENT SIGNATURE /DATE Training continued -
- g. Respirator FSAR, 13.2.1.1.7.
Training May be waived at discretion of Operations
- /
Manager o
/J/y/&6 Certification of Company practices and Competency -
commitment.
- a. Corporate Security Clearance S/S/f4
- b. Corporate health examination; includes drug and psychological screening
/ M S/f/fd
- c. Employee annual evaluations; analyzed for:
l'I M / 3/5 / fl (1) dependability i
(2) ctability (3) trustworthi-ness (4) demonstrated abilities (5) apparent health (i.e.,
sick time) f operations Manager Date OP-AP.22-014(Q) 2 of 2 Rev. 1
\\
R ga a s i1 L PSEG 1 ' " ' "
R ShitetgAp8??S feoos19h! unPE CRE E~
Pubtsc St'. :s Electre and Gas Comoany M Chestnut Street b..........,.....-.-
'c---
Nuclear T aining Center i
beribkCkh9 1 Decem
_>....._t NTC-91-327 u-v :v. ', ~ ~ ' *
~'
Mr. Richard Conte, Chief p-a<3 J, i
!A BWR Section
.n.. :
.t
{4 11j
,'i" '.i operations Branch
- 1..;. 9. :
a Division of Reactor Safety
[~G. s..
U.S. Nuclear Regulatory Commission
+. < -
T.
- Region I
[.,
j
~~
I~~'~
, 3 " 6 f f..
475 Allendale Road lp King of Prussia, PA 19406 f-----
Dear Mr. Conte:
T
.... _ : -.. ?.
Please be advised thatf_
)
[_. del.i _
j no longer meets the general medical conditions as neated in 10CTR55.33(a) (1).
Therefore, it is requested that his license be terminated.
If you have any questions regarding this matter, please contact Robert Hovey at (609) l 339-3478.
Sincerely, N!b Arthur Orticelle Manager - Nuclear Training GPMaal C General Manager - Nuclear Services VCentral Manager - Hope Creek Operations Manager - Licensing and Regulation operations Managtr - Hope Creek Nuclear Medical Director Principal Trainer - operations Training Prin. Trng. Supr. - Bope Creek Operations L.O. Requal Supervisor
~
IesattouA4.
ar.ADeen 808t s*UCL2Mt TSAMesQ
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E C0ffl0EDT&
CPSEG Pubhc Serwce Electnc and Gas Cornoany P O Box 236 Hancocks andge, New Jersey 08038 Hope Creek Generating Siaon TO:
[i"
_ ],
FROM:
Robert Hovey Operations Manager - Hope Creek E
DATE:
October 29, 1992 In January 1991, you t.ere assigned to Emergency Preparedness on a two (2) year rotational assignment. [
,) You were advised or this determinat: on in my letter to you in December 1991, and that you therefore vill be unable to return to your former position at the end of your rotational assignment (12/31/92).
The Human Resources Department is currently conducting a job search for a position within the Company for which you possess the necessary skills and abilities,[
]Please be advised that, should this search be unsuccessful, your employment with Public Service Electric and Gas will be terminated at the end of your rotational assignment.
C:
R.
Sutton T.
DiGuiseppi y{p[f Employee Relations g ULl i
I Personnel File p, g a o
- h oh j
sow Ackno) 6
- s. ~& W a uo'C W'
N *\\*4=-
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s
),
OW
1 l
O PSIKi Pubec Serwee Electric and Gas Company P.O. Box 236 Hancocks Brege, New Jersey 08038 Hope Creek Owwwumg Sunon TO:
(
)
FROM:
Robert Hovey Ajlt Operations Manager - Hope CreekIviL---3 DATE:
December 31, 1992 On October 29, 1992, you were notified that your employment with PSE&G would be terminated at the end of your two-year rotational assignment (12/31/92) if the job search being conducted by Human Resources was unsuccessful.
This memo is to inform you that I have extended your rotational assignment for one (1) month, through January 31, 1993, to allow i
for further review of job placement opportunities.
If you have any questions, please feel free to contact Barbara i
- Bronson, H.R.
Client Consultant, at ext. 3070.
cc:
T. DiGuiseppi Employee Relations i
Personnel File i
1 The Energy Peopkt j
-,n n i
I
f O PSIKi Put*c Senace Doctic and Gas Company P.O. Box 236 Hancock.s Bndge, New Jersey 08038 Nuclear Department TO:
[-
~
_ 3 FRON:
Thomas DIGuisepjW Nuclear Emergent:y Preparedness Manager
SUBJECT:
TFMPORARY POSITION DATE:
January 26, 1993 As you were informed on December 31, 1992, your rotational position in Emergency Preparednesc Sit 11 and January 31, 1993.
I have arranged for you to remain in Emergency Preparedness in a temporary position for four (4) months, through May 31, 1993, to allow for finalization of proposed staffing changes within Emergency Preparedness.
If you have any questions, please feel free to contact Suzanne Phillips, Human Ramources Client Consultant, on extension 2435.
C Employee Relations Personnel File The Energy People l
-=
t I
l CONSENT AND AUTHORITY TO REQUEST AND RELEASE INFORMATION i
Namesb
]
SSNeb
]I Datas O'h 3
d a PSE&O clearance for unescorted access I understand that as a condition to be grante to the PSE&O Sales / Hope Creek nuclear facilities, I must undergo a medical examination l licensed physician l and a psychological evaluation administered under the direction of a An conjunction with a licensed psychologist. I understand that a urinalysis to identify
' the presence of drugs and a breath test to detect alcohol, will be conducted as part of the medical examination as required by the Nuclear Regulatory Commission's Fitness-For-Duty Rule, 10 CPR 26.
background check will be conducted which may Anelude but not be i
I understand that a limited tot employment history, listed and developed references, educational records, I motor vehicle records, credit histories through credit reporting or other agencies, criminal history check through law enforcement agencies and court records, and l
fingerprinting for a criminal records check by the FBI, as required by the Nuclear Regulatory Commission regulation 10 CPR 73.57.
i l I understand that the medical, psychological and background evaluations will be reviewed by persons in positions specified in the PSE&O Personnel Access Progree, to i determine my suitability for unescorted access to the PSE&O Sales / Hope Creek neclear facilities. Dental af access may be appealed under the Appeal provisions of the program. I understand that this information will not be disclosed to other persons except as required by law. I understand that all information and results complied for my access clearance (including any adverse inf ormation relating to ritness-For-Duty I concerns under 10 CrR 26) may be transmitted to other Nuclear Regulatory Commission l'. censed nuclear power facilities. I understand that I have the right to review this inf ormation at an appropriate time at the offices of the PSE&O Screening Supervisor and/or Site Access Administrator. I may withdraw consent at any time by providing written notice to the PSE&G Screening Supervisor and/or the Site Access Administrator.
If I withdraw my consent, my access clearance will be revoked, i
Based upon my understanding of the above, I bereby consent to undergo a medical examination, urinalysis and breath tests, psychological evaluation and a background check.
I hereby authorize Public Se rvice Electric & Cas Company and/or its agents to conduct an appropriate investigation of my background, including but not limited to, personal int e rv iew s and record searches, to determine my eligibility to be granted a PSEEG clearance for unescorted access to the PSE&O Sales / Hope Creek nuclear facilities.I authorize all persons who say have lawful information to disclose it to the Public Service Electric and Gas company or its agents. I release all persons giving or receiving such information in good faith, from any liability due to its disclosure.
I I hereby further authorize the transmittal of any data related to my unescorted access authorization to other Nuclear Regulatory Commission licensees to facilitate granting l my access authorization to other nuclear plants. I also authorize transmittal and disclosure of in f o rma t ion relevant to any dental or revocation of unescorted access j
authorization for Fitness-For-Duty or other reasons (for example, if I have been found I or am later found not to be fit for duty on account of drug or alcohol use) to other I
licensees, as required by 10 CFR 26. I hereby f urther authorize transmittal of my f inge rp rint s, through the Nuclear RegulatorT Commission, to the Federal Bureau of Investigetion, for a check of prior arrests and convictions.
1 (I am willing that this authorization ce valid for five years and that a photocopy be l
considered as effective and valid as the original.
Sicnature of Subiect! b 3_
PSE&G PERSONNEL ACCESS PROGRAM
(\\ 0 PERSOpL ACCESS QUESTIONNAIRE FINGERPRINT DATA SHEET I
Namet'last first, full middle)
- w Aliases / Maiden Name i
pk Address E-
]
Social Security Number Armed Forces Serial Number
[a
]
4//4
' Tate ofi3irth (month, day, year)l Place of Birth (city, state)
E J
[
]
Citizenship (If applicable) Naturalization No. or Alien d5A Registration No.
Sex Male A
Female Race [
]
IJeight Weight Eye Color Hair Color r
]
[
]
[
]
[
]
- FOR OFFICE USE ONLY
- r Date Fing Responsibility Center Initials Form PAP-01 Page 8 Rev. 5 -
PSE&G PERSONNEL ACCESS PROGRAM PERSONNEL ACCESS QUESTIONNAIRE f3
.d clearly and answer all quest ons. The Personnel Access Quesuonnaire is a separate document and has no correlabon with plication for employment or resume and must be completed in its entirety. Place in a sealed envelope marked ' Personal and Confidential and forward to ' %blic Service Electnc & Gas Company, Screau ig Supervisor, Processing Center M/C N44,PO Box 236, liancocp Bridge, NJ 08038.
nk M an aArto l
l CAUTION: Failure to complete this form in its entirety will result in s Procesing.
l l
Today's Date:
p-f - 73 Unescorted access within last 5 years at this facility ? M
/ Comuncsor Em#yee 3:" Y ^
jEAG Em@yee.
- 2. Name(last,first, full nudule)
- 3. Social Security Number
[~
]
[w
}
- 4. List all other nianes pu have used,(alines. nicknames. maiden names), and time periods names were used.
I I
w/A l
S. Telephone Numbers: Home [~
.]
Business:(6oS )
M 9 - / i 5 5~
- 6. Sex Male
/ Female Date of Birth (month, day, year)
~
-1
. Country of Citizenship:
If applicable: U.S. Alien Registration Number V 5A If naturalized ciL:en: Naturalization Certification Number:
Name and address of court where naturalized:
Date of naturalization:
- 3. Military Service: No
./
Yes If Yes, complete Military and Civilian j
Authorization Form PAP-01, Page 9
- 9. Provide Dpqcense inforruption:
]
Nos 1 State
[..
- 10. Marital Status : Single / Married Separated Widowed Full name of present spouse (maiden name if female):
- .. ~::.;. M :'...
I 11.
List three personal references. Do not list relatives /in-laws, past or Telephone #
present employers or persons outside of the United States.
DAYTIME NUMBERS ONLY f
T HOME:
z WORK:
i 1
I 4
HOME:
q f-WORK:.
I
/
M' HOME:
[
d WORK:
~
PAP-01 Page i Rev.5
FITNESS-FOR DUTY }llSTORY Negative information you supply about yourself to PSE&G on this form will be evaluated. Negative info
's, automatically result in denial of an access clearance. Omission of material information including previous reyocation of unescorted access or criminal history will be sufficient cause for denial of unescorted access.
.\\nswer all questions. If "YES" provide full explanation in Section 21. DO NOT use checkrnarks, in by writing your initials in the appropriate YES or NO box.
YES NO lias your access to a nuclear power facility ever been denied, revoked or 12.
suspended?
IIave you ever participated in a plan or program for treatment of substance abuse 13.
(except for self referral), including for example, counseling, hospitalization or other forms of medical or psychological treatment for addiction to drugs or f
alcohol abuse?
linve you ever experienced any condition which mentally or physically prevented 14.
or impaired your ability to safely or competently perform your work duties?
g llave you ever experienced: (A) any withdrawal of application for access to a 15.
nuclear power plant; (B) any discharge or resignation under threat of discharge j
from employment for any reason.
linge you ever tested positive for drugs or use of alcohol at any place of work or 16.
upon reporting to work or refused to take such a test?
.)
1 llave you ever been arrested / convicted of driving while intoxicated or under the 17.
)
influence of alcohol or any other substance?
linve you be[ convicted, since your 18th birthday, of violations of any criminal 18.
statute, law, regulation, or ordinance, including by court-martial. You may omit:
(A) traffic violations for which court appearance was not mandhtory and was resolved by paying a fine; (B) any conviction the record of which has been expunged under Federal or State law;and (C) any conviction set aside under the Federal Youth Corrections Act or similar State Authority.
11 ave you been arrested or charred,since your 18th birthday, for a violation of 19.
any cdminal statute, law, regulation or ordinance. You may omit traffic violations for which a court appearance was not mandatory and was resolved by paying a fine.
I 20.
Itas your driven license been suspended or revoked?
w i
Provide full explanation (including dates and locations) for any "YES"answen from above.
21.
~~
continued on next pagel Re-Iorm PAP-01 Page 2 I
I
- 21. (Continued from previous page) y l
l W
22.
Ust all nuclear power plants that you have worked at or applied for unescorted access within the last Sve (5) years. Include dates. Start with most recent. If none write "NONE".
AD A/C l
L l
I i
}
I
_i l
- gey, Form PAP 411 p3ge 3
~..
1 23.
List all r==='aac=
1 in the past tive years at which you have resided for a penod of thi complete street address, city, state and zip code. Do not give Post Office box nu=E =.
rty days or more: Prtmi l
MonthtYear (Enter present address tirst)
>l y,9 39
....-mw 4L
@f / wer da?
r I
l 24.
t A) List all employers and penods of unemployment for the last 5 years. Start ih c part-time and summer employment while attending dooi. (B) If unemployed for 30 days or ume student, provide the dates and the name and telephone number of reference kno activities. (D) Account for all time consecutively and pro WERE ASKED TO RESIGN OR WERE FIRED FROM ANY POSITION.
Unen local (if appl cabic) Name & Tekpt.une No.:
i Penod Of Unemploymers: Frorn:'/[ib[5L y
O'8 M '(_
To.
of person who can venfy:
tw e,s r.*
rw. N-a un-p 5 e 1'&
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Penod Of Unemployman: From:
To:
Nime & Tel.No. of person who can venty:
muumuuumunuseum Deus (m 6er m rm,6,r.r. N e um :
Freen To TelN. ( )
R e for Leevans:
W a f-5 ap rvi r's Huma Yow Pnemen:
\\
Penod Of Unemploymera: From:
t l To:
N:me & Tel.No. of penon who can ventv:
"orm PAPA)!
Page 4 Rev.5
i-l o-
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f i s' i
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ist.No.(
)
l ls e aeN l
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To:
Nune & Tel.No. of person who can venfy:
P ow w.n~
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- E88'=
I*
Tel No j )
I wm,_
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Yo.e W-P: nod Of Unemreymem: From:
To:
(
Name A Tel.No of person who can venfy:
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was t--
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a-.== r. - :. -==.= :=: : = - - z=.. _:_
l Penoo Of Unemp6oyment: From:
To:
Name & Tel.No. os person who can veniy:
- ==m -.,. =
z :- - --
-===.==.a_
- =z=-
_. = :.
.=;
Dew bnewy.m:
Emeww e hesen Addre t
I rent
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l T.
7,g g,. ( )
w i- -
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. m r-Penod Of Unemployment: From:
To:
i Name a ret No. os person wno can vensv:
0.w. emww Derwen e >=
e.4 A44, F ema.
.T lt
- <- t- = :
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5 eerwoore Nems;
. art Lanuoe I
i
- Tour russiana; C. -- DAPA4 page j ggy j
1
- 5.
r'rotessionaj licenses. ;enifications or registrations:
i Title l
Date issued Numoer State or atang_ Agency l
l l
I l
26.
List all schools attended even if diploma / decree was not awarded. If General Eauivalency Diploma was received list cate and location wnere awarded. include priotocopy of cenificate.
i I
Name of School Address Dates Auendens Major Desmo Grassed FremiTo YES NO 1
l High School 9/g g gg
/
l~
W osnq n ucce+ casm
+t 77 s
[ College / Universities ge m w,v, ccerre) duc t ce Swa
/9G G /983 N# cMM t/
th iT M4A l
1996 Tsify (v6 atere o A p/
)
't I
Graduate School (s) 1 I
CERTIFICATION
- certd, that au informatmo prowwied above as true, complete and correct to the best of my knowledgeand belief and is gives in good faith.1 -
undentand that act material mis 4tatements contained hereis may be cause for denial or revocation of a Perseased Access Ciserames. I furtl understand that ornative information presented on this form about myself may not be is itself be reason for rejection. Ilow,1 maderstaar that intentional omassion of any informatma or fauure to list reasons for removalor revocation of unescorted access shall be suelelset easee,
denial of unescorted access.
j e **<
/I' S 3
SIGNATtJRE DATE
_r.
j Form PAP-01 Page 6 t
3, J.
TO:
D. Powell - Senior Operations Technical Supervisor Stoxed Senior ;;aff Engineer FROM:
D.
)
SUBJECT:
QUALIFICATIONS SEARCH ON [_,,
[.
4.d ]
DATE:
March 18, 1994 In accordance with your instructions, I have searched the department's personnel files of both the Staff and the SNSS for education documentation on the subject individual.
There was no file for[
_31n the SNSS's personnel
~'~~~
file.
The department has unofficial copies of some of the tuments that underlie personal qualification.
The cofficial file holders are designated by NC.NA-AP.ZZ-0014(Q).
We maintain unofficial files to make it easier to determine what official documenting departments have available.
In 1991, to prepare for a potential NRC audit, we asked F.
Mustica, Principal Nuclear Compensation Administrator for copies of High School Diplomas, DD-214s, employee resumes or applications and any degrees, including disci for all of the personnel in the department including [pline, f]
'~
Copies of these records were sent to us in stages as they were being copied.
From these copies and copies of other records we had on file, I found the following information and have attached copies for your use:
- 1. A memo from Mr. Mustica acknowledging our request for information.
- 2. An unsigned " Application for Employment", page one, i] Mad a Mechanical Engineering Degree stating L
_, J The information states [
F]
[Qom[ ))fattended between September of 1976 and June of 1982 and obtained a Bachelor's Degree.
The application is dated 5-18-92.
_."]name on it that
- 3. An. unsigned resume with(
states [,_ ~
3has a Bachelor of Science in Mechanical 5ngineering as of June 1982 from[I'((']
E
%,,) 3
- 4. A Medical and Security Clearance form that states a background check was conducted on[
~~'] The form I
is signed June 30, 1982.
5.,A Nomination form for Station Qualified Reviewer for[.
f#
'] stating he meets or exceeds the qualifications of DQR~a~nd documents are on file.
To qualify, a person
would have to meet or exceed the qualifications of Section 4.4 of ANSI /ANS-1981.
This qualification does not require a BS degree for the identified discipline.
The form was signed on February 5, 1986.
- 6. A high school Diploma dated June 1976.
- 7. A SA-AP. ZZ-014 (Q) form, Verification of Qualification for Position, for STA with attached supporting verification of Bachelor degree or equivalent in a " scientific or Engineering discipline".
The verification was signed 12-4-1986.
It shows that he has a Mechanical Engineerina Bachel5 7',Jkj' I chec,ked the PDS Data Base for Education on[_ I
_.t Degree and "Some Graduate Work" from[.
^ ~~~]}
A
~~~~~
copy of the appropriate screens is attached.
Our files.do not contain a copy of a Diplomr. from[__,
]
[
jon[
T
]
I recommend that the files maintained by the Security Department or their contractors be searched.
I further recommend that the Training Center's files be searched for Senior Reactor Operator License applications signed by[..
']
[
]The educational qualifications for candidates is a required section of the application.
I recommend that official records retained by the Compensation department, both inside of the station and at TB2, be searched also.
In 1991, Mr. Niezpiel of tl.e Nuclear Training Department began working on improving the company's processes for verification and retention of qualifications.
Mr. Niezpiel would be the bas,t source.for coordinating a search for documentation ofL ~ I
".] qualifications since he has extensive experience in this area and has been investigating ways to improve the program with all of the appropriate departments.
Enclosures DBS C:
'W. P. O'Malley l
Fact Finding [ _,j,,'
a]
Marchj 1994 12:40pm-12:55pm Attendees:
Tom DiGuiseppi Suzanne Phillip's
[
'Y 5 S.
Phillips I need to ask you some questions about some discrepancies discovered in your background check for site access.
Has your driver's license for Pennsylvania been suspended?
[
]
Yes S.
Phillips When was your driver's license suspended?
[
]
I'm not really sure.
S.
Phillips Does April of 1988 sound about right?
[ *.
]
Yes S.
Phillips Why was your driver's license suspended?
[,' AL-..,..e b
S.
Phillips I understand you talked with Ron Fisher, from site access, yesterday.
k,m. _.
] Yes S.
Phillips At that meeting you were informed you were not permitted to drive company vehicles.
Is that correct?
knam-Yes S.
Phillips I have a letter I would like you to read.
It speaks about not driving Company vehicles or personal vehicles on the Company's property.
(He read the letter and understood with no questions.)
S.
Phillips Is there any other adverse information involving your driving record that we should know?
]'
b' s
a
l S.
Phillips What prompted you to call the DMV?
~
- g. ((.dwa,.
0 S.
Phillips During the background check another issue arose about whether you had_a degree or not.
Do you have a degree from [
]
[eA T f]
Technically, no S.
Phillips coul'd you please explain the discrepancies on these two documents.
(The PAQ where the degree indicated "NO" and the employment application..
Where the degree indicated was a BSME from[,
j 6/82)
[~
]
I was my intent to have my degree in June of 82.
(The application was completed in 5/82)
S.
Phillips Could you tell me how may credits you had towards your degree?
6
] I'm not really sure.
S.
Phillips Your transcript, dated 12/93,. indicates you have 135 credits.
How many credits would you have needed to complete your degree?
[p
]
I'm not really sure.
S.
Phillips I called [
]today and they informed me that you would have needed 192 credits to graduate.
Can you explain to me how you expected to obtain this many credits in that time period referenced?
[L
,,_ ]
(after a 3-4 minute pause and studying the transcript)
I thought there would have been more.
(credits)
S.
Phillips What is not there? Did you have credits at another University or College?
[tl 2
~3
- Yes, S.
Phillips From where?
{
S.
Phillips When did you attend [
] How many credits did you obtain from[
]
1
)
l
(
[
11 Winter / Spring of 82, there were substantial credits, not really sure how many.
'~
S.
Phillips Did you ever come forward and notify anyone in the Company that you had not completed you degree?
~
[ mf.=
3 NO S.
Phillips Is there anything else about the discrepancies of your driving record or your degree you would like to tell me?
(j~~
]
(Af ter a several minute pause)
No, I don't think so.
S.
Phillips Is there anything else we may find during the background check that you would like to tell us now?
]
No, I don't think so.
[-
1
O PSEG Public Service Electnc and Gas Company P.O. Box 236 Hancocks Bndge, New Jersey 08038 Nuclear Department March 18, 1994
{
A L y'
r
%, c.ug%..- "
Dear [.
]
During our discussion on March 17, 1994 you stated your Driver's License for the State of Pennsylvania had been suspended.
In light of this information, you were informed not to drive any of the Company's vehicles.
Additionally, it is the Company's position that you are not to drive any vehicle, personal or Company, on any property owned by PSE&G.
Should you be found driving on Company property, you will subject yourself to an administrative suspension pending an evaluation of your employment status.
Should there be any changes in your status regarding this matter, you are to inform me immediately.
h Thomas DiGuiseppi Nuclear Emergency Preparedness Manager T?
m_
m._
t J.
AX EMPLOYMENT SERVICES ar i
um w
l I
G Social Security Number DMV Account Number l
h 008 Sea Height Wt E esgReguested Ae/Also Known As
)
04/19/68 M a
DRIVER LICENSE INFORMATION f
Clase leeued Emphe Status Res trictone SINGL VEH < = 26,000 043088 SUSPENDED
- i j
MISCELLANEOUS AND STATE SPECTIC INFORMATION i
THREE YEAR DRIVING RFCORD i
LICENSE TYPE: REG LICFNSE NO VIOLATIONS OR DEPARTMENTAL ACT!ONE DURING THIS REPORTING PERIOD NO MEDICALS OR DEPARTMENTAL ACTIONS DURING THis REPORTING PERIOD NO ACCIDENTS DURING THIS REPORTING PERIOD DRIVING RECORD i
i Vio/ Sue Conv/ Rem Des cripton Vio/Conv Pts Type Date Date Code MVR RECORD CLEAR i
i End of Report 11311/93 11111/93 PSE&G 459745 3
I
,n..
l
i l
1 1
]
PERSONNEL.sCCESS FILE INFORMATION REVIEW g
ay.
l
j e
i CONTINUATION PAGE a
m N
O P
b
b" PERSONNEL ACCESS FILE INFORMATION REVIEW w
i J
age Ib.
1 3/22/94 RDWT Of K)IOR f00L VD11CLE USE
/C
) RIVE 2 PICKII) UP RDURNED PSF 4G l RFASON Al?Ill0RIZED BY FOR USE 133 133 ICRGIN, D.
01/06/93 01/08/93 3461 SIREN MfEFLNG WI1M DE DIGUISEPPI, T.
STATE IOLICE IN IIATR, DE 133( _
3 01/06/93 01/11/93 3467 WASilINGIW, D.C. - NUMARC DIGUISDTI, T.
FAL ADVIDORY MITHE 133 SQJIL, D.
01/15/93 01/21/93 3466 IIX713, MA DIGUISDTI, T.
133 IURGIN, D.
02/09/93, 02/12/93 42621MNIM, HAMTNKN &
MNND, C.
DFIAWARE CTIY 133 FURGIN, D.
03/08/93 03/15/93 3463 'IMNIDN & Wi!TI liRUNSWICK DIGUISD ?1, T.
- TRALNING 133 iVP.1T., S.
03/15/93 03/17/93 3578 OY!713 CRDI DIGUISEPPI, T.
133 It'kGIN, D.
03/23/93 03/25/93 3466 IMNRE - IkAINING WITH DIGUISDTI, T.
frTATE AGINCIFI, I(
]N/05/93 04/08/93 4'h261f3EIHESDA,MD-NUMAkKHIU DIGUISDTI, T.
WrIH NkC 133 SWIL, D.
04/08/93 N/14/93 3461 11111A/ SEMINAR DIGUISDTI, T.
133 IURGIN, D.
04/14/93 04/15/93 3462 DDAWARE CITY - MDTING DIGJISDTI, ',
13^, IITRGIN, D.
04/15/93 N/19/93 3463 TRfNim, NJ - MFITINGS DIGilSD il, T.
1(
]N/27/93 N/29/93 3466 NEV YORK - NUMARC EAL DIGUISDTI, T.
PRESENIATION 10 ANS 133 IUkGIN, D.
N/28/93 04/30/93 1462 %KEM/HMA FOR 1994 DIGUISDil, T.
D:DtCISE Otu. TMNKU -
MIU.
~
13 (
]05/06/93 05/07/93 4261 ATLAVTIC CITY - W: DM RANNER, C.
MrEnNG 133 DIOR, M.
05/05/93 05/07/93 3462 WASHINGIm, D.C DIGUISEPPI, T.
l 133 bTD3 REIN, W. 05/N/93 05/10/93 3464 CRANTUd> - TRAINING DIGUISDTI, T.
133 IURGIN, D.
06/22/93 06/24/93 4261 DDAWARE CrlY, DE -
DIG'TSDTI, T.
SCENARIO MEETIGN
'RGIN, D.
07/19/93 07/23/93 H If466 IIATR, DE - TRAINIMi, DIGIISEPPI, T.
i MUTCIDWN,R1 - SIREN TEM 133 DIOR, M.
08/09/93 08/12/93 3461 ROCAYIllf, MD MNNU, C.
i.
i uge No.
2
'3/22/94 RDORI 0F M710R KX)L VENICIE USE
/C 4(IVFR PICKED L'P RDURNED lSG,G # REASON ALTI10RIZED BY FOR USE 133 RUJI, R.
08/30/93 09/01/93 3464 WASHINGKW, D.C. - DOGE MNNER, C.
ESE!;SMENT MfLTING 133 fi'RGIN, D.
10/01/93 10/11/93 3578 DELAWARE HE MEEIING &
R WTR, C.
OYS'lTR CRDI - TRUNLNG 133 hTDTTEIN, W. 10/26/93 10/28/93 3463 DDAWARE CI'IY - E.P. drill llA%TR, C.
t
)
)
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[
O I)SIEG g CORPORATEMOTORPOOL
, _,,,m us -
ycnica ntooss, USEH EMPLOY EE NO.
slGNATURE PHONE E i vel %.J
.1 1
I CF MGE8' -
3
]
/ S,5~.S~
, j' PICKUP DATE D E P A R Titet.N T NO. O F P AS MO DAY EmE%'&ENy 0AEY.
/
PICKUP TIME DESTIN ATION/N ATURE OF BUSaNESS O l' '
w A.S H/Al Gr 7DW, DC l A/ V m &tl' HR E/p 7AM-SPM A Dv/,$o A y g m g, 7-y g-g i
EST. RETURN DATE AUTHORIZE D BY (MGNATURE)
PRINT N AME MO.
DAY h{} {,
[ p D, Q w,,
I n
EST. R ETURN TIME TITLE H R.
SA 7AM-SPM Ef ()1 a g,qg IF COMPAN Y V E HICLE 15 NOT A V AILABL E AUTHORIZAYlON IS GRANT E D TO RENT VE HICLE.
AUTHORIZE D BY TIT L E:
RESERVATION INSTRUCTIONS ON REVERSE SI
.. - ~,
l%'l['
CORPORATE M() TOR POO L V
k VEHICLE REQUEST FOR OFFICE USE ON USE R EMPLOYLE NO.
I SIGNATURE PHONE E XT l.-
OF usrR
[.j,v,,,i..r.s,--
b
)
/S F 5 PICKUP DATE DEPdjTMENT NO. O F P AS:
j M o.
Day QQ O$
SM [Alvd7Y'L'f SESN.
l PICKUP TIME DESTiN ATiON/ NATURE OF BUSINESS
~
I O C7WC"5 Dd/t,/k (m,O,/ M V fMMC MT
.-N R.-
l h
7AM.SPM y f ;rf/
EST. RETURN DATE AUTHORIZED BY (SIGN ATURE)
PRINT N AME
- M O*, D AM' j&
>+'16 i M!l eff/
A EST. RETURN TIME TIT LE
//
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RESERVATION INSTRUCTIONS ON REVERSE S
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wje No.
1 13/22/94 RDWT OF PDIDP KDL VDlICLE USE
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> RIVER P101D UP Reft'RNED 15F#5 # REASON AlTIlDRIZED BY EDR USE 133 133 It'RGIN, D.
01/07/92 01/09/92 3466 NIV WRK, NY - FTMA RFUION InNNTR, C.
11 FNRCISE MfLTING 133 IURGIN, D.
01/10/92 01/20/92 3466 DNITSIURG, MD fnNNIR, C.
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05/04/92 05/07/92 3461 RochYI!JE, MD -
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05/06/92 05/08/92 4262 NIVARK - TRAINING DIGUISEPPI, T.
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05/19/92 05/22/92 l 9463 PHIIA, PA - FIX\\ RID. III DIGJICEPPI, T.
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05/19/92 05/22/92 2388 NEWARK - TRAINING DIGUISD'PI, T.
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06/05/92 06/15/92 3464 EMMITSIURG, MD - CIASS ER%D, C.
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12/15/92 12/16/92 3578 MFDFDRD, NJ - MUTING DIGUISEPPI, T.
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9 RESERVATION INSTRUCTIONS ON P.EVERSE Sl!
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Fact Finding [
f.]
March 25, 1994 3:25pm-3:35pm Attendees:
Tom DIGuiseppi Suzanne Phillips
[
]
S.
Phillips This should be the last of the fact findings.
There is a couple of other pieces of information I need to ask you about.
The first is this form (presented to the employee NRC form 398).
Is this form accurate as best as you can r.m2mber?
( x..
]
Yes S.
Phillips This form indicates that you have five years of college.
[.
]
Yes, and that is true, and technically I have five years of college.
S.
Phillips This form also indicates that you have a Bachelors Degree in Mechanical Engineering.
[
T
.3 Yes, that is correct.
S.
Phillips Are you aware that this form was submitted to the NRC under your signature?
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Yes S.
Phillips Do you understand how serious the Company Icels about providing false information to the NRC?
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]
Yes S.
Phillips Have,ou at any time since your driver's license been suspended driven Company vehicles?
s, Niy
]
Yes S.
Phillips Due to the seriousness of these issues, you are suspended without pay.
This period of time will allow the Company to complete its investigation and evaluate your employment status.
Is there anything you can add to clear up any of these matters?
[
]
No, I don't think so.
I
\\
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S.
Phillips Before you leave today I am going to need you PS identification card and any keys you have that belong to the trailer or other building, cabinets, l
desks, etc.
4E[ 1
] OK Do youliveath_,yyouaddressandphonenumber.
I need to verif S.
Phillips J'
l{_ ]_ _,)) gg]y Yes S.
Phillips Is your phone number [~
J
[ " i. ~
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Yes r
S. Phillips Is that where you can be reached?
[dC 1,
]
Yes i
S.
Phillips How did you get to work today?
[.
] I have been driving into Salem and catching rides i
with people into work.
S.
Phillips How are you getting home tonight?
We are prepared to take you home should you need some assistance.
b@l_[__.
3 My ride should be here by 4:30.
S.
Phillips The general idea behind a suspension is that you leave the property immediately.
T. DiGuiseppi If your car is in Salem, I can urive you there.
l
[ I]I"~'
'T ] No, I will call my ride.
S. Phillips I can make arrangements to release you ride from work so you can leave.
l
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No, my ride will be ready to leave by 4.
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Pubhc Service Electnc and Gas Company P.O. Box 236 Hancocks Bnoge. New Jersey 08038 l
Medical Department. Nuclear TO:
Suzanne Philips Personnel Representative 4
FROM:
Martha Bostonp,$
i Psychologist
~
~~
SUBJECT:
DATE:
March 29,1994 I
i
[.
]was interviewed at Psychological Services on November 10,1993 as part of the process to be badged to go in the nuclear facilities. During this interview he told me that he had a B.S. in Mechanical Engineering and he denied legal financial l
problems. Neither of these statements were true. Ron Fisher shared with me after the
(_. _..
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,]
interview that [.
- ] does not have a college degree and that he has a[
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'ET.< IEVE TRANSACTION: EMPLOYEE NOMEN-SALARY INQUIRY PTiON:
TRX: 6NS KEY:[
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SELCCTION:
- ENTER A SELECTION NUMBER FROM THIS SCREEN ***
i NOMEN NOMEN NOMEN EFF DATE U/M CODE DESCRIPTION 1
05/10/93 99 11750 SENIOR STAFF ENGINEER 2
12/30/85 99 11140 NUCLEAR SHIFT SUPERVISOR 3
12/01/83 99 11120 MEDICAD-ADMBE6HWPOR $/1/[f I d C /1 M I C A / A d W M I I 4
07/16/82 99 11170 m SIff 74c/rn/Ca/ MULE @
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TRX: 6EI KEY:(
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EMPNAME:[
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EMI aO:[
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t NOMEN INFO:
05/10/93 11750 SENIOR STAFF ENGINEER PAY FREQ:
2 RC/ ALPHA:
133A EMERG PREPAREDNESS i
MAIL CODE:
N37 FORMER RC:
101A OPER HOPE CR STA
.00 STATUS CODE:
10 l
W2 COMMUTER USE AMT:
' 7 7/16/82'(]
SOC SEC NO:
(,
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03
~
EFF SERV DATE:
07/16/82 HIRE DATE:
DISC DATE:
00/00/00 DISC CODE:
000 AGE AT DEATH:
.00 DATE OF DEATH:
00/00/00 BIRTH DATE:
[
]
[
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SEX:
M hACE CODE:
1 MOP CADET PGM YEAR:
00 VACATION ADV %:
25 EMP HANDICAPPED IND:
N EMP MILITARY SERVICE CODE:
0 ACCT CL CODE 1:
8244 DATE 1:
12/27/93 i
ACCT CL CODE 2:
3763 DATE 2:
09/05/86 k
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1 HOME ADDR:
NAME LINE 2 STREET 1,
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NAME LINE 2 STREET CITY STATE ZIP AND CNTRY CHECK MAIL CODE': A2 BANK ACCT NO HOME MAIL ADDR:
NAME LINE 2 STREET CITY STATE ZIP AND CNTRY ET HUMAN RESOURCES SYSTEM 03/25/9
'03 0CC17 EMPLOYEE PHONE NUMBER CHANGE 15:15:1 ETRIEVE OPTION:
TRX: 6ET KEY:[
3 EMPLOYEE NUMBER EMP NAME (
];
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HOME PHONE NUMBER:[
]
LIST CODE U COMPANY PHONE NUMBER 1:
000 429 1555 EXTEMSION 0000 LIST CODE 01 I
l COMPANY PHONE NUMBER 2:
000 000 0000 FXTENSION 0000 LIST CODE 00 OR BEEPER NUMBER 1
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PAGE 1 DF 2
1 STUDENT ID:f
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DATE: 12/Uits C COURSE COURSE TITLE CRDT GRD PNTS l JRSE COURSE TITLE CRDT ORD PNTS UNDERORADUATE l
W INTER 1977-78 WECHANICAL ENGINEERING j Bell PRIN OF ECONOMICS 3.0 COLLEGE OF ENGINEER 1NO l E321 STATICS 0.0 l E522 INTRO DIGITAL SYS 0.0 FALL 1976 - 77
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CUW-CREDITS 66.0 CUW.OPA
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l PROBATION TERM. CREDITS 13.0 TERM.GPAi l SUMMER 1977-78 REMOVED FROM ACADEMIC l
PROBATION CUM. CREDITS 85,0 CUU.GPA
~~ IFALL 1981 82 DROPPED FOR POOR ED07 BASIC FLUID MECH 0.0 SCHOLNtSHIP rALL 1979. 80 l
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S920 INTRO TO SOC 4.0 l
TERM. CREDITS 11.0 TERM.OPA ]
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