County of Los Angeles Employee Information Sheet
1. LAST NAME FIRST NAME MIDDLE NAME
Simpson Rhys Allen
2. Social Security Number 3. Driver License Number and Expiration date
613-88-1359 F1422883
4. Residence—Street Address City State, Zip Code
40735 Fieldspring st Lancaster CA
5. Date of Birth 6. Cell Phone No. 7. Work Phone No.
09/20/1991 6614941002 6614941002
8. Do you have a relative currently employed by the County?
Yes No
If yes, please indicate Name, Relationship and Department below:
9. Education
(Name and Location of School) Last Grade Date Major Degree or
Completed Completed Diploma
Grammar and High School
Littlerock High School
12 04/2010 Diploma
Other
High Desert Trucking 2014 CDL License
Other
10. First Emergency Contact
a.Name: Emily Andrade
b.Relationship:
Girlfriend
c. Phone Number: Home: Work: Mobile: (661)429-4551
d. Home Address:
2732 westland dr rosamond ca 93560
11. Second Emergency Contact
a. Name: Kodi Snell
b. Relationship:
Friend
c. Phone Number: Home: Work: Mobile: (661)418-3107
d. Home Address:
16605 valport ave lamcaster ca 93535
12. Description:
a. Height: 5’11
b. Eye Color: Brown
c. Hair Color: Brown
13. Professional or Technical Licenses, Permits, etc. (W rite state, county or city in which registered/licensed):
14. County of Los Angeles Employee No.:
672103
15. Department Name:
Public Works
16. Job Title:
Public Works Laborer
17. For County employment you must be either (a) a citizen of the United States of America, or (b) a
registered alien with government permission to work in this country. Does either (a) or (b) describe your
status as a resident of this Country?
Yes No
18. Employment History: Begin with present or last experience Account for past ten years or past 5 employers
Time in
From MM/ YYYY To MM/ YYYY Months Position
Sun Glow Auto
1 09/30/2014 Present Glass Tech/Manager
California Insulated Wire and Cable
2 Machienist
2011 2014
Delta Scientific
3 2010 2011 Wleder
8
18. Employment History Continued:
Duties performed Wages or Name and addresses of all former Reason for Leaving
Salary employers including other county depts.
As well as private firms.
Glass installation
Payroll Sun Glow Auto
1 Insuring all employees were prompt Leaving to work for County
and correctly doing jobs assigned 80,000 11333 Moorpark St North Hollywood Ca
California Insulated Wire and Cable
2
Running machines 40,000 3050 North California St Burbank CA Better work opportunity
Delta Scientific
3 Welder
Fabricator
40,000 40355 Delta Ln Palmdale Ca Better work opportunity
Additional Comments:
19. Certification of Employee:
I certify that all information and statements made in this Employee Information Sheet and on any attachments pertaining thereto are true
and complete to the best of my knowledge. I understand that any false information and/or statements of material facts or omissions, may
subject me to disqualification or dismissal.
12/15/2021
DATE: SIGNATURE OF EMPLOYEE:
