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Application for Employment 1338 Rumsey Ave. PO Box 2200 CODY, WY 82414 (307) 527-7511 POSITION APPLIED FOR DATE OF APPLICATION / / NAME LAST FIRST MIDDLE LIST OTHER NAMES USED, IF MAILING ADDRESS STREET OR PO BOX CITY STATE ZIP CODE PRIMARY TELEPHONE NUMBER ( ) - ALTERNATE TELEPHONE NUMBER EMAIL Are you under the age of 14? YES NO Are you over the age of 18? YES NO (For Police Officers in WY, the minimum age is 21) Have you ever been employed by the City of Cody? YES NO If yes, give dates I understand, if hired, I will be required to provide proof of eligibility to work in the United States. YES NO Have you ever been convicted of any law violation other than a minor traffic violation? YES NO (“YES” answer does not automatically disqualify you from employment since the nature of the offense, date and the job for which you are applying will also be considered.) If yes, give details: Are you related to anyone presently working for the City of Cody? YES NO If Yes, list name Do you have a valid license? YES NO Driver’s License # STATE? Do you have a Commercial Driver’s License? YES NO Class: (A,B,C) Endorsements Held: Hazardous Material Tanker Airbrakes Passenger Have you ever been terminated, dismissed or asked to resign from any position? YES NO If yes, please explain Educational Background COLLEGE/UNIVERSITY/TRADE SCHOOLS CITY/STATE CREDITS COMPLETED DEGREE/ DIPLOMA YEAR MAJOR MINOR High School: City Website: http://www.cityofcody-wy.gov Email:[EMAIL REDACTED] ---PAGE BREAK--- Employment History List your employment history starting with the most recent employer. List all positions held, including military experience, part-time, summer and/or volunteer work and periods of unemployment. Explain any gaps in employment in comments section below. EMPLOYER TELEPHONE ( ) - DATES EMPLOYED Summarize your job responsibilities FROM TO ADDRESS JOB TITLE SALARY FINAL IMMEDIATE SUPERVISOR AND TITLE $ PER HOUR PER WEEK PER MONTH REASON FOR LEAVING MAY WE CONTACT? EMPLOYER TELEPHONE ( ) - DATES EMPLOYED Summarize your job responsibilities FROM TO ADDRESS JOB TITLE SALARY FINAL IMMEDIATE SUPERVISOR AND TITLE $ PER HOUR PER WEEK PER MONTH REASON FOR LEAVING MAY WE CONTACT? EMPLOYER TELEPHONE ( ) - DATES EMPLOYED Summarize your job responsibilities FROM TO ADDRESS JOB TITLE SALARY FINAL IMMEDIATE SUPERVISOR AND TITLE $ PER HOUR PER WEEK PER MONTH REASON FOR LEAVING MAY WE CONTACT? Additional job history and/or resume can be attached. EXPLAIN GAPS IN EMPLOYMENT: SPECIAL SKILLS AND QUALIFICATIONS: Summarize special skills and qualifications you would like us to consider including certifications and licenses. Professional References List three (non-related) persons who can objectively assess your professional or scholastic performance. NAME TELEPHONE YEARS KNOWN ---PAGE BREAK--- CERTIFICATION OF ACCURACY & AUTHORIZATION TO RELEASE INFORMATION I certify that all information provided in this application is true and complete. I understand misrepresentation or omission of facts during the application or selection process may disqualify me from further consideration and may be cause for dismissal. I understand the City of Cody may conduct a background investigation, which may include obtaining information as to my character, reputation, and mode of living. This may include interviews with my relatives, neighbors, friends, former employers, schools and others. I authorize the City of Cody to investigate my employment background and personal history. I authorize the City of Cody to obtain any and all information relevant to determining my qualifications for the job for which I have applied. I further authorize the City of Cody to obtain copies of and review any and all employment records, documents and such other information as the City of Cody may determine relevant to its investigation. I agree to sign an authorization and consent to release of information to allow the City of Cody to obtain copies of prior employment records, documents and information from prior employers, organizations, references, and individuals who may have information relevant to my qualifications to work for the City of Cody. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand that I may also be required to successfully pass drug and alcohol screening examinations. I hereby consent to pre- and/or post-employment drug and alcohol screens as a condition of employment, if required. I have read, understand, and by my signature, consent to these statements. I authorize investigation of all information contained in this application. Signature of Applicant Date ---PAGE BREAK--- City of Cody Temporary and Provisional Positions - Not to Exceed 1039 Hours 10 year driving record requirement - Applicants applying for position(s) requiring a driving record – may either obtain at their cost the 10 year driving record or complete section of the Release for Driving Record. Note: by authorizing the City of Cody to obtain your driving record will result in delay of the application process up to 14 days. Parks & Public Facilities Divisions Job Title Rate of Pay Maintenance Worker I $10.12 Maintenance Worker II $10.76 Maintenance Worker I: Irrigation Maintenance Worker Assists with the repair and replacement of underground irrigation lines and sprinklers. Landscape Maintenance Worker Assist with watering, planting, weeding, and minor pruning of trees, shrubs, and flowers, maintaining tree wells, shrub and flower beds. Employee may also treat trees, shrubs, flowers or other foliage with spray herbicide. Park Mowers Responsibilities include using riding power mowers to cut grass on all city property. May assist other City divisions as assigned. Must be 18 years of age or older and have a valid driver’s license. These positions may require a varied schedule including evenings, holidays and weekends. Must submit a Driving History Record with application. Maintenance Worker II: Playground Inspector Employees will inspect playground equipment, and if necessary make repairs and document repairs of faulty equipment. Must roto-till and rake sand areas on a basis. Park Trimmer General maintenance duties include operating power and push mowers and motorized weed trimmers to cut grass and weeds around trees, facilities and equipment; including the Greybull Hill and 13 th Street Hill parkways and various other grass areas within the City. Ball Field Maintenance Workers Duties include the maintenance of the City’s three softball fields, five baseball fields and the maintenance and cleanliness of the ball fields. Must be able to drive maintenance vehicles and various equipment including mowers, sand-pro and tractor to perform various functions in the ball fields. Carpenter Helper Must assist with construction projects including concrete work, roofing projects, painting and other various projects. Must have basic carpentry skills and willingness to learn construction procedures. These positions may require a varied schedule including evenings, holidays and weekends Park Attendant Employee must be able to work a schedule that accommodates the opening and closing of City parks and must be able to clean restrooms, wash picnic tables, clean fire grills, empty garbage receptacles, pick up garbage and provide general cleaning and maintenance of all park grounds. Employee must interact with the public as necessary. Employees are required to work rotating shifts and will work weekends, evenings, early mornings and holidays throughout the summer. May assist other City divisions as assigned. Must be 18 years of age or older and have a valid driver’s license. Must submit a Driving History Record with application. Aquatics Division Job Title Rate of Pay Aquatics I $9.49 Aquatics II $10.12 Aquatics III $11.39 Aquatics IV $15.30 Aquatics Fitness/Aerobics Instructor $12.02 Aquatics I: Duties include serving as an aide during swimming lessons, dispatching patrons down the water slide, acting as a shallow water attendant, interacting with the public and assisting with custodial ---PAGE BREAK--- duties. Employee must be willing to communicate clearly and concisely with the public of all ages. Employees must be certified through the American Red Cross in CPR and First Aid (preferably Professional Rescuer) and attend an in-house Water Safety Instructor Aide class. Employees must be at least 14 year of age and available to work approximately 10-40 hours per week depending upon the season including evenings, weekends, and holidays. May assist other City divisions as assigned. Aquatics II: Employees must be certified through the American Red Cross as either a Lifeguard or Water Safety Instructor and be certified in CPR (preferably Professional Rescuer). Employee may be certified as both Lifeguard and Water Safety Instructor; however, the employee will primarily be employed to serve as one or the other. Water Safety Instructor’s must be at least 16 years of age and duties include planning, instructing and evaluating the American Red Cross Learn to Swim program. Employee must be able to assess swimming skills for various levels and determine appropriate instruction. Lifeguards must be at least 15 years of age and duties include patron safety, recognizing unsafe conditions, implementation of safety protocol, and emergency response. Employees will assist with custodial duties and water testing and maintenance. Employees must be able to communicate clearly and concisely with patrons of all ages. Employees are expected to demonstrate a high level of professionalism, maturity and responsibility. Participation in training and frequent skills review is mandatory. Employees should expect to work approximately 10-40 hours per week depending on the season including evenings, weekends and holidays. May assist other City divisions as assigned. Aquatics III: Employees must be certified through the American Red Cross as both a Lifeguard and a Water Safety Instructor and serve in both capacities on a regular basis. Duties of the Aquatics II apply to the Aquatics III position. Employees should expect to work approximately 10-40 hours per week depending on the season including evenings, weekends and holidays. Duties will be assigned based on qualifications and department needs. May assist other City divisions as assigned. Aquatics IV: Employees must be certified through the American Red Cross as Lifeguard and serve in this capacity on a regular basis. Duties of the Aquatics II apply to the Aquatics IV position. Employees should expect to work approximately 10-40 hours per week depending on the season including evenings, weekends and holidays. Will perform as “shift supervisor” and be responsible for assigned staff during shift, implementation of shift duties/responsibilities, review daily and weekly maintenance logs. Review timesheets at the end of each day. Assist in performing duties associated with closure of pool area. Duties will be assigned based on qualifications and department needs. May assist other City divisions as assigned. Aquatic Fitness/Aerobics Instructor: Employees will instruct a variety of ongoing and new programs including water aerobics, and other strength/cardiovascular training. The primary duties include designing and teaching fitness/aerobic classes to seniors, adults and youth including physical activities, special interest classes and special events. Applications will be taken on an ongoing basis and positions will be filled as needed. Actual open position(s) dependent upon seasonal classes being offered. The City of Cody will maintain applications to review throughout the year as positions become available Recreation Division Job Title Rate of Pay Recreation Assistant I $10.12 Recreation Assistant II $10.76 Fitness/Aerobics Instructor $12.02 Recreation Assistant I: Employee will help Recreation Staff coordinate and supervise a variety of recreational activities for children of all ages including tennis, gymnastics, volleyball, basketball, soccer, gymnastics, day camp, arts and crafts and a variety of other programs. In addition, employee may serve ---PAGE BREAK--- as a facility monitor at the Recreation Center. Duties include monitoring the activities in the gymnasium and workout area as well as cleaning weight and cardiovascular fitness equipment and setting up and taking down equipment for league games. Employee may also serve as a concession stand attendant, preparing and serving food and snacks, stocking shelves, monitoring inventory and cash handling. Employee should expect to work approximately 10-35 hours per week depending on the season including evenings, weekends and holidays. Must be at least 14 years of age. May assist other City divisions as assigned. Recreation Assistant II: Employee will assist Regular Part-time Recreation Assistants with the coordination and supervision of the Kidz on the Move Daycamp as well as the After School Activities Program when in session. Employee may also serve as a facility monitor at the Recreation Center. Duties include monitoring the activities within the facility as well as cleaning weight and cardiovascular equipment and setting up and taking down of equipment for league games and special events. Employee may also serve as a concession stand attendant, preparing and serving food and snacks, stocking shelves, monitoring inventory and cash handling. Employee may also answer phones, meet and greet patrons, swipe membership cards check patrons into facility, take registrations for programs, make facility reservations, and handle cash drawer and daily balancing of drawer and file. Employee should expect to work approximately 10-35 hours per week depending on the season including evenings, weekends and holidays. Must be at least 14 years of age. May assist other City divisions as assigned. Fitness/Aerobics Instructor: Employees will instruct a variety of ongoing and new programs including yoga, step aerobics, spinning, Pilates, water aerobics, and other strength/cardiovascular training. The primary duties include designing and teaching fitness/aerobic classes to seniors, adults and youth including physical activities, special interest classes and special events. Applications will be taken on an ongoing basis and positions will be filled as needed. Certifications from organizations such as ACE and ACSM are desired. May assist other City divisions as assigned. Actual open position(s) dependent upon seasonal classes being offered. The City of Cody will maintain applications to review throughout the year as positions become available. Miniature Golf Course Job Title Rate of Pay Lead Attendant: $14.71 Attendant: $11.30 Lead Attendant: Employee will schedule and assign staff to facilitate daily operations of miniature golf course, as well as, oversee all operations including answering questions, maintaining cleanliness and properly maintained course. Provide superior levels of customer service to golf course customers, report for all scheduled shifts or find a substitute. Must be able to provide own transportation to work, able to work flexible hours, able to handle and count cash. A work schedule may fall anywhere between 11:00 am and 9:00 pm Sunday through Saturday, including holidays. Must be at least 18 years of age. Attendant: Work assigned shift to facilitate daily operations of miniature golf course, as well as, oversee all operations including answering questions, maintaining cleanliness and properly maintained course. Provide superior levels of customer service to golf course customers, report for all scheduled shifts or find a substitute. Must be able to provide own transportation to work, able to work flexible hours, able to handle and count cash. A work schedule may fall anywhere between 11:00 am and 9:00 pm Sunday through Saturday, including holidays. Must be at least 16 years of age. ---PAGE BREAK--- To provide your driving record (State of WY) at no cost to you complete Section B Date, sign and return with application - Record will only be obtained if required for position applying for X City of Cody C Baker PO Box 2200 Cody WY 82414 [PHONE REDACTED] [PHONE REDACTED] X