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11 POSITION APPLIED FOR: Date: Employment Application City of Cody P.O. Box 2200 ~ Cody, WY 82414 Name Last First Middle Street/Mailing Address: City St Zip Email Address: Work Phone: Home Phone: Cell Phone: List other names, if any, used on employment or education records: Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? □ Yes □ No Are you 18 yrs or older? □ Yes □ No Are you under the age of 14? □ Yes □ No For Temporary/Seasonal Hire – Please complete the following. Dates Available for Employment: From to Have you ever been convicted of a felony? □ Yes □ No If yes, describe in full detail, giving dates (Criminal convictions are not an absolute bar to employment, but will be considered in relation to specific job requirements.) Have you ever worked for or are you currently working for the City of Cody? □ Yes □ No If yes, please give dates and department(s): Prior Position(s): Reason(s) for leaving: Do you have any relatives working for the City of Cody? □ Yes □ No If yes, please give their name, department and relationship: P E R S O N A L I N F O R M A T I O N ---PAGE BREAK--- E D U C A T I O N School Name and Address of School Course Circle Last Year Did You List Diploma Of Study Completed Graduate or Degree(s) High 8 9 10 11 12 □Yes □No College 1 2 3 4 □Yes □No Other (Specify) S P E C I A L S K I L L S Special Skills Relating To The Position For Which You Are Applying: (clerical skills, heavy equipment operating skills, etc.) C E R T I F I C A T I O N S Driver’s License: If required for this position: Do you have a valid Driver’s License? □ Yes □No State: License Number: Expiration Date: Do you have a Commercial Driver’s License? □Yes □No If yes, specify: Class: B, C) Endorsements Held: Hazardous Material □ Tanker □ Airbrakes □ Passenger □ (Please check all that apply) Other (specify) Certificates: (CPA, PE, Boiler Operator, Life guard, etc) Name and address of Licensing Agency Type of License Endorsement/Restriction (if applicable) Date Licensed Date Expires (if applicable) ---PAGE BREAK--- E M P L O Y M E N T H I S T O R Y Employment Experience Instructions: Begin with your present or most recent job and list your entire work experience with emphasis on experience relevant to the position for which you are applying. Include military service and any volunteer work which provided experience that would help you qualify. If the space below is not adequate, you may continue this section on a separate sheet of paper. This information must be completed. Notice to Applicants: Information that you provide on this application is subject to verification. Previous employers may be contacted as references or for verification. Do you want to be informed before we contact your present employer? □Yes □No Current Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: Past Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: Past Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: 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 understand I have the right to make a written request within a reasonable time for the disclosure of the name and address of any consumer reporting agency which may be utilized in the background investigation so I may obtain a complete disclosure of the nature and scope of the investigation. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer (except as previously noted), past employers and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. 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 (Revised 2013) References: List three references, excluding relatives, who have knowledge of your ability to perform this job. Name of Reference Complete Mailing Address Telephone Number Years Acquainted ---PAGE BREAK--- Past Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: Past Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: Past Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: Past Employer: Mailing Address: Street Address: Date Employed: From Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: ---PAGE BREAK--- City of Cody Temporary and Provisional Positions - Not to Exceed 1039 Hours Aquatics Division Job Title Rate of Pay Aquatics I $9.49 Aquatics II $10.12 Aquatics III $11.39 Aquatics IV $15.30 Party Coordinator $10.76 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 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. ---PAGE BREAK--- 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 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.