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11 Employment Application City of Cody P.O. Box 2200 ~ Cody, WY 82414 POSITION APPLIED FOR: RPT Facilities Maintenance Worker $14.02/hr Date: Name Last First Middle Street/Mailing Address: P E Email Address: R S O Work Phone: N Home Phone: City St Zip Cell Phone: A List other names, if any, used on employment or education records: L Are you prevented from lawfully becoming employed in this country because of Visa or I Immigration Status? □ Yes □ No N F O Are you 18 yrs or older? □ Yes □ No Are you under the age of 14? □ Yes □ No R M For Temporary/Seasonal Hire – Please complete the following. A Dates Available for Employment: From to T I Have you ever been convicted of a felony? □ Yes □ No If yes, describe in full detail, O giving dates N (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: ---PAGE BREAK--- School Name and Address of School Course Circle Last Year Did You List Diploma Of Study Completed Graduate or Degree(s) E D High U C A T College I O N Other (Specify) 8 9 10 11 12 1 2 3 4 □ Yes □ No □ Yes □ No S Special Skills Relating To The Position For Which You Are Applying: (clerical skills, heavy P equipment operating skills, etc.) E C I A L S K I L L S Driver’s License: If required for this position: Do you have a valid Driver’s License? □ Yes □ No State: License Number: C E Expiration Date: R Do you have a Commercial Driver’s License? □Yes □ No T If yes, specify: Class: B, C) I Endorsements Held: Hazardous Material □ Tanker □ Airbrakes □ Passenger □ F (Please check all that apply) I Other (specify) C A Certificates: (CPA, PE, Boiler Operator, Life guard, etc) T Name and address of I Licensing Agency O N S Type of License Endorsement/Restriction (if applicable) Date Licensed Date Expires (if applicable) ---PAGE BREAK--- Current Employer: Mailing Address: Street Address: Date Employed: From To 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 To 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 To Salary/Wage: Position(s) Held: Contact Name and Title: Phone Description of work performed: Reason for leaving: 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 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) 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 E M P L O Y M E N T H I S T O R Y ---PAGE BREAK--- Past Employer: Street Address: Salary/Wage: Contact Name and Title: Description of work performed: Mailing Address: Date Employed: From To Position(s) Held: Phone Reason for leaving: Past Employer: Street Address: Salary/Wage: Contact Name and Title: Description of work performed: Mailing Address: Date Employed: From To Position(s) Held: Phone Reason for leaving: Past Employer: Street Address: Salary/Wage: Contact Name and Title: Description of work performed: Mailing Address: Date Employed: From To Position(s) Held: Phone Reason for leaving: Past Employer: Street Address: Salary/Wage: Contact Name and Title: Description of work performed: Mailing Address: Date Employed: From To Position(s) Held: Phone Reason for leaving: ---PAGE BREAK--- City of Cody Job Description Title: Regular Part-Time Facilities Maintenance Worker Code: 275 Department: Parks/Recreation/Public Facilities Effective Date: 03/2007 Division: Parks & Public Facilities Last Revised: GENERAL PURPOSE Performs working level custodial and facilities maintenance duties; maintains premises of Cody Quad Center, City Hall, Auditorium and all other City Facilities in a clean and orderly condition. SUPERVISION RECEIVED Works under the general supervision of the Parks & Public Facilities Supervisor. SUPERVISION EXERCISED May provide direction to seasonal, temporary or part-time workers during training or on a project by project basis. ESSENTIAL FUNCTIONS Greets visitors, maintains cordial interaction with all ages of the public at all times; assists with set up and take down for special events at these facilities. Performs a variety of maintenance functions on buildings and the associated equipment; maintains record of work completed; tracks material usage and recommends annual materials purchases. Cleans rooms, hallways, lobbies, lounges, rest rooms, corridors, stairways and locker rooms and other work areas as assigned. Cleans light fixtures and replaces bulbs and light ballasts. Monitors HVAC functions to ensure proper indoor climate; operates climate controls to establish needed or request changes; may perform routine HVAC system maintenance. Sweeps, extracts, scrubs, waxes and polishes floors; cleans rugs, carpets, upholstered furniture and draperies; sweeps, mops, scrubs, and vacuums hallways, stairs and office space; strips and refinishes floors. Washes walls, ceiling, and woodwork. Washes windows, door panels, and sills. Replenishes supplies and monitors supply stock and reorders as necessary. Empties trash and garbage containers. Patrols facility and grounds and disposes of litter. Transports equipment and supplies to various facilities in preparation for community events and functions. Presents facility to the public and may assist in facility scheduling. Maintains building, performing minor and routine painting, plumbing, electrical wiring, and other related maintenance activities. Monitors heating and cooling systems. Assists with minor equipment repairs. ---PAGE BREAK--- Assists in removing snow and debris from surrounding sidewalks. Coordinates with facility users during special events including set up and tear down, decorating, clean-up and maintenance of rest rooms during peak use; opens and closes facilities, locking and unlocking as needed. Maintains kitchen appliances by cleaning and assisting with the maintenance of swamp coolers, ice machines and boiler systems. Assists various service organizations during regularly scheduled facility use. Performs related duties as assigned. MINIMUM QUALIFICATIONS 1. Education and Experience: A. Graduation from high school or G.E.D.; AND B. One year of experience performing above or related duties; OR C. An equivalent combination of education and experience. 2. Knowledge, Skills, and Abilities: Working knowledge of interpersonal communication skills; procedures, tools, equipment, materials and cleaning agents used in custodial work; emergency measures to be taken in the event of accident, injury or chemical hazards; safety practices of custodial work and use of cleaning agents and equipment; effective operation of equipment such as carpet extractors, vacuums and snow blowers. Some knowledge of HVAC operating systems. Ability to recognize building malfunctions in heating, cooling, plumbing, and electrical systems; operate tools and equipment used in custodial work; follow oral and written instructions; perform heavy lifting and other duties requiring moderate physical strength; develop working relationship with other employees and supervisor(s). 3. Special Qualifications: Must possess and maintain a valid Wyoming Class C Driver’s License. Must work abnormal work schedules including evenings, weekends and holidays. 4. Work Environment: Incumbent of the position performs both indoor and outdoor physically demanding duties. Tasks require a variety of physical activities, generally involving muscular strain, such as lifting, walking, standing, stooping, reaching, and lifting. Hearing, seeing and reading are essential to performance of daily duties. Common eye, hand, finger, leg and foot dexterity also expected. Mental application utilizes memory for details, verbal instructions, emotional stability and discriminating thinking, guided problem solving. May be required to lift in excess of 50 pounds in normal course of job performance.