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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.cit yofcody -wy.gov Email:[EMAIL REDACTED] 5 Year Driving Record must be submitted with Application SEASONAL PARKS ---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 Five Year Driving Record must be submitted with application to be considered for any positions with the Parks Division. Obtain this record from the DMV (Department of Motor Vehicle) ---PAGE BREAK--- Please check(,/) the jobs you would be most interested in performing if you were hired by the City of Cody. If there are any that are of particular interest, please mark them with a star ( * In the comments section below, please note any specific experience you have with each job. Please indicate if you would like to be considered in a pool of applicants for positions with the City of Cody on a year-round basis. If you mark yes, then the City of Cody will keep your application active for one year and consider your application for a variety of jobs that become available throughout the year. Parks & Public Facilities Mowing with push or riding mower Watering Weeding Planting flowers, trees, shrubs Pruning flowers, trees, shrubs Trimming with hand held trimmer Ro to-tilling Yes Raking Ballfield maintenance Cleaning outdoor No restrooms, picnic tables, grills, picking up trash, etc. Concrete work Building Roofing Painting Operating hand and power tools Cleaning inside restrooms Dusting Washing windows Vacuuming Mopping Event set up and tear dO\vn ---PAGE BREAK--- City of Cody Temporary and Provisional Positions - Not to Exceed 1039 Hours 5 year driving record requirement - Applicants applying for position(s) with the Parks Division are required to submit a 5 year driving record with application. Driving record can be obtained from the DMV. Parks Divisions Job Title Rate of Pay Maintenance Worker II $10.76 . Must submit a Driving History Record with application. Maintenance Worker II: Jobs will include a variety of task associated with the following: 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 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.