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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] RECREATION/AQUATIC SEASONAL APP ---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 ALL APPLICANTS OVER AGE 18 must complete the Application for Child & Adult Abuse/Neglect Central Registry Screen Document (pages 4/5 of application and return with application) ---PAGE BREAK--- COMPLETE ONLY IF AGE 18 OR OVER ---PAGE BREAK--- COMPLETE IF ONLY AGE 18 OR OVER ---PAGE BREAK--- Aquatics Division Job Title Rate of Pay Aquatics I $9.49 Aquatics II $10.12 Aquatics III $11.39 Aquatics IV $15.30 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--- Recreation Division Job Title Rate of Pay Recreation Assistant I $10.12 Recreation Assistant II $10.76 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. 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.