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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] Wastewater Dist Operator I ---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 Job Description Title: Wastewater Operator I Code: 486 Department: Public Works Effective Date: 03/2007 Division: Wastewater Last Revised: GENERAL PURPOSE Performs a variety of entry level skilled duties related to wastewater treatment and laboratory analysis ensuring operational compliance through water sample collection, process management, meter testing and installation, service order completion and utility locates. SUPERVISION RECEIVED Works under general supervision of the Water Systems, Sanitation and Public Transportation Superintendent. SUPERVISION EXERCISED None. ESSENTIAL FUNCTIONS In a training capacity, assists in the operation of wastewater treatment plant; directs the flow of sewage through the plant to best utilize the various infiltration ponds, monitors plant operations to ensure proper flow and purification of wastewater through lagoon system. Assists to monitor safety as it relates to the handling, processing and testing of wastewater; monitors effectiveness of process by conducting water sampling at various stages of purification; performs various testing procedures to identify suspended solids, oxygen content, etc.; delivers samples for laboratory analysis; may review sampling results to determine compliance; completes reports and sends to State Department of Environmental Quality (DEQ). Maintains records on all maintenance performed as outlined in the yearly maintenance schedule. Meets with the public and may provide tours of wastewater facilities; educates visitors regarding treatment processes, effluent water quality and related environmental quality standards. Monitors wastewater lift stations to ensure efficient flow; cleans or clears grinder jams. Assists with the Performance of sewer collection system installation, maintenance, and repairs; installs new sewer mains, taps mains for service lateral connections, repairs leaks in sewer system; assists with Confined Space Entry in compliance with established safety standards. Operates Jet/Rodding truck; maintains and cleans city sewer collection system main lines; inspects manholes and sewer lines to detect leaks or malfunctions; opens clogged sewer lines using various pipe cleaning equipment. Performs other related duties as required. MINIMUM QUALIFICATIONS 1. Education and Experience: A. Graduation from high school or GED; AND B. One year experience performing above or related duties; OR C. An equivalent combination of education and experience. ---PAGE BREAK--- Wastewater Operator I, page 2 2. Knowledge, Skills, and Abilities: Some knowledge of operating basic manual and power tools; interpersonal communication skills. Ability to operate heavy equipment of various kinds under varying conditions; perform heavy physical labor; Operate sewage collection equipment in the event of an emergency or as a backup operator; develop and maintain effective working relationships with co-workers and the general public; communicate effectively, both verbally and in writing; work from blueprints; tolerate weather extremes in the work environment; ability to perform basic mathematical computations in reading and using various meters, gauges and related devices. 3. Special Qualifications: Must possess a valid class commercial driver’s license. Must be able to lift 50-75 pounds. Must be on the on-call schedule and live within a 45 minute response time. Must possess Level I Wastewater Certification and Level I Water Distribution Certification within one year of employment. 4. Work Environment: Tasks require variety of physical activities, generally involving muscular strain, such as walking, standing, stooping, sitting, reaching and lifting. Talking, hearing and seeing essential to performing required job functions. Common eye, hand, finger dexterity exist. Mental application utilizes memory for details, verbal instructions, emotional stability and discriminating thinking. Daily potential for hazardous exposure to electrical shock, industrial wastes and raw sewage (containing pathogens such as typhoid, paratyphoid, dysentery, polio, tetanus, etc.). Periodic local travel required in normal course of job performance. Disclaimer: The above statements describe the general nature, level, and type of work performed by the incumbent(s) assigned to this classification. They are not intended to be an exhaustive list of all responsibilities, demands, and skills required of personnel so classified. Job descriptions are not intended to and do not imply or create any employment, compensation, or contract rights to any person or persons. Management reserves the right to add, delete, or modify any and/or all provisions of this description at any time as needed without notice. This job description supersedes earlier versions. I have reviewed the above job description. (Employee)