Questionaire for Facilities Specialist in the Power Plant

NAME DATE

QUESTIONAIRE FOR FACILITIES SPECIALIST IN THE POWER PLANT

1. Have you read the job description for Facilities Specialist Power Plant and do you understand the duties of such a position? Can you work nights, weekends, and holidays? If no, please explain.

2. Have you been employed as a power plant operator, boiler man, or stationary fireman? If yes, please list where, when, and for how long. (If additional space is needed; use the back of this sheet.)

3 Have you participated in any formalized boiler training? If yes, please list where and when?

4. Are you familiar with the operation of gauges, small pumps, and valves associated with boilers? Does working around noisy machinery bother you?

5. Can you lift bags of water treatment, boiler parts, and other items? If no, please explain.

6. Can you climb ladders and work on boilers while on platforms at various heights. If no, please explain.

7. This position requires the employee to work in small, enclosed areas. Are you able to do this? If no, please explain.

8. Can you work effectively with fellow operators and other employees? If no, please explain.

Is working by yourself a problem for you? If yes, please explain.

9. Do you have experience working in areas where many other people also work or pass through daily?

10. Would you be willing to change shifts on short notice or cover extra hours for vacation/sick leave of other employees? If no, please explain.

11. Do you have experience working in a university environment? If yes, where?

Pittsburg State University is an Equal Opportunity, Affirmative Action and Veteran’s Preference Eligible Employer. Employment will require a criminal background check.

PHYSICAL PLANT CUSTODIAL AND GENERAL SERVICES - EMPLOYMENT INFORMATION

PITTSBURG STATE UNIVERSITY

PRESENT DATE

NAME (print) (LAST) (FIRST) (MIDDLE)

PRESENT ADDRESS

(STREET, ROUTE, BOX) (CITY)

TELEPHONE STATE ZIP

PLEASE LIST YOUR EDUCATION AND TRAINING:

NAME AND ADDRESS OF SCHOOLS: CIRCLE HIGHEST GRADE COMPLETED

GRADE SCHOOL 1 2 3 4 5 6 7 8

HIGH SCHOOL 9 10 11 12

DESCRIBE FULLY ANY BUSINESS, CORRESPONDENCE, TRADE SCHOOL, OR COLLEGE TRAINING. GIVE FULL DETAILS REGARDING COURSES TAKEN, HOURS CREDIT, AND MAJOR SUBJECT STUDIED.

DEGREE OR HOURS NAME AND LOCATION OF SCHOOLS TYPE OF SCHOOL/MAJOR COMPLETED

POSITION DESIRED AND QUALIFIED FOR WILL YOU ACCEPT TEMPORARY EMPLOYMENT? _________________________________________________________

REFERENCES (OTHER THAN RELATIVES):

NAME ADDRESS CITY PHONE

(OVER)

EMPLOYMENT HISTORY: (Last position first)

Are you presently employed? yes no part-time full-time

May we contact your current employer? yes no

Employer Position Held Address Employed from to (Street) (City) Salary (per month) Supervisor’s Name DUTIES

Employer Position Held Address Employed from to (Street) (City) Salary (per month) Supervisor’s Name DUTIES

Employer Position Held Address Employed from to (Street) (City) Salary (per month) Supervisor’s Name DUTIES

Employer Position Held Address Employed from to (Street) (City) Salary (per month) Supervisor’s Name DUTIES

Employer Position Held Address Employed from to (Street) (City) Salary (per month) Supervisor’s Name DUTIES

I authorize Pittsburg State University to utilize the information given in determining my eligibility for employment. Fraudulent statements made on this application may be cause for dismissal. I understand that, as a condition of employment, PSU reserves the right to grant compensatory time off in lieu of overtime hours worked.

Signature Information received by Pittsburg State University will be handled confidentially.

Pittsburg State University is an Equal Opportunity, Affirmative Action and Veteran’s Preference Eligible Employer. Employment will require a criminal background check