City of Wautoma

Experience Questionnaire – DPW Service Worker

The purpose of the questionnaire is to get a better understanding of the experience you may have. It does not have to be experience or knowledge that you gained during employment. Many individuals gain experience outside of employment through volunteer work or home improvement projects. Please answer the questions below and submit with your application.

Full Name: ______Date:______

Do you have a valid and current Commercial Driver’s License (CDL)? ______

How many years have you had a CDL? ______

How often do you drive a vehicle that requires a CDL? (please circle)

3-5 days a week once a week once a month once a year never

Have you ever used a plow vehicle? (please circle)

Pick-up truck Patrol truck/dump truck other ______

How many years have you plowed snow? ______

Please circle what you have plowed:

Driveway parking lot City streets other ______

Have you ever cleaned or maintained sewer pipe? ______

Have you ever laid sewer pipe or drainage tile? ______

Have you ever worked with concrete block and mortar? ______

Have you ever built a manhole or inlet? ______

Have you ever worked placing concrete? (please circle)

Sidewalk garage slab driveway roadway

Have you ever worked placing asphalt? (please circle)

Sidewalk garage slab driveway roadway

Do you have any experience in electrical wiring? ______

Have you ever had to clean or maintain a large building? ______

What type of facility? (please circle)

School Church Business Apartment complex Government building

Have you ever done landscaping work? (please circle work that you have done)

Mowed lawns trimmed bushes planted & maintained flower beds

Have you ever been involved with forestry work? (please circle work that you have done)

Tree cutting Tree trimming planting trees staking trees

Have you ever worked where there was a lot of public contact/customer service? ______

In what capacity? (please circle those that apply)

Cashier Waiter Attendant Sales clerk Usher Other

Have you ever done volunteer or service work? ______

In what capacity & for what organizations: (Please list)

Capacity Organization

______

______

______

______

______

Please circle the equipment/machinery that you have used and the number of time you have used them:

Equipment Used / # of years Used / How often
Daily / Weekly / Monthly
Computer
Calculator
Hammers, wrenches
Electrical power tools, saws, drills, etc.
Gas powered tools: weed-eater
Chain Saw
Shovel, rake, broom, etc
Jack-hammer
Concrete Saw
Automobile
Light truck (pick-up)
Heavy truck (dump truck)
Light truck with trailer
Heavy truck with trailer
Loader
Backhoe
Tractor
skid steer/bobcat
Sewer Jetter
Other

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