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Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Have you ever been convicted of a violation of the law other than a minor traffic violation?*
1. Yes
1. No
If yes, please explain:
Are you eligible to work in the United States?*
1. Yes
1. No
Do you meet the age requirement for the position you are applying for?
1. Yes
2. No
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This supplemental questionnaire must be completed and submitted with a completed Village of Cross Plains job application, in order to be considered for this position.
Please describe any experience you have in the following areas:
Maintenance, construction, repair, and cleaning (including sweeping, snow and ice removal) of streets, paths, and sidewalks.*
Performing routine minor repairs and maintenance on vehicles and equipment (please be specific on what types of equipment).*
Maintenance of a water and sewer system including: well repair, main/lateral repair, meter installation, equipment reading, sewer cleaning, and general maintenance/repairs.*
Carpentry experience and capabilities.*
Please list any other experience, skills or abilities (including relevant vehicle and equipment experience) that would enable you to adequately and efficiently perform the duties identified in the job description.
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I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of my application and that if hired I may be released from employment.

I understand that the company may require me to successfully complete a pre-employment drug and alcohol test and a background check as a condition of employment and that continued employment may be based on the successful completion of similar tests.

Your electronic signature below indicates your agreement with the following statements: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.
Applicant Signature*

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