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Date: J Name: 1/,2i S i7 F—Ej C-l- L—P Nb (please print name) <br />Seasonal General Laborer <br />Supplemental Questionnaire <br />In order to assist us in evaluating you as a candidate, we ask that you take a few minutes to answer "yes" <br />or "no" to each of the following questions: <br />Are you willing to do .... <br />�1 <br />1. <br />Building /custodial maintenance? <br />X Yes <br />❑ <br />No <br />2. <br />Parks /restroom cleaning? <br />0 Yes <br />❑ <br />No <br />3. <br />Painting? <br />pL Yes <br />❑ <br />No <br />4. <br />Work in and around sanitary sewage and perform <br />Smoke testing of sanitary sewers? <br />V, Yes <br />❑ <br />No <br />5. <br />Grounds /landscape maintenance <br />w Yes <br />❑ <br />No <br />6. <br />Garbage and Litter pick -up? <br />X Yes <br />❑ <br />No <br />7. <br />Graffiti removal? <br />g Yes <br />❑ <br />No <br />8. <br />Concrete /asphalt? <br />* Yes <br />❑ <br />No <br />9. <br />Dead anlmal pick -up? <br />g Yes <br />❑ <br />No <br />10. <br />Vegetation Removal <br />p Yes <br />❑ <br />No <br />11. <br />Work in and around poison oak? <br />oC Yes <br />❑ <br />No <br />12. <br />Work in and around traffic hazards? <br />lac, Yes <br />❑ <br />No <br />13. <br />Irrigation repair? <br />0 ' e's <br />9d <br />No . <br />14. <br />Heavy Labor? <br />�Z Yes <br />❑ <br />No <br />15. <br />Work in extreme weather conditions? <br />pA Yes <br />❑ <br />No <br />16. <br />Provide appropriate footwear that meets safety standards? <br />a4 Yes <br />n <br />No <br />17. <br />Do you possess a valid CDL? (beneficial for some positions) <br />❑ Yes <br />1 W <br />No <br />