For Office Use Only s6

AVAILABILITY FORM

RETURN TO: Attn: Returning MPS Employee Department of Recreation and Community Services 5225 W. Vliet Street, Room 56 – Milwaukee, WI 53208 ID #

Check all Positions you are Interested in Applying for: Aquatics Instructor (Adult) Playgrounds Before & After School Child Care Instructor (Youth) Summer Recreation Enrichment Camps Community Centers Outdoor Educ / Environmental Educ Therapeutic Recreation Field Attendant Performing / Visual Arts Youth Sports

Name(s) of Recreation Supervisor(s) you worked with last season ONLY:

Are you currently a MPS If YES, what position and school / location: Are you 18 Years of age employee? or over? Yes No YES NO

INSTRUCTIONS: Print answers in INK. Date and sign the application on the reverse side. Telephone #’s

Last Name: First Name: MI:

Former Names Used:

Address: City / State: Zip:

Email: @

MOST RECENT WORK EXPERIENCE: (Paid or Volunteer) DATES OF EMPLOYMENT From To POSITION HELD PLACE OF EMPLOYMENT (NAMES, ADDRESS, PHONE OF CONTACT PERSON)

MILWAUKEE PUBLIC SCHOOLS IS REQUIRED TO UPDATE CRIMINAL BACKGROUND RECORDS ON EACH EMPLOYEE.

NOTE: Convictions and pending charges are not an automatic bar to employment, but are reviewed in relation to the job for which you applied.

I certify that all statements made on this application are true, complete, accurate and not misleading to the best of my knowledge. I understand that any false or incomplete statements or misrepresentations may subject me to disqualification or dismissal. I further understand that

OVER   mts: 0904886db75ec3ddfe7c7a40e3af216e.doc after I am hired and during my employment, I am responsible for notifying the Director of Recreation or his/her designee of any convictions or pending charges involving criminal offenses, including felonies, misdemeanors and ordinance violations.

APPLICANT Dat SIGNATURE e

NOTE: FILLING OUT THIS APPLICATION DOES NOT GUARANTEE AN ASSIGNMENT!

OVER   mts: 0904886db75ec3ddfe7c7a40e3af216e.doc Last Name First Name MPS Employee ID #

DAYS and TIMES AVAILABLE for WORK: EARLIEST DATE AVAILABLE TO START MONDA TUESDA WEDNESD THURSDA FRIDA SATURDA SUNDA DAY: Y Y AY Y Y Y Y MORNING HOURS: AFTERNOON HOURS: EVENING HOURS:

PREVIOUS MPS Division of Recreation position(s): (Please list most recent first.) L O C A T I O N : YEAR: POSITION:

Are you related (by blood or marriage) to a current MPS part-time, or full-time recreation employee? (This includes guardianships as well as legal adoptions.) If yes, list individual name(s), Yes relationship & work location(s).

Yes Are you a student? School Year Major

SKILLS / ABILITIES: Please list any New Skills you could instruct or trainings you have had since your last assignment:

CERTIFICATIONS: (Please check () those that apply) (CPR) Cardiopulmonary Water Safety First Aid Lifeguard Training Resuscitation Instruction Expiration Date : // Expiration Date : // Expiration Date : // Expiration Date : //

 FOR OFFICE USE ONLY 

WINTER SPRING SUMMER FALL – YEAR 20 RETURNING RECREATION EMPLOYEE

Job Title Job Classification: Recreation Leader Location & Starting / Ending Address Dates Rate of Day( Hour( Pay s) s)

Job Title Job Classification: Recreation Leader Location & Starting / Ending Address Dates

OVER   mts: 0904886db75ec3ddfe7c7a40e3af216e.doc Rate of Day( Hour( Pay s) s)

Job Title Job Classification: Recreation Leader Location & Starting / Ending Address Dates Rate of Day( Hour( Pay s) s)

INSERVIC I INSERVIC E 1 N E 3 S E R V I C E

2 Location L Location o c a t i o n Address A Address d d r e s s Date D Date a t e Time T Time i m e

Initial / Date Received Sent To / Date Sent Comment(s):

OVER   mts: 0904886db75ec3ddfe7c7a40e3af216e.doc MILWAUKEE PUBLIC SCHOOLS DEPARTMENT OF RECREATION AND COMMUNITY SERVICES SUPPLEMENTARY APPLICANT INFORMATION

PLEASE NOTE: THIS FORM MUST BE FILLED OUT IN ORDER TO PROCESS YOUR APPLICATION

No applicant for employment shall be discriminated against because of race, color, creed, religion, sex, genetic testing, sexual orientation, marital status, membership in the military reserves, national origin, ancestry, age, arrest or non-job-related conviction record, non-job-related physical or mental disability, or the use or nonuse of lawful products off the employer’s premises during nonworking hours.

Completion of questions 1, 3 and 4 are MANDATORY. Completion of questions 2, 5, and 6 are voluntary. We ask, however, for your cooperation in completing the following information. It will be treated confidentially. The data collected will be used to process your application, to help us monitor the Milwaukee Public Schools’ Equal Employment Opportunity/Affirmative Action efforts and to comply with Federal record-keeping requirements.

PLEASE PRINT OR TYPE

1. NAME: Last First Middle

2. Sex (please check one) Male Female

3. DATE OF BIRTH: Month Day Year (This information will be used for conducting a criminal background check which is mandatory for all applicants.)

4. SOCIAL SECUITY NUMBER: - -

5. Race (please check one) Native American Hispanic African American White Asian/Oriental/Pacific Islander Other

6. Position applied for:

CONTRACTORS ONLY:

Address City State Zip Code

The above completed information is true to the best of my knowledge.

SIGNATURE: DATE:

mts: 10/27/140904886db75ec3ddfe7c7a40e3af216e.doc FOR RECREATION OFFICE USE ONLY: CBC Requested By: Site:

mts: 10/27/140904886db75ec3ddfe7c7a40e3af216e.doc