Do you have the ability, with or without reasonable accommodations, to work overtime, if overtime is required by the job for which you are appling? ☐ Yes ☐ No

Would you be willing to perform all the tasks required by the job you are applying for? ☐ Yes ☐ No

Will you abide by the rules and regulations of the city? ☐ Yes ☐ No

Have you ever been disciplined for violating company safety rules or regulations? ☐ Yes ☐ No

How many days of work or school have you missed in the last 2 years?

How many times have you been late for work or school in the last 2 years?

Will you be willing and able to report to work on time every day on a regular and consistent basis? ☐ Yes ☐ No

Have you filed any type of fraudulent claim against any of your present or past employers? ☐ Yes ☐ No

Do you type? ☐ Yes ☐ No If yes, what is the words per minute?

Have you had any computer or word processing experience or training?

☐ Yes ☐ No

If yes, please describe.

What languages do you speak fluently?

Have you operated any machinery or special equipment?