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City of Cedar Rapids

Seasonal Employment Application
Please send applications to the hiring department listed below:
All Golf applications: All Parks Maintenance applications: All Aquatics and Recreation applications:
Golf Operations Parks Operations Ambroz Recreation Center
3601 42nd Street NE 3601 42nd St. NE 2000 Mt. Vernon Rd. SE
Cedar Rapids, Iowa 52402 Cedar Rapids, Iowa 52402 Cedar Rapids, Iowa 52403
Hours: 7:00 AM - 4:00 PM Weekdays Hours: 7:00 AM - 4:00 PM Weekdays Hours: 8:00 AM - 5:00 PM Weekdays
Phone: 286-5588 Fax: 386-5593 Phone: 286-5750 Fax: 386-5690 Phone: 286-5731 Fax: 286-5732

First Name Last Name Middle Initial Primary Phone Secondary / Mobile Phone
Shawn Engbretson M (319) 521 - 6035
Mailing Address E-mail Address
820 Oakland Road Ne ShawnEngbretson@gmail.com
City State Zip County of Residence
Cedar Rapids IA 52402 Linn

Position for which you are applying: Available to start work on:
Parks dept, Recycling waste, Or Streets Dept Asap
How did you hear about this opening? If you are under the age of 18 list your date of birth:
Gazette News Paper

Are you eligible to work in the United States? Yes No Are you a veteran of the US Military? Yes No

Check all types of work you will accept: Day-time Evenings Weekends Anytime Part-time
Are you now or have you ever been employed by the City? Yes No If yes, list position title and date(s).

Have you ever been convicted of a misdemeanor or felony? Yes No If yes, please explain, including date(s).
8 Years ago when I was 17. Will Discuss if needed to explain further.
The existence of a conviction record will not automatically disqualify you from the job. It will be reviewed along with other information that is relevant to the position.
Are you currently required to register as a sex offender in this or any other jurisdiction? Yes No If yes, please explain, including date(s)
and location of incident.
Was Convicted in 2004, 10 years on the registry. I have 3-4 more years left until I'm off the registry.

In the last 10 years, have you been discharged, suspended, or asked to resign from employment for disciplinary reasons?
Yes No If yes, give name of company and reason.

List the name(s), department and relationship of any relatives working for the City of Cedar Rapids. If none, so indicate.
My uncle used to work for you before he died, Douglas Engbretson. And Roy Grapes.

Highest degree received: High School/GED Technical Associates Bachelors Masters Doctorate
Name of School or Training Program State Major/Minor or Certificate Earned

Professional Licenses or Memberships:

Valid Driver's License: Yes No State of Issue: Iowa Driver's License Number: 979AA7646

CDL: Yes No Class: A B C Endorsements:

 Name of present / last employer Your Job Title Type of Business
A SilverCrest Recycling General Labor Recycling
City, State of employer Supervisor's name Supervisor's title Supervisor's phone
Cedar Rapids, IA Phil Manager (319) 362-7594
May we contact? Hours per week Start Date End Date Starting Pay Ending Pay
Yes No 40 2006 2/24/2011 7.75 8.00
Explain the specific reason for leaving / wanting to leave
Discrimination, and issues with other employees and manager being disrespectful.
Describe job responsibilities
Unloading semi Trucks, Driving forklift, General Machine Maintenance.
Name of present / last employer Your Job Title Type of Business
B Red Robyns Line cook Resturant
City, State of employer Supervisor's name Supervisor's title Supervisor's phone
Cedar Rapids NA NA
May we contact? Hours per week Start Date End Date Starting Pay Ending Pay
Yes No 30-40 2006 6 months 8.00 8.00
Explain the specific reason for leaving / wanting to leave
Laid Off
Describe job responsibilities
Prep Cooking, making sauces ect for the day. Line cook.

Experience: Check all that apply.

Years Years Years
Equipment Office Skills Certifications
Used Used Used
Typing (WPM) 8 First Aid
Manual transmission Microsoft Office Suite Lifeguard
Automatic transmission 5 Telephone CPR
Automatic mowing equipment 7 Customer Service CPR-P
Manual mowing equipment 10 CashRegister WSI
Other (Specify) Other (Specify) LGI
Age groups you have worked with Positions of interest: (Place a "1" by positions you are most interested in and a "2" by those you have
or have experience with. List years some interest in.
of experience in the space provided.
5 & under Youth Sports Clerical Special Populations
6 to 13 Adult Sports 1 Maintenance Greenhouse
14 to 18 Lifeguarding / Swimming Pools Art / Music / Dance Zoo
Adult Preschool / School Age Activities 1 Golf 1 Other (specify)
Cashier / Concession Work
The City of Cedar Rapids is an Equal Opportunity Employer.
All information provided is evaluated for relevance to the open position.
Application assistance provided for the disabled upon request.
I hereby certify that the answers and information given on this application and accompanying documents are trye and correct and without consequential omissions
of any kind whatsoever. I authorize all previous employers to furnish the City of Cedar Rapids, to the extent permitted by law, my reasons for leaving, and all other
information they may have concerning me. I release them and the company from all liability that may arise from such investigation. I also authorize officials of
education institutions that I have attended herein to give any information to verify listed education. I agree to submit to a pre-placement post-offer physical
examination before hiring and/or any time after hiring if required, at City expense. I hereby acknowledge the City of Cedar Rapids is notifying me of intent to conduct
drug or alcohol testing in connection with my employment, or workers compensation benefits. I understand also that the City may, at its discretion, any time during
my employment with the City, conduct a credit report of my person. I consent to the city of Cedar Rapids, Iowa, retaining whatever outside investigators, credit
reporters, doctors, pathologists, labs, Iowa Court System web site and/or other similar public records, etc., to conduct this testing and/or investigation. I understand
that I may, if I request, see the results of third party testing, investigations, etc., and have an opportunity to refute the finding. I further understand and certify that a
xerographic copy of this statement and my signature is as valid as the original for the purposes named above. The existence of a conviction record will not
automatically disqualify me from the job. It will be reviewed along with other information that is relevant to the position. By signing this application, I authorize the
City to make investigations and I indicate my awareness that false statements for failures to disclose certain information may be sufficient to disqualify me for
employment or, if employed, may result in my dismissal.

Signature of applicant: Shawn Engbretson Digitally signed by Shawn Engbretson

DN: cn=Shawn Engbretson, o, ou, email=ShawnEngbretson@gmail.com, c=US
Date: 2011.03.08 10:12:44 -06'00'
Date:

Open positions with the City of Cedar Rapids are updated weekly at www.cedar-rapids.org/government/departments/hr/employment/Pages/
default.aspx. Positions are also listed on our job line (319) 286-5095