Maintenance Repair Worker Supplemental Questionnaire

Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

This position requires employees to work a rotating on-call schedule (approximately 3-4 times a year one week each time) and be available for on-call snow removal outside of regularly scheduled hours. Are you able to fulfill this requirement?

Yes No

Do you have a valid driver’s license?

Yes No

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. CARPENTRY

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. PAINTING/DRYWALL

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. TILE/GROUT WORK

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. MASONRY

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. PLUMBING

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. ELECTRICAL

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. HVAC

Describe any experience/training in the following areas and what company you performed this work for. Please include formal education, training programs, apprenticeships, employment, self-employment. WATER HEATERS

Please list other experience/training/skills that you possess which you feel are applicable to the position for which you are applying:

The Lincoln Housing Authority serves a variety of clients, including the elderly, low-income, persons with disabilities, individuals and persons from a variety of ethnic/cultural backgrounds. Describe your experience working with persons of the above mentioned populations.