WORK APPLICATION Date: *1/03/2024
Last Name
Liegeois
First Name
Ray
Middle Name
P
Present Address (number, street, city, state, zip code) 1222 South 6th Street De Pere, Wisconsin 54115
Home Phone
E-Mail Address
************@*****.***
Alternate Phone
What shift(s) are you available to work?
First Second Third
Mornings Afternoons Evenings
Rotating Weekend Non-Standard
Types of Employment Preferred (Check more than one box if desired) Permanent (Full Time) Permanent (Part Time)
Temporary (Full Time) Temporary (Part Time)
On Call Project / Contract
On Call Temporary Apprentice
Internship
What days are you available to work?
Monday-Friday Weekends Only Non-Standard
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you have transportation available? Yes No
Do you have a valid driver’s license? Yes No
Are you 18 or older? Yes No
Are you a veteran? Yes No
Desired Salary
EDUCATION AND TRAINING
Do you have a High School Diploma, HSED, or GED?
Yes No
Check the box next to the highest grade or year completed in school: 1 2 3 4 5 6
7 8 9 10 11 12 Highest grade completed in college
Dates Attended
Name of School From To Course(s) of Study Degree / Awards CERTIFICATIONS, LICENSES, AWARDS
Employee of the Month at Woodside in 2020
jobcenterofwisconsin.com
DETB-16521-E (R. 6/2010)
WORK EXPERIENCE
Employer
Woodside Lutheran Home
From (Month/Year)
5/2015
To (Month/Year)
10/2024
City, State
Green Bay, Wisconsin
Your Title(s)
Maintenance
Your Duties
• Perform routine maintenance, such as inspecting drives, motors, or belts, checking fluid levels, replacing filters, or doing other preventive maintenance actions.
• Repair machines, equipment, or structures, using tools such as hammers, hoists, saws, drills, wrenches, or equipment such as precision measuring instruments or electrical or electronic testing devices.
• Order parts, supplies, or equipment from catalogs or suppliers.
• Assemble, install, or repair wiring, electrical or electronic components, pipe systems, plumbing, machinery, or equipment.
• Clean or lubricate shafts, bearings, gears, or other parts of machinery.
• Record type and cost of maintenance or repair work.
• Maintain or repair specialized equipment or machinery located in cafeterias, laundries, hospitals, stores, offices, or factories.
• Dismantle machines, equipment, or devices to access and remove defective parts, using hoists, cranes, hand tools, or power tools.
• Dismantle machines, equipment, or devices to access and remove defective parts, using hoists, cranes, hand tools, or power tools.
• Install equipment to improve the energy or operational efficiency of residential or commercial buildings.
• Set up and operate machine tools to repair or fabricate machine parts, jigs, fixtures, or tools.
• Fabricate or repair counters, benches, partitions, or other wooden structures, such as sheds or outbuildings.
• Paint or repair roofs, windows, doors, floors, woodwork, plaster, drywall, or other parts of building structures.
• Perform routine maintenance on boilers, such as replacing burners or hoses, installing replacement parts, or reinforcing structural weaknesses to ensure optimal boiler efficiency.
• Test and treat water supply.
Employer
Rennes Health & Rehab Center
From (Month/Year)
1/2008
To (Month/Year)
5/2015
City, State
DePere, Wisconsin
Your Title(s)
Maintenance
Your Duties
• Perform routine maintenance, such as inspecting drives, motors, or belts, checking fluid levels, replacing filters, or doing other preventive maintenance actions.
• Order parts, supplies, or equipment from catalogs or suppliers.
• Repair machines, equipment, or structures, using tools such as hammers, hoists, saws, drills, wrenches, or equipment such as precision measuring instruments or electrical or electronic testing devices.
• Diagnose mechanical problems and determine how to correct them, checking blueprints, repair manuals, or parts catalogs, as necessary.
• Maintain or repair specialized equipment or machinery located in cafeterias, laundries, hospitals, stores, offices, or factories.
Employer From (Month/Year) To (Month/Year)
City, State
DETB-16521-E (R. 6/2010)
Your Title(s)
Your Duties
Employer From (Month/Year) To (Month/Year)
City, State
Your Title(s)
Your Duties
DETB-16521-E (R. 6/2010)
SPECIFIC SKILLS
Inspecting Equipment, Structures, or Materials — Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.
Related occupations
Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person. Related occupations
Repairing and Maintaining Mechanical Equipment — Servicing, repairing, adjusting, and testing machines, devices, moving parts, and equipment that operate primarily on the basis of mechanical (not electronic) principles. Related occupations
Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources. References available upon Request