STATE APPLICATION INSTRUCTIONS



Date: July 11, 2014

To: Applicants for Waste Management Specialist Senior

Job Announcement Code: 14-02979

From: Stephanie Holzem, Human Resources Assistant Adv

Facilities Planning and Management, UW-Madison

608/265-4059

Re: Special Application/Examination Materials

Thank you for your interest in the position of Waste Management Specialist Senior with Chemical Safety, Environment, Health and Safety, Facilities Planning and Management, University of Wisconsin-Madison. Starting salary is between $46,917 and $77,414 depending on qualifications, with excellent benefits. This position is included in pay schedule 15, range 3. A six-month probationary period will be required. The register created from this vacancy will be used to fill vacancies for the next 6-12 months.

The next steps in the application process are as follows:

1. Read and complete the Objective Inventory Questionnaire (OIQ). The OIQ is the civil service exam for this position and is designed to obtain information about your qualifications and experience as they relate to the skills, training, and experience that are essential for successful job performance. In order to be considered for this position, you must complete the questionnaire and return it along with the other application materials noted below.

2. Complete and return the attached Application for State Employment form. If you are eligible for Veterans Preference Points or Disabled Expanded certification, please complete the appropriate form and return it with your other materials. These forms can be downloaded at (Veterans Preference Form) and (Disabled Expanded Form).

3. Read carefully, sign and return the sheet marked Affidavit Certification Statement.

4. UW-Madison is required by law to request data from applicants for employment in order to monitor our recruitment and selection practices.  In order for us to meet this federal reporting requirement, please go to to fill out the Voluntary Self-Identification of Disability and Protected Veterans forms.  Please reference Vacancy ID # 91368 when uploading your completed forms. Completing these forms is voluntary and your responses will be kept confidential and is not considered as part of the hiring criteria.

5. Please do NOT substitute your resume in lieu of responses to the items in this questionnaire. Your eligibility to participate in the next step of the selection process will be based on your response to the OIQ questions.

6. Return all the above materials no later than 4:00 pm on Wednesday, July 23, 2014 to: Tamera Stanley at 608/265-4058, tstanley@fpm.wisc.edu, FP&M Human Resources, 1217 University Avenue, Madison WI 53706.

STATE OF WISCONSIN

APPLICATION FOR STATE EMPLOYMENT

General Instructions

• These instructions are for use in completing the Application for State Employment, form OSER-DMRS-38.

• Applications will be accepted only for vacancies announced online at Wisc.Jobs, WiscERS.state.wi.us (for at-risk or laid-off state employees only), or in the Wisc.Jobs Bulletin.

• Read the announcement carefully and submit application materials to the address listed in the announcement.

• Print clearly! If we cannot read your information we cannot process your application.

• You must provide the following: job announcement title, job announcement code, first name, last name, last four digits of social security number, month of birth, day of birth, mother’s maiden name (last name only), mailing address, city, state, zip code, country, legal authorization to work in the U.S., Wisconsin residency, work hours, county(ies) where you will accept employment, and signature on certification statement.

• You must ensure that the completed, signed application is received on or before the announced deadline date, at the specified location. The Office of State Employment Relations (OSER) and other state agencies are not responsible for late, lost, misdirected or damaged mail.

• You may take clean photocopies of the application, printed front and back on one sheet of paper, and submit that as the official application.

• As a veteran with an honorable discharge or a spouse of a veteran, you may be eligible to receive additional points on your civil service scores. Current state employees are not eligible for veterans points. Please view the Veterans Preference Supplement form OSER-MRS-38L, found online at under “Jobs” at Application Forms.

• Qualified persons with a disability may be eligible for consideration in the interview process. Please complete the Disabled Expanded Certification form OSER-MRS-159, found online at under “Jobs,” at Application Forms.

• Questions should be directed to the contact in the job announcement, or the Office of State Employment Relations, Employment Services Center can be contacted by telephone (608) 266-1731, or e-mail ESC@.

• SCORE REUSE: Some exams allow applicants to reuse their score instead of retaking the exam, and the grade notice will indicate if an applicant can use this option. Applicants interested in score reuse should do so by the Score Reuse date indicated on their Notice of Examination Results or Reuse Score By date in their online Wisc.Jobs job cart. This can be completed online by creating an account on Wisc.Jobs or checking the score reuse box in section 1 of this application (under the job announcement title) and submitting to the contact on your grade notice or the Office of State Employment Relations, P.O. Box 7855, Madison, WI 53707-7855. Applicants also may call the Office of State Employment Relations, Employment Services Center at (608) 266-1731, or e-mail ESC@. Refer to Wisc.Jobs or the contact listed in the job announcement for more information.

State of Wisconsin

Application for State Employment - Instructions - page 2 of 4

1. JOB ANNOUNCEMENT TITLE

A job title is required to process your application. Complete an application for each job you apply for unless the job titles were announced in the same announcement. Enter the job title as it appears in the announcement.

JOB ANNOUNCEMENT CODE

An accurate Job Announcement Code is required to process your application. The Job Announcement Code is listed in the heading of the job announcement. If the job announcement lists two Job Announcement Codes, enter the second code on the line provided.

2. NAME

A last name, first name, and middle initial (if applicable) are required to process your application.

LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER

The last four digits of your Social Security Number are required to process your application.

DATE OF BIRTH

Use numbers to identify the month and day you were born (MM and DD) example: January 2 would be 01 and 02. The month and day of your birth are required to process your application. Year of birth is optional and is used as an additional identifier only.

MAILING ADDRESS

Your Address, City, State, Zip Code and Country are required to process your application. If you have an existing Wisc.Jobs job cart you may update your information online anytime at Wisc.Jobs. If you do not have an existing job cart, you may create one at Wisc.Jobs or notify the Office of State Employment Relations by mail: P.O. Box 7855, Madison, WI 53707-7855; phone (608) 266-1731; or e-mail ESC@.

MOTHER'S MAIDEN NAME

This information is required to process your application. Enter your mother’s maiden name (last name only) or another name or word that will serve as an additional identifier to make your applicant record unique.

PHONE NUMBER(S)

Please provide a phone number(s) where you can be reached if there are questions regarding your application or to schedule an interview.

3. LEGALLY AUTHORIZED TO WORK IN THE U.S.

Completion of this section is required to process your application. Check YES only if you are one of the following: (1) a citizen or national of the United States; (2) a lawful permanent resident; or (3) an alien authorized to work in the United States.

4. WISCONSIN RESIDENCY

Completion of this section is required to process your application. Indicate whether you are a permanent resident of the State of Wisconsin. Wisconsin residency is required only for Limited Term and Project positions.

5. WORK HOURS

You must include the type of work you will accept in order for us to process your application. Check all types of work hours that you will accept.

INSTRUCTIONS CONTINUE ON THE NEXT PAGE

State of Wisconsin

Application for State Employment - Instructions - page 3 of 4

6. COUNTIES WHERE YOU WILL ACCEPT EMPLOYMENT (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED.)

At least one code is required to process your application. Select the desired code(s) below for the county(ies) where you will accept work and transfer that two-digit number to section 6 in the application. We will only consider you for jobs in the locations you indicate on your application.

|Code County |Code County |Code County |Code County |Code County |

| 00 - All Counties | 15 - Door | 30 - Kenosha | 44 - Outagamie | 59 - Sheboygan |

| 01 - Adams | 16 - Douglas | 31 - Kewaunee | 45 - Ozaukee | 60 - Taylor |

| 02 - Ashland | 17 - Dunn | 32 - La Crosse | 46 - Pepin | 61 - Trempealeau |

| 03 - Barron | 18 - Eau Claire | 33 - Lafayette | 47 - Pierce | 62 - Vernon |

| 04 - Bayfield | 19 - Florence | 34 - Langlade | 48 - Polk | 63 - Vilas |

| 05 - Brown | 20 - Fond du Lac | 35 - Lincoln | 49 - Portage | 64 - Walworth |

| 06 - Buffalo | 21 - Forest | 36 - Manitowoc | 50 - Price | 65 - Washburn |

| 07 - Burnett | 22 - Grant | 37 - Marathon | 51 - Racine | 66 - Washington |

| 08 - Calumet | 23 - Green | 38 - Marinette | 52 - Richland | 67 - Waukesha |

| 09 - Chippewa | 24 - Green Lake | 39 - Marquette | 53 - Rock | 68 - Waupaca |

| 10 - Clark | 25 - Iowa | 72 - Menominee | 54 - Rusk | 69 - Waushara |

| 11 - Columbia | 26 - Iron | 40 - Milwaukee | 55 - St. Croix | 70 - Winnebago |

| 12 - Crawford | 27 - Jackson | 41 - Monroe | 56 - Sauk | 71 - Wood |

| 13 - Dane | 28 - Jefferson | 42 - Oconto | 57 - Sawyer | 99 - Outside Wisconsin |

| 14 - Dodge | 29 - Juneau | 43 - Oneida | 58 - Shawano | |

State of Wisconsin

Application for State Employment - Instructions - page 4 of 4

7. GENDER - Check only one box.

8. RACE/ETHNICITY - Check only one box using the following definitions:

Black--Not of Hispanic origin: All persons having origins in any of the black racial groups of Africa.

Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.

American Indian or Alaska Native: Persons descending from any of the original peoples of North America who possess ¼ degree of documented tribal descendancy or are enrolled with a federally or state recognized tribe, or are recognized by a federally or state recognized tribe as American Indians for state affirmative action purposes.

Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

White--Not of Hispanic origin: All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Gender and race/ethnicity information is used for equal employment opportunity/affirmative action (EEO/AA) purposes only. This information is confidential and is retained by state human resources professionals. If you do provide this information, you may be eligible for further consideration of job opportunities through the State of Wisconsin EEO/AA Plan.

9. EDUCATION LEVEL - Check only one box on the application. Indicate your single highest level of education completed.

10. HOW DID YOU FIND OUT ABOUT THIS JOB?

Please identify the source(s) of information that led you to apply for this vacancy. Use the check boxes on page 2 of the application.

11. ACTIVE MILITARY DUTY

If you are an active military duty member and unable to test at the regularly scheduled exam centers, complete this section along with the rest of the required application information, and return to the Office of State Employment Relations; Attention Exam Administration Coordinator; P.O. Box 7855; Madison, WI 53707-7855.

12. CERTIFICATION STATEMENT

Your application must be signed in order to process the application.

Thank you for your interest in Wisconsin State Government employment. Wisconsin wants to find the best qualified people available to serve its citizens. Although everyone who applies cannot be hired, your application will be given every consideration.

STATE OF WISCONSIN

APPLICATION FOR STATE EMPLOYMENT

1. * Job Information

|Job Announcement Title (Complete an application for each job.) |Job Announcement Code(s) (seven digits) |

| | |

|Waste Management Specialist Senior |1 4 – 0 2 9 7 9 |

| |

|Score Reuse: Some exams allow applicants to reuse their exam scores. See page 1 of the instructions to learn more about score reuse. |

2. Personal Information

|* Last Name: |* First Name: |Middle Initial: |

|* Last Four Digits of Social Security Number: |*Month of Birth (MM): |*Day of Birth (DD): |Year of Birth (YYYY) (optional) |

|____ ____ ____ ____ |____ ____ |____ ____ |__ __ __ __ |

|* Mailing Address 1: |

|Mailing Address 2: |*Mother’s Maiden Name: (last name only) |

|* City: |* State: |* Zip Code: |* Country: |

|E-Mail Address: |

|Daytime Phone Number: |Evening Phone Number: |

|Other Phone Number (e.g., cell): |Fax Number: |

3. * Are you currently legally authorized to work in the United States? Yes No

4. * Are you a Wisconsin resident? Yes No

5. * Work Hours (Check all that you will accept.)

Full Time (40 hrs/week)

Part Time (less than 40 hrs/week)

Seasonal (minimum of 600 hours per year but less

than 1,828 hours per year.)

Evening 2nd Shift (3pm to 11 pm or similar hours)

Evening 3rd Shift (11pm to 7am or similar hours)

6. * Counties Where You Will Accept Employment (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED.)

County Code(s): 1 3 | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __

Gender and race information are used for equal employment opportunity/affirmative action purposes only.

7. Gender 8. Race / Ethnicity

| | |

|(Check only one.) |3. American Indian or Alaskan Native |

|1. Black (not Hispanic) |4. Hispanic |

|2. Asian or Pacific Islander |5. White (not Hispanic) |

Female Male

9. Education Level

| | |

|(Check highest level completed.) |5. One-year vocational diploma |

|1. Did not complete high school/GED |6. Two-year associate degree |

|2. Completed GED/HSED |7. Bachelor's degree |

|3. Graduated from high school |8. Some graduate degree courses |

|4. Some college, no degree |9. Graduate college degree |

10. How did you hear about this job?

| | |

|1. Office of State Employment Relations |Internet: |

|2. Job Service/Job Center |9. Wisc.Jobs |

|3. State Agency/UW Campus |10. (JobNet) |

|4. Wisc.Jobs Bulletin |11. State Agency/UW Campus Website |

|5. Referred by Current State Employee | |

|6. Referred by Friend or Family | |

|7. Job Fair |12. Other:____________________________ |

|8. Newspaper | Please list other source |

| | |

11. Active Duty Military

12. * Certification Statement

By signing below, I certify that the information I have provided in this application is true to the best of my knowledge and I understand that I may be required to verify the information before being appointed.  I understand that any false, misleading, or missing information may disqualify me from employment consideration.

* Signature:___________________________________________________________ Date: __ __ / __ __ / __ __ __ __

AFFIDAVIT

CERTIFICATION STATEMENT

Waste Management Specialist Senior

JAC 14-02979

Please read the following statements, sign below, fill out the information requested, and return this form attached to your completed examination/application materials.

I understand that the Objective Inventory Questionnaire is a screening device used prior to the interview and that the practice or attempt to practice any deception or fraud will result in my application being withdrawn or that I will be removed from the position if I am hired.

WISCONSIN ADMINISTRATIVE CODE

ER-MRS 6.10. . . the Administrator may refuse to. . . certify. . . or remove an applicant from a certification. . . ;

(5) who has made a false statement of any material fact in any part of the selection process;

(7) who practices, or attempts to practice, any deception or fraud in application, certification, examination, or in securing eligibility or appointment;. . .

(10) who has in any manner gained access to special or secret information regarding the content of an examination.

WISCONSIN STATUTES:

Section 230.43 Misdemeanors; how punished. (1) Obstruction or Falsification of Examinations. Any person. . . (c) who willfully or corruptly makes any false representations concerning the same (examination). . . (e) … shall for each offense be guilty of a misdemeanor.

(3) Penalty. Misdemeanors under this section are punishable by a fine of not less than $50, nor more than $1,000, or by imprisonment for not more than one year or both.

I certify that I have read and acknowledge that I understand the preceding excerpts from the Wisconsin Administrative Code, ER-MRS 6.10, and Wisconsin Statutes, sec. 230.43 which relate to security of examination information in any part of the selection process. I also certify that my responses to the

|First Name (Print) |Last Name (Print) |

|Last Four Digits of Social Security Number: |Day Phone # |

|Address |City, State & Zip |

|Applicant Signature |

|Date Signed |

questions on this Objective Inventory Questionnaire are true to the best of my recollection and that I can document these experiences if required to do so at some time in the future.

|Waste Management Specialist Senior |Last Four Digits of Social Security Number: ____ ____ ____ ____ |

|Objective Inventory Questionnaire | |

Please check [pic] “yes” or “no” in Licensure below. If you cannot answer “YES” to at least one of the statements, you do NOT meet the minimum regulations

and should not proceed further.

| COMMERICAL LICENSURE |YES |NO |

|I currently possess a valid Commercial Driver’s License with hazardous waste endorsement issued by the State of Wisconsin. | | |

|I have the ability to obtain a valid Commercial Driver’s License with hazardous waste endorsement issued by the State of Wisconsin within six months of appointment to | | |

|the position of Waste Management Spec or Waste Management Spec Senior. | | |

For more information on obtaining Commercial Drivers’ Licenses, see the WI Dept of Transportation website:

The following section lists typical task or activity experiences that are related to one or more of the job duties of the Waste Management Specialist Senior position. Please read each item carefully and select the "EDUCATION OR TRAINING RESPONSE CRITERIA" AND the "PROFESSIONAL WORK EXPERIENCE RESPONSE CRITERIA" found below which best describes your experience with each task or activity. Use the spaces provided for responses.

NOTE: You may be asked to substantiate any claim that you make.

EXPERIENCE RESPONSE CRITERIA

|EDUCATION OR TRAINING (EOT) |PROFESSIONAL WORK EXPERIENCE (PWE) |

|A |I have not been trained to perform this task or activity. |A |I have not performed this task or activity. |

|B |I have informal training on performing this task or activity (i.e., self-taught). |B |I have performed this task or activity with some assistance. |

|C |I have formal classroom training or employee development training on performing this task or activity. |C |I have performed this task or activity independently. (Independent refers to performing |

| |(Employer in-service training or vendor-provided training.) | |alone and without review of completed tasks.) |

|D |I have formal academic training for performing this task or activity |D |I have trained or led others to perform this task or activity. |

|EXAMPLE |EOT |PWE |

|Presented training materials to groups using Power Point |1. C |2. D |

|Analyzed budget using cost/benefit analysis |3. B |4. A |

|Section 1. Waste Handling/Transportation MANAGEMENT Questions 1-44 |

|TASK OR ACTIVITY STATEMENT |EOT |PWE |

|Packed hazardous chemicals for safe transportation. |1. |2. |

|Performed large scale acid/base neutralization. |3. |4. |

|Collected, transported and/or incinerated waste animal tissue. |5. |6. |

|Evaluated hazardous waste packaging to ensure safety and compliance in transportation. |7. |8. |

|Waste Management Specialist Senior |Last Four Digits of Social Security Number: ____ ____ ____ ____ |

|Objective Inventory Questionnaire | |

|Utilized a segregation table to ensure compliance in the transportation of hazardous waste containers. |9. |10. |

|Managed the disposal of waste for a large quantity generator. |11. |12. |

|Disposed of hazardous materials after determining material composition and/or characteristics of materials. |13. |14. |

|Determined the proper personal protective equipment to be worn when handling chemical and/or hazardous waste. |15. |16. |

|Transported hazardous materials in accordance with state, federal, local and/or institutional regulations (e.g. proper placarding, labeling). |17. |18. |

|Completed a bill of lading and/or manifest for hazardous materials. |19. |20. |

|Altered a hazardous material into a non-hazardous material. |21. |22. |

|Worked with flammable solvents, other than gasoline, in 5-gallon quantities or greater. |23. |24. |

|Worked with corrosives in one-gallon quantities or greater. |25. |26. |

|Worked with pesticides in two-gallon quantities or greater. |27. |28. |

|Worked with a commercial hazardous waste disposal contractor. |29. |30. |

|Driven a one-ton truck or larger for the purpose of transporting hazardous waste. |31. |32. |

|Operated an incinerator for the purpose of disposal of biologic material. |33. |34. |

|Maintained and/or repaired laboratory equipment. |35. |36. |

|Cleaned up a hazardous chemical spill. |37. |38. |

|Identified reactive chemicals and determined suitable disposal option. |39. |40. |

|Identified the requirements of Large and Small Quantity Generator designations. |41. |42. |

|Participated in a state, federal, local and/or institutional recycling, reuse and/or waste reduction program. |43. |44. |

|Waste Management Specialist Senior |Last Four Digits of Social Security Number: ____ ____ ____ ____ |

|Objective Inventory Questionnaire | |

|Section 2. Training and guidance of STAFF ON SAFE CHEMICAL MANAGEMENT Questions 45-54 |

|TASK OR ACTIVITY STATEMENT |EOT |PWE |

|Developed facility, company and/or institutional standard operating procedures for safe handling (e.g. use, storage, disposal) of hazardous chemicals. |45. |46. |

| | | |

| | | |

| | | |

| | | |

|Provided guidance and/or training to staff on federal, state, local and/or institutional regulations for safe handling (e.g. use, storage, disposal) of hazardous chemicals. |47. |48. |

|Provided guidance and/or training to staff on emergency preparedness (e.g. chemical spill response). |49. |50. |

|Provided safety guidance and/or compliance information to staff (e.g. Material Safety Data Sheets). |51. |52. |

|Provided guidance and/or training to staff on treatment procedures for hazardous materials to ensure proper disposal in accordance with federal, state, local and/or institutional |53. |54. |

|regulations. | | |

|Section 3. COMMUNICATION Questions 55-82 |

|TASK OR ACTIVITY STATEMENT |EOT |PWE |

|Worked within a comprehensive workplace waste management safety program. |55. |56. |

|Conducted a documented waste management safety inspection as part of a comprehensive safety program for a facility, company and/or institution. |57. |58. |

| | | |

|Developed written project and/or program waste management progress reports for a facility, company and/or institution. |59. |60. |

|Prepared facility, company and/or institutional waste management safety and /or compliance reports for federal, state and/or local regulatory agencies. |61. |62. |

|Consulted with outside parties (e.g. federal, state and/or local authorities) over facility, company and/or institutional waste management safety and/or compliance issues. |63. |64. |

|Worked with computer software/database systems designed to collect and/or extract waste management data. |65. |66. |

|Implemented new facility, company and/or institutional policies related to waste management. |67. |68. |

|Reviewed a waste management safety and/or environmental citation from a federal, state and/or local governmental agency issued to a facility, company and/or institution. |69. |70. |

|Identified non-compliant waste management safety practices in a facility, company and/or institution. |71. |72. |

|Interpreted and applied federal, state, local and/or institutional waste management regulations to workplace operations in a facility, company and/or institution. |73. |74. |

|Waste Management Specialist Senior |Last Four Digits of Social Security Number: ____ ____ ____ ____ |

|Objective Inventory Questionnaire | |

|Implemented waste management procedural changes in a facility, company and/or institution to ensure compliance with federal, state, local and/or institutional chemical and/or |75. |76. |

|environmental regulations. | | |

|Participated in a facility, company and/or institutional waste management inspection performed by a federal, state, and/or local government regulatory inspector. |77. |78. |

|Monitored and/or collected data on a facility, company and or institutional waste management safety project. |79. |80. |

|Presented waste management technical information at staff and/or committee meetings. |81. |82. |

|Section 4. HAZARD IDENTIFICATION AND CHARACTERIZATION Questions 83-100 |

|TASK OR ACTIVITY STATEMENT |EOT |PWE |

|Sorted hazardous chemicals for disposal. |83. |84. |

|Segregated chemicals by hazard class. |85. |86. |

|Sampled hazardous waste to aid in characterization. |87. |88. |

|Developed standard operating procedures to properly categorize material according to its possible waste characterization. |89. |90. |

|Identified environmental risk of chemicals and/or materials. |91. |92. |

|Identified regulatory status and regulations of chemicals and/or materials. |93. |94. |

|Performed standard chemical laboratory techniques. |95. |96. |

|Performed lab cleanout activities involving hazardous waste (e.g. consolidation, segregation, and manifesting). |97. |98. |

|Identified unknown chemicals according to an unknown chemical identification system |99. |100. |

End of Exam Questions

Waste Management Specialist Senior June 2014

-----------------------

Cities with population of more than 100,000:

• Madison (state capital) is in Dane County, code 13

• Milwaukee (largest city) is in Milwaukee County, code 40

• Green Bay is in Brown County, code 05

Search State of Wisconsin government employment opportunities online

at Wisc.Jobs.

* Indicates mandatory fields

Note: We will only consider you for jobs in the locations you indicate below. You must identify at least one county for us to process your application. Enter 2-digit County Code(s) below using the list provided on page 3 of the instructions.

Application continues on next page

We will test active duty military members stationed out of state who are unable to test at a regularly scheduled exam center. We will test only at approved U.S. military installations and only if the exam is administered by a Test Control Officer or equivalent person. Please provide the following information for the person who has agreed to administer the exam. A fee may be charged for this service.

Test Control Officer: Last Name:_______________________________ First Name:__________________________ M.I.:____

Title:____________________________________________ Agency:_______________________________________________

Complete Mailing Address:__________________________________________________________________________________

City:_______________________________ State:_______ Zip:__________________ Phone:__________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download