	Santa Cruz County Personnel Department

	#20-BDX-YY
	Supplemental Questionnaire


Last Name	First Name

1.

I am interested in:

Shelter Manager

Assistant Shelter Manager

Other Disaster Worker Assignments

2.

I am available to work:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

3.

My hours of availability are:

4.

I am willing to work in:

Santa Cruz

Watsonville

Mid-County

All