October 11, 2012


Applicants for Mortician
Job Announcement Code: 1203983


Tina Manke, Human Resources Assistant

School of Medicine and Public Health
(608) 263-4935; or

Special Application/Examination Materials

Thank you for your interest in the full-time position of Mortician with University of Wisconsin-Madison, School of Medicine and
Public Health, Department of Anatomy, body Donor Program. Minimum starting pay is $17.609 per hour, plus a competitive benefit
package. This position is included in pay schedule 06, range 14. A six-month probationary period will be required.
Special requirements: Valid State of Wisconsin Funeral Director license under Chapter 445. Valid National Board
Accreditation in Mortuary Science/Funeral Service. A Valid Driver’s License with a driving record sufficient to meet the
requirements of the UW Office of Risk Management. The ability to lift 50-75 pounds.
The next steps in the application process are as follows:

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.


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).


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


Please submit your current:
 Copy of current Funeral Director’s License from the state of Wisconsin
 resume
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.
5. Return all the above materials by 4:30 p.m. on Thursday, October 25, 2012 to:
School of Medicine and Public Health Human Resources
Attn: Tina Manke
750 Highland Avenue, Rm. 4150
Madison, WI 53705
FAX #: (608) 262-9515, PHONE #: (608) 263-4935
The first step in the selection process will be a review of the completed questionnaires.


county(ies) where you will accept employment. and the grade notice will indicate if an applicant can use this option.O.  SCORE REUSE: Some exams allow applicants to reuse their score instead of retaking the country. state.  You must ensure that the completed.Jobs job cart. Current state employees are not eligible for veterans points. Please view the Veterans Preference Supplement form (for at-risk or laid-off state employees only).wi.S. mailing address. city.  Qualified persons with a disability may be eligible for consideration in the interview process. found online at http://OSER. or e-mail ESC@wisconsin.state. first name. Applications will be accepted only for vacancies announced online at www. or the Office of State Employment Relations. misdirected or damaged mail. Box 7855. day of birth. and submit that as the official application.Jobs. signed application is received on or before the announced deadline date.wi. WI 53707-7855. Please complete the Disabled Expanded Certification form OSER-MRS-159. work hours.wi. Madison. This can be completed online by creating an account on lost. Employment Services Center can be contacted by telephone (608) 266-1731.Wisc. mother’s maiden name (last name only).Wisc.  Print clearly! If we cannot read your information we cannot process your application. Refer to www. 2 .. Employment Services Center at (608) 266-1731. you may be eligible to receive additional points on your civil service scores.Wisc. The Office of State Employment Relations (OSER) and other state agencies are not responsible for late.Jobs or the contact listed in the job announcement for more information. zip code.Jobs Bulletin.  Read the announcement carefully and submit application materials to the address listed in the announcement.  You must provide the following: job announcement title. Wisconsin residency.  Questions should be directed to the contact in the job announcement. WiscERS. or e-mail under “Jobs” at Application Forms. printed front and back on one sheet of paper. Applicants also may call the Office of State Employment Relations.” at Application Forms. 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. last four digits of social security number.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 under “Jobs.state. job announcement code.STATE OF WISCONSIN APPLICATION FOR STATE EMPLOYMENT General Instructions   These instructions are for use in completing the Application for State Employment.  You may take clean photocopies of the application. or in the Wisc.state. at the specified location.  As a veteran with an honorable discharge or a spouse of a veteran. last name. found online at http://OSER. legal authorization to work in the U. form OSER-DMRS-38. month of birth. and signature on certification statement. P.

WISCONSIN RESIDENCY Completion of this section is required to process your application. or e-mail ESC@wisconsin. Year of birth is optional and is used as an additional identifier only. INSTRUCTIONS CONTINUE ON THE NEXT PAGE 3 . MAILING ADDRESS Your Address. 3. City. phone (608) 266-1731.Jobs. MOTHER'S MAIDEN NAME This information is required to process your application. 2. or (3) an alien authorized to work in the United States. 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.Wisc. Zip Code and Country are required to process your application.O. 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. you may create one at www. JOB ANNOUNCEMENT TITLE A job title is required to process your application. Wisconsin residency is required only for Limited Term and Project positions. enter the second code on the line provided. Madison. JOB ANNOUNCEMENT CODE An accurate Job Announcement Code is required to process your application. 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. If you have an existing Wisc. LEGALLY AUTHORIZED TO WORK IN THE U. NAME A last name.Instructions .State of Wisconsin Application for State Employment . If you do not have an existing job cart. WORK HOURS You must include the type of work you will accept in order for us to process your application. If the job announcement lists two Job Announcement Codes.S.Jobs job cart you may update your information online anytime at The Job Announcement Code is listed in the heading of the job announcement. Enter the job title as it appears in the announcement. Complete an application for each job you apply for unless the job titles were announced in the same announcement. The month and day of your birth are required to process your application. (2) a lawful permanent resident. Box 7855. Check YES only if you are one of the following: (1) a citizen or national of the United States. first 3 of 4 1. Completion of this section is required to process your application.Wisc. State. Indicate whether you are a permanent resident of the State of Wisconsin. 5. and middle initial (if applicable) are required to process your application. 4. WI 537077855. Check all types of work hours that you will accept.Jobs or notify the Office of State Employment Relations by mail: P. LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER The last four digits of your Social Security Number are required to process your application.

Croix Sauk Sawyer Shawano 59 . Code County 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 - All Counties Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Code County 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 - Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Code County 30 31 32 33 34 35 36 37 38 39 72 40 41 42 43 - Code County Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 - Code County Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk St.Washburn 66 .Washington 67 .Waushara 70 . code 40  Green Bay is in Brown 3 of 4 6.Instructions .Sheboygan 60 .Waukesha 68 .Wood 99 .Winnebago 71 .State of Wisconsin Application for State Employment .Vernon 63 .Walworth 65 .Trempealeau 62 .) At least one code is required to process your application. We will only consider you for jobs in the locations you indicate on your application. code 13  Milwaukee (largest city) is in Milwaukee County.Vilas 64 .Outside Wisconsin Cities with population of more than 100. 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. COUNTIES WHERE YOU WILL ACCEPT EMPLOYMENT (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED. code 05 4 .000:  Madison (state capital) is in Dane County.Taylor 61 .Waupaca 69 .

regardless of race. 8. or the Middle East. Asian or Pacific Islander: All persons having origins in any of the original peoples of the Far East. Attention Exam Administration Coordinator. or the Pacific Islands. Although everyone who applies cannot be hired.State of Wisconsin Application for State Employment . 11. your application will be given every consideration. White--Not of Hispanic origin: All persons having origins in any of the original peoples of Europe. Use the check boxes on page 2 of the application.Instructions .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. RACE/ETHNICITY . ACTIVE MILITARY DUTY If you are an active military duty member and unable to test at the regularly scheduled exam centers. Box 7855. North Africa. Southeast Asia. you may be eligible for further consideration of job opportunities through the State of Wisconsin EEO/AA Plan. GENDER . Madison. Gender and race/ethnicity information is used for equal employment opportunity/affirmative action (EEO/AA) purposes only. Search State of Wisconsin government employment opportunities online at www.Wisc.Jobs. WI 53707-7855. Hispanic: All persons of Mexican. 9.Check only one box. Central or South American or other Spanish culture or origin. CERTIFICATION STATEMENT Your application must be signed in order to process the application. and return to the Office of State Employment Relations. 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. the Indian Subcontinent.Check only one box on the application. HOW DID YOU FIND OUT ABOUT THIS JOB? Please identify the source(s) of information that led you to apply for this vacancy. complete this section along with the rest of the required application information. 5 . 4 of 4 7. Cuban. Indicate your single highest level of education completed. This information is confidential and is retained by state human resources professionals. If you do provide this information.O. Thank you for your interest in Wisconsin State Government employment. Puerto Rican. EDUCATION LEVEL . 12. Wisconsin wants to find the best qualified people available to serve its citizens. P. or are recognized by a federally or state recognized tribe as American Indians for state affirmative action purposes.

* Job Information Job Announcement Title (Complete an application for each job.STATE OF WISCONSIN APPLICATION FOR STATE EMPLOYMENT * Indicates mandatory fields 1..____ ____ ____ ____ ____ Score Reuse: Some exams allow applicants to reuse their exam scores. You must identify at least one county for us to process your application. Middle Initial: *Day of Birth (DD): ____ ____ Year of Birth (YYYY) (optional) __ __ __ __ *Mother’s Maiden Name: (last name only) * State: * Zip Code: * Country: E-Mail Address: Daytime Phone Number: Evening Phone Number: Other Phone Number (e.03983 ____ ____ . Enter 2-digit County Code(s) below using the list provided on page 3 of the instructions. Personal Information * Last Name: * First Name: * Last Four Digits of Social Security Number: ____ ____ ____ ____ * Mailing Address 1: *Month of Birth (MM): ____ ____ Mailing Address 2: * City: See page 1 of the instructions to learn more about score reuse. * Counties Where You Will Accept Employment (PLEASE NOTE THAT COUNTY CODES HAVE CHANGED. * Work Hours (Check all that you will accept. 2.) 6.828 hours per year. * Are you currently legally authorized to work in the United States? 4. * Are you a Wisconsin resident? Yes Yes No No 5.g.) Mortician Job Announcement Code(s) (seven digits) 12. cell): Fax Number: 3.) Full Time (40 hrs/week) Evening 2nd Shift (3pm to 11 pm or similar hours) Part Time (less than 40 hrs/week) Evening 3rd Shift (11pm to 7am or similar hours) Seasonal (minimum of 600 hours per year but less than 1.) Note: We will only consider you for jobs in the locations you indicate below. County Code(s): 13 | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ | __ __ Application continues on next page 6 .

Referred by Friend or Family 7.) 3. Wisc.:____ Title:____________________________________________ Agency:_______________________________________________ Complete Mailing Address:__________________________________________________________________________________ City:_______________________________ State:_______ Zip:__________________ Phone:__________________________ 7 . Black (not Hispanic) 2. Some college. Race / Ethnicity Male (Check only one. Completed GED/HSED 7.) 1. One-year vocational diploma (Check highest level completed.Gender and race information are used for equal employment opportunity/affirmative action purposes only.I.Jobs 10. Two-year associate degree 2. Please provide the following information for the person who has agreed to administer the exam. Referred by Current State Employee 6. Job Fair 8. Job Service/Job Center 3. A fee may be charged for this service. How did you hear about this job? 1. White (not Hispanic) 9. State Agency/UW Campus Website 12. Asian or Pacific Islander (JobNet) 11. no degree 9. Some graduate degree courses 4. military installations and only if the exam is administered by a Test Control Officer or equivalent person. Active Duty Military We will test active duty military members stationed out of state who are unable to test at a regularly scheduled exam center. Graduated from high school 8. Other:____________________________ Please list other source 11. Hispanic 5. Education Level 5. State Agency/UW Campus 4. Test Control Officer: Last Name:_______________________________ First Name:__________________________ M. We will test only at approved U. American Indian or Alaskan Native 1.Jobs Bulletin 5. Office of State Employment Relations 2. Wisc. Gender Female 8. Newspaper Internet: 9. Graduate college degree 10. 7. Bachelor's degree 3.S. JobCenterOfWisconsin. Did not complete high school/GED 6.

misleading. * Signature:___________________________________________________________ 8 Date: __ __ / __ __ / __ __ __ __ . or missing information may disqualify me from employment consideration. I understand that any false. 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.12. * Certification Statement By signing below.

.AFFIDAVIT CERTIFICATION STATEMENT Mortician Job Announcement #12-03983 Please read the following statements. or remove an applicant from a certification. . . or attempts to practice. how punished. WISCONSIN ADMINISTRATIVE CODE ER-MRS 6. (3) Penalty. . . . . fill out the information requested. . (c) who willfully or corruptly makes any false representations concerning the same (examination). (1) Obstruction or Falsification of Examinations. sec. certify. .10.000. State & Zip Applicant Signature Date Signed 9 . 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. examination. Any person. WISCONSIN STATUTES: Section 230. and Wisconsin Statutes. . or by imprisonment for not more than one year or both. 230. and return this form attached to your completed examination/application materials. (7) who practices.10. . (e) … shall for each offense be guilty of a misdemeanor. (5) who has made a false statement of any material fact in any part of the selection process. . the Administrator may refuse to. I certify that I have read and acknowledge that I understand the preceding excerpts from the Wisconsin Administrative Code. First Name (Print) Last Name (Print) * Last Four Digits of Social Security Number: Day Phone # Address City. Misdemeanors under this section are punishable by a fine of not less than $50.. sign below. (10) who has in any manner gained access to special or secret information regarding the content of an examination. nor more than $1.43 Misdemeanors. certification. any deception or fraud in application. . I also certify that my responses to the 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. . or in securing eligibility or appointment. . ER-MRS 6.43 which relate to security of examination information in any part of the selection process.

60.asp?profid=95&locid=0 for details. (Go to http://165. __ __ __ __ Objective Inventory Questionnaire SECTION 1: MINIMUM QUALIFICATIONS QUESTIONS 1-2 To pass the minimum qualification for Mortician you must be able to respond as indicated below regarding your experience: Answer YES to questions 1 or 2 If you were unable to answer YES to question 1 or 2. 10 . would be able to obtain a Wisconsin Funeral Director’s License.145/profession.189. I have a Funeral Director’s License from another state having requirements similar to those in Wisconsin and therefore.) 2. Body Donor Program Last Four Digits of Social Security No.Mortician School of Medicine & Public Health Department of Anatomy. please do not continue with the applicant process because you do not meet the minimum qualifications required KEY A = NO B = YES TASK OR ACTIVITY STATEMENT ANSWER I have a Funeral Director’s License from the State of Wisconsin. 1.