Employment Application(v.2)

524 W. Exchange St Crete, Illinois 60417 (708)672-5431

Position Applied For*

Equal access to programs, services and employment opportunities is available to all persons without regard to age, ancestry, citizenship status, color, physical or mental disability, genetic information, marital status, military status, national origin, race, religion, sex (including pregnancy), sexual orientation, or any other basis protected by federal, state, and/or local law. In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the Human Resources Department. Examples of reasonable accommodations include making a change to the application process, providing written materials in an alternate format such as braille, large print, or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Name*

First NameLast Name

MI*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone*

Email*

example@example.com

Date Available*

Date

Are you a citizen of the United States?*

YESNO

If no, are you authorized to work in the U.S.?*

YESNO

Desired Salary*

Have you ever worked for the Village of Crete?*

YESNO

If so when

Do you have any relatives employed by the Village of Crete or current member of the Board of Trustees?*

YESNO

Have you ever been convicted of a felony?*

YESNO

If yes, please explain on a separate sheet of paper.

If you are under the age of 18, can you submit a work permit after an offer of employment has been made?

YESNO

If offered, will you accept a position requiring shift, weekend, or holiday work if essential to the job?*

YESNO

EDUCATION

The highest grade you have completed.*

High School Graduate?*

YESNO

Name of High School*

College/University*

School City, State/Country*

Major*

Degree Received*

Other trade schools, courses, or training

Institution

Satisfactorily Completed*

YESNO

Licenses or Certificates which are related to the position for which you are applying

List professional, trade, business, or civic activities and offices held related to the position for which you are applying. (if desired, you may exclude those that indicate race, color, religion, sex, sexual orientation, marital status, national origin, age, or disability).

PREVIOUS EMPLOYMENT (Please list chronologically)

Company*

Company Address*

Type of business or organization of latest company*

Name/Title of your immediate supervisor latest company*

May we contact him/her*

NOWLATER

Supervisor's Phone number

Dates of Employment (month, year) From:To:

From*

Date

To*

Date

Job Title*

Hours/Week*

Full-time or Part-time*

Full-timePart-time

Salary*

Pay*

per*

Are you still employed?*

YESNO

If NO reason for leaving

Number of people and types of positions you supervised

Description of duties*

Company*

Company Address*

Type of business or organization*

Name/Title of your immediate supervisor*

May we contact him/her*

NOWLATER

Supervisor's Phone number*

From*

Date

To*

Date

Job Title*

Full time or partime*

Full-timePart-time

Hours/Week*

Salary*

Rate*

per*

Are you still employed?*

YESNO

If NO reason for leaving

Number of people and types of positions you supervised

Description of duties*

Company*

Address*

Type of business or organization*

Name/Title of your immediate supervisor*

May we contact him/her*

NOWLATER

Supervisor's Phone

From*

Date

To*

Date

Job Title*

Full-time or Part-time*

Full-timePart-time

Hours/Week*

Salary*

Rate*

per*

Are you still employed?*

YESNO

If NO reason for leaving

Number of people and types of positions you supervised

Description of duties:*

Company*

Address*

Type of business or organization*

Name/Title of your immediate supervisor*

May we contact him/her*

NOWLATER

Supervisor's Phone

From*

Date

To*

Date

Job Title*

Full-time or Part-time*

Full-timePart-time

Hours/Week*

Salary*

Rate*

per*

Are you still employed?*

YESNO

If NO reason for leaving

Number of people and types of positions you supervised

Description of duties*

REFERENCES (Please list three personal references)

Full Name*

Relationship*

Company*

Phone*

Address

Full Name*

Relationship*

Company*

Phone*

Address

Full Name*

Relationship*

Company*

Phone*

Address

Do you have a valid Driver's license*

YESNO

If yes License number?*

Which State?*

What Class?*

Do you have any restrictions?*

YesNo

If yes list restrictions*

Do you have a Commercial Driver's License?*

YESNO

If yes CDL number*

Which State?*

Do you have any endorsements?

YESNO

If yes list endorsements

I certify that all information that I have provided in order to apply for and secure work with this employer is true, complete, and correct. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law. I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer. This company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her age, ancestry, citizenship status, color, physical or mental disability, genetic information, marital status, military status, national origin, race, religion, sex (including pregnancy), sexual orientation, or any protected status under applicable federal, state or local law. Please be advised pursuant to Illinois law, applicants are not obligated to disclose expunged juvenile records of adjudication, arrest, or conviction. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. Signature of ApplicantDate

Signature of Applicant

Date

Employment Application

Application Information

IDENTIFICATION INFORMATION

PLEASE READ THE FOLLOWING STATEMENT BEFORE SIGNING THIS APPLICATION