Employment Application Form

Employment Application

GENESEO PARK DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER. Employment with the Park District is governed on the basis of merit, competence and qualifications and will not be influenced in any manner by race, age, color, sex, religion, sexual orientation, veteran status, national origin, marital status, mental or physical disability, pregnancy or related medical conditions or any other legally protected status. THOSEAPPLICANTS REQUIRING REASONABLE ACCOMODATION TO THE APPLICATION/INTERVIEW PROCESS SHOULD NOTIFY THE HUMAN RESOURCE DEPARTMENT.
Date

MonthDayYear
Name*

First NameMiddle NameLast Name
Phone Number*
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you are under 16 years of age and it is required, can you furnish a work permit (these can be obtained from your High School)?*

YesNo
Have you submitted an application here before?*

YesNo
If Yes, give date

MonthDayYear
Are you currently employed?*

YesNo
If yes, may we contact your present employer?

YesNo
Note: We reserve the right to contact all past employers as part of our reference checks.
Are you legally eligible for employment in this country?*

YesNo
Application for (check all applicable):*

Geneseo Community CenterJohn & Carla Edwards Aquatic CenterRecreation DepartmentCentral TheaterMaintenance/Custodial
Available for (check all applicable):*

Part Time EmploymentFull Time EmploymentSeasonal
Position applied for*
Will you be able to meet the attendance requirements of the position?*

YesNo
Are you willing to work overtime as required?*

YesNo
Date available to begin work:*

MonthDayYear
Are you currently on “lay-off” status and subject to recall?*

YesNo

Educational Background *

	School Name/Location	Number of Years Completed	MAJOR	Degree/Diploma YES/NO	Degree/Diploma Year Received
High School
College/ University
Other Training, Education

Resume (upload here if you have a resume)

Cancelof
Work History

Complete below, beginning with most current employment.
NOTE: Please explain any gaps in employment.
Please list skills, licenses, training, etc. applicable to the position for which you are applying:
Note to Applicants: DO NOT ANSWER THE QUESTION BELOW UNLESS YOU HAVE BEEN INFORMED ABOUT THE ESSENTIAL REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. YOU MAY OBTAIN A COPY OF THE JOB DESCRIPTION FROM THE HR DEPARTMENT OR ONLINE AT WWW.GENESEOPARKDISTRICT.ORG.
Are you capable of performing in a reasonable and safe manner, with or without reasonable accommodation, the essential job duties for the job or position for which you have applied?

YesNo
References

Please list three (3) references, not related to you, that we may contact.
Check One

Past EmployerOther
Reference*
Check One

Past EmployerOther
Reference
Check One

Past EmployerOther
Reference
APPLICANT’S CERTIFICATION AND AGREEMENT

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION AND HEREBY RELEASE AND WAIVE ANY CLAIM AGAINST THE PARK DISTRICT THAT MAY ALLEGEDLY ARISE FROM SUCH INVESTIGATION. I FURTHER UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE EITHER CONTAINED IN MY APPLICATION OR GIVEN DURING ANY INTERVIEW AND ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE PARK DISTRICT’S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT IS “AT-WILL” AND MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANYTIME, AT EITHER MY OR THE PARK DISTRICT’S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITION OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE AT ANY TIME BY THE PARK DISTRICT.

This application for employment shall be considered active for a period of time not to exceed 1 year. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I understand that if I am hired, I will be required to provide proof of identity and information for compliance with the Immigration Reform and Control Act.
Applicant's Certification and Agreement Signature*

Clear
Date

MonthDayYear
Criminal Background Check Authorization

I understand the Park District is required by state statute [70 ILCS 1205/8-23] to obtain criminal conviction information concerning applicants and shall perform a criminal background check for applicants for all positions, including the position for which you have applied. Pursuant to said statute, certain convictions shall automatically disqualify the applicant from consideration for working for the Park District. All other convictions shall not automatically disqualify the applicant from consideration, but rather, the conviction will be considered in relationship to the specific job. Applicants are not obligated to disclose sealed or expunged records of conviction. Further, the Park District complies with all aspects of the Illinois Human Rights Act and other applicable laws regarding, for instance, requirements for pre-adverse action notices, adverse action notices and interactive discussions to determine the relevance of convictions to the job position.

I herby authorize the Geneseo Park District to conduct an investigation of possible criminal offenses in my background, as required by section 8-23 of the Park District Code. (70ILCS1205/8-23)
Applicants Criminal Background Check Authorization Signature*

Clear
Date

MonthDayYear
Should be Empty: