General Employment Application Form

City of Belvidere Employment Application

An Equal Opportunity Employer. You must fully and accurately complete this application. Incomplete applications will not be considered.
Position(s) Applying For:
Department
Referral Source:

Other
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Cover Letter: Please upload cover letter. If already provided, skip to next section.

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Resume: Please upload resume. If already provided, skip to next section.

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Have you filed an application to work here before this date?
If yes, what date was the application filed?
Have you been previously employed with the City of Belvidere?
If yes, what dates were you employed?
Do you have a valid Driver's License?
What state issued the Driver's License?
Driver's License Number:

Have you ever been convicted of a felony? You are NOT obligated to disclose any sealed or expunged records of convictions or arrests. you are also NOT required to disclose expunged juvenile records of convictions or arrests.
If yes, please explain:
Have you ever been convicted of any one or more of the following misdemeanors? You are NOT obligated to disclose any sealed or expunged records of convictions or arrests. You are also NOT required to disclose any expunged juvenile records of convictions or arrests.

Indecent Soliciation of a Child (11-6)	Unlawful Use of Weapons (24-1)
Adultery (11-7)	Unlawful Possession of Firearms & Ammunition (24-3.1)
Public Indecency (11-9)	Defacing Identification Marks of Firearms (24-5)
Prostitution (11-14)	Mob Action (25-1)
Soliciting for a Prostitute (11-15)	Keeping a Gambling House (28-3)
Keeping a House of Prostitution (11-17)	Resisting or Obstructing a Peace Officer (31-1)
Patronizing a Prostitute (11-18)	Obstructing of Justice (31-1)
Pimping (11-19)	Escape (31-6)
Aggrevated Assault (12-2)	Aiding Escape (31-6)
Intimidation (12-6)	Compounding a Crime (32-1)
Criminal Sexual Abuse (12-15)	Perjury (32-2)
Eavesdropping (14-4)	Subordination of Perjury (32-3)
Theft (16-1)	Communicating with Jurors & Witnesses (32-4)
Residential Picketing (21.1-3)	Tampering with Public Records (32-8)

If yes, please explain:
Are you prevented from lawfully becoming employed in this country for any reason?

Please include any information NOT included in your resume/cover letter.

EDUCATION

Rows	Name of School	No. of Years Attended	Did You Graduate?	Subjects Studied
High School
College
Trade School

Indicate which languages you speak, read and/or write.

Rows	Fluent	Good	Fair
Speak
Read
Write

List professional, trade, business or civic activities and offices you have held or been involved in.

Please include any information NOT included in your resume/cover letter.
Are you employed now?
May we contact your present employer?
EMPLOYMENT EXPERIENCE:

Start with your current job or most recent job. Include military service assignments and volunteer activities.
1
2
3
If additional employment information, please list here.

Please include any information NOT included in your resume/cover letter.
REFERENCES

Give the name, address,telephone number and email of three (3) references who are not related to you and are not previous or current employers.
Reference #1
Reference #2
Reference #3

An exhaustive background check will be conducted. If you are appointed (employed), can you supply the required documentation to verify your lawful right to work in the United States (such as birth certificate and driver's license or Employment Authorization card)?
I understand and agree that all information furnished in this application may be verified by the City of Belvidere or its agents. I waive any right to receive notification from any individuals or organizations identified in this application prior to release of any employment information to the City of Belvidere. I authorize all individuals in organizations identified in this application and any law enforcement organizations to provide the City of Belvidere any information relating to any verification conducted by the City of Belvidere and release any such individuals, organizations and City of Belvidere from any and all liability for any claim or damage resulting from verification.

I, the undersigned, certify that all facts contained in this application are true and complete to the best of my knowledge. I understand that omissions or misrepresentations of facts may be grounds for rejection of this application or for dismissal from employment if subsequently discovered. I understand that this application is not intended to be a contract of employment. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Disclosure Regarding Background Investigation
The City of Belvidere (City) may obtain information about you from a third-party consumer reporting agency for employment purposes. This information may be obtained in the form of a “consumer report” and/or an “investigative consumer report” (commonly known as background reports). These reports may contain information regarding your criminal history, social security verification, motor vehicle records, credit history, verification of your education and employment history, drug screening and other background checks. This information may be obtained from private and public record sources. The reports may contain information about your general character and reputation and may involve personal interviews with individuals or companies.

Any criminal history, consumer report, investigative consumer report, or other background information will be obtained and used only as permitted by applicable law. By executing below, I acknowledge receipt and review of this NOTICE.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
CITY OF BELVIDERE IS AN EQUAL OPPORTUNITY EMPLOYER

All applicants are considered without regard to race, color, religion, sex, national origin, age or other prohibited status. Reasonable accommodations are available upon request.
Should be Empty:

City of Belvidere Employment Application

Disclosure Regarding Background Investigation