PERSONAL INFORMATION First Name * Middle Name Last Name * Current Address * 1. City & State * Email Address * Telephone * Work Number * Call in Confidence * Are you 18 years of age or older? * Are you authorized to work in the United States? * US Armed Forces Service? * Duties Active Duty Period From: Active Duty Period To: Branch Reserves Period From: Reserves Period To: Reserves Period Branch: If the job you are applying for requires driving a vehicle, do you possess a valid Illinois driver's license? * If yes, indicate Driver's License Number: Is your license currently or has it ever been revoked, suspended or restricted?* * Please explain: EMPLOYMENT DESIRED Position Apply for (1) * 1. Dept: * Position Apply for (2) 2. Dept: What kind of work schedule are you available for? * Shift: Date you can start? * Salary Desired: * Are you available to work weekends when required by the position you have applied for? * Have you ever been employed with Will County? * If Yes, From: To: Dept. : Name if different than above: List any relatives currently employed within the department in which you are applying: EDUCATION 1. Name of High School attended * 1. City & State * 1. Did you graduate * 1. Other Education * 2. Name of High School attended 2. City & State 2. Did you graduate 2. Other Education 3. Name of High School attended 3. City & State 3. Did you graduate 3. Other Education Please list any skills, abilities, hobbies, training, etc. which you feel may be an asset. (Example: business machines, volunteer work, additional languages, word processing, clerical.): * Please list any license, registration, certificates, etc. which are related to the job you are applying for: * Have you ever had a license, registration, certificate, etc. related to the position you are applying for suspended, revoked, placed on probation or lapsed for any reason? * If yes, please explain EMPLOYMENT HISTORY - 1 1. Name and Address of Employer * 1. Dates of Employment To: * 1.Dates of Employment From: 1. Work Type on Start * 1. Work Type on Leaving * 1. List Job Responsiblities: * 1. Position Held * 1. Job Title * 1. May we contact this employer for a reference prior to a job offer? * 1. Supervisor's Name & Title: * 1. Work Telephone: * 1. Reason for Leaving: * 1. If Involuntary, Please Explain: * Employment History - 2 2. Name and Address of Employer 2.Dates of Employment From: 2. Dates of Employment To: 2. Work Type on Start 2. Work Type on Leaving 2. List Job Responsiblities: 2. Position Held 2. Job Title 2. May be we contact this employer for a reference prior to a job offer? 2. Supervisor's Name & Title: 2. Work Telephone: 2. Reason for Leaving: 2. If Involuntary, Please Explain: Employment History - 3 3. Name and Address of Employer 3.Dates of Employment From: 3. Dates of Employment To: 3. Work Type on Start 3. Work Type on Leaving 3. List Job Responsiblities: 3. Position Held 3. Job Title 3. May be we contact this employer for a reference prior to a job offer? 3. Supervisor's Name & Title: 3. Work Telephone: 3. Reason for Leaving: 3. If Involuntary, Please Explain: PROFESSIONAL REFERENCES - 1 1.Full Name * 1.Business or Home Address * 1.Occupation * 1.Telephone Number * PROFESSIONAL REFERENCES - 2 2.Full Name 2.Business or Home Address 2.Occupation 2.Telephone Number PROFESSIONAL REFERENCES - 3 3.Full Name 3.Business or Home Address 3.Occupation 3.Telephone Number Applications without Signatures will not be considered for employment Applicant Signature (Type your Name) * Date: * Verification of Signature *
I certify that answers/information given herein are true, complete and accurate. I understand that any omission or misrepresentation of information may be sufficient cause for rejection of this application or, if employment has commenced, grounds for immediate dismissal. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby authorize any schools that I have attended, current and previous employers, and organizations named in this application to provide the County of Will with any information that may be requested to make an employment decision. I hereby specifically waive written notice from any and all former employers regarding their disclosure to the County of Will of any information including disciplinary action. I understand that if I am offered employment, it is contingent upon satisfactorily passing a physical examination and/or drug test prior to placement in the position for which I have applied when such tests are required. I specifically authorize law enforcement agencies to release any records of prior criminal convictions and/or pending felony charges it may have or may obtain from other sources to the County of Will. I hereby release the County of Will and other agencies from any and all actions and claims that may be sustained by me from the release and use of the information. I understand and agree that in the absence of an express written agreement to the contrary executed by the employer, any employment I accept shall be for an indefinite term and shall be terminable at any time, with or without notice or cause, either by me or at the will and sole discretion of the employer.
I have read or had read to me and understand the above statement. For purposes of this electronic form, my typed name in the signature box represents my signature.
APPLICATIONS WITHOUT SIGNATURES WILL NOT BE CONSIDERED FOR EMPLOYMENT.
Verification of Signature