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General Information

Position Applied For:*
Date
Date
First Name*
Last Name*
Address*
City*
State*
Previous Address (within last 10 years)
City
State
Phone No.*
Email Address*
Facebook Info
Referred Source (How did you hear about us?)
Available start date*
Salary Desired*
Type of employment desired
1. Full Time
2. Part Time
3. Temporary
4. Seasonal
Ever applied here before? If yes, give dates and positions:
Are you at least 18 years old?*
(Individuals under age 18 must provide a work certificate and proof of parental consent)
If under age, birth date:
If under age, birth date:
Are you eligible for employment in the U.S?*
Can you perform the essential functions of the position?*
The question above is not designed to elicit information about an applicant’s disability, particular accommodations, or whether the accommodation is necessary. These issues can be addressed at a later stage to the extent permitted by law.
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Employment History (List last 4 employers starting with the most recent first)

Employer
Address
Phone
From (MM/YYYY)
From (MM/YYYY)
To (MM/YYYY)
To (MM/YYYY)
Position
Salary
Supervisor/Manager
Reason for Leaving
Employer
Address
Phone
From (MM/YYYY)
From (MM/YYYY)
To (MM/YYYY)
To (MM/YYYY)
Position
Salary
Supervisor/Manager
Reason for Leaving
Employer
Address
Phone
From (MM/YYYY)
From (MM/YYYY)
To (MM/YYYY)
To (MM/YYYY)
Position
Salary
Supervisor/Manager
Reason for Leaving
Employer
Address
Phone
From (MM/YYYY)
From (MM/YYYY)
To (MM/YYYY)
To (MM/YYYY)
Position
Salary
Supervisor/Manager
Reason for Leaving
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Education History

High School
City
State
How Many Years Attended
Graduate?
Graduation Date
College
How Many Years Attended
Graduate?
Graduate Degree
Graduation Date
Graduation Date
Other Schooling
How Many Years Attended
Graduate?
Military Service?
Years and Rank
Honorable Discharge?
Special Work Experience/ Qualifications / Extra Training Skills:
References
(Give the names of three people not related to you, who we may contact.)
Name
Relationship
Years Known
Phone
Email Address
Name
Relationship
Years Known
Phone
Email Address
Name
Relationship
Years Known
Phone
Email Address
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Applicant Statement & Certification

Applicant Statement
I certify that all information 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 pensions, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this 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 30 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 I 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 in 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 specific 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 identify 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. The 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 sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.
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 (i) may result in immediate discharge from the employer’s service, whenever it is discovered.
By checking the box below, I certify that the facts constrained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application will be grounds for dismissal. I also understand that in order to be employed by Waukegan Township, I must reside within the Waukegan Township boundaries. *
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General Information

Employment History (List last 4 employers starting with the most recent first)

Education History

Applicant Statement & Certification