Applicants are considered for all positions without regard to race, color, religion, sex, national origin, sexual
orientation, age, marital or veteran status, or the presence of a non-job related medical condition or disability.
Application for Employment
Position(s) Applied for ____________________________________________________
Name ______________________________ _______________________________ _____ __________________
Last First Middle
Street Address _____________________________________________________________________________
City _________________________________________ State __________ Zip Code __________________
Telephone (_______)____________________
Area Code
Email ______________________________________________
If you are under the age of 18 can you furnish a work permit? Yes No
Have you filed an application here before? ˜Yes ˜No If yes, give date(s) _________________
Have you ever been employed here before? ˜Yes ˜No If yes, give date (s) _________________
Are you currently employed? ˜Yes ˜No
Are you lawfully authorized to work in the United States? ˜Yes ˜No
On what date would you be available to start work? ________________________________________ What
is desired or expected salary? Monthly _________________ Annual __________________
Are you able to work... Full-Time Part-Time Temporary
Are you on a layoff and subject to recall? Yes No
Can you travel if a job requires it? ˜Yes ˜No
How did you hear about this position? Check one:
Internal Posting/Walk in Internet Posting
Personal Contact(specify)________________________________________________________________________
Employment Experience
Start with your present or last job going back ve years. If you need additional space, please continue on a
separate sheet. Please attach a copy of your current resume.
Job Title
Duties Performed
Dates From To
Reason for leaving
Job Title
Duties Performed
Dates From To
Reason for leaving
Job Title
Duties Performed
Dates From To
Reason for leaving
Are you a member of the National Guard or a veteran of the U.S. military service? Yes No
If yes, branch: __________________________________________________________________
Dates of service: ________________________________________________________________
Are you currently in compliance with all state and federal income tax requirements? Yes No
If your answer to any of the following questions is “Yes,” please attach a signed, detailed explanation.
Have you ever been red from a job? (downsizing/layoff is not applicable) Yes No
Are you currently involved in any litigation? Yes No
Do you owe any back taxes? Yes No
Are you in arrears on child support payments? Yes
Are you currently in default on the repayment of any educational loan? Yes No
Indicate languages you speak, read, and/or write.
Fluent Good Fair
List professional, trade, business, or civic activities and of ces held.
Give names, addresses, and telephone numbers of three references (do not include relatives).
May we contact your present employer? Yes No
Name of contact: ____________________________________ Phone: ________________________________
Name Address Phone Number
Special Skills and Quali cations
Summarize special skills and qualifications acquired from employment or other experience, such as computer
skills, etc. _________________________________________________________________________________
High School
School Name
Years Completed
9 10 11 12 1 2 3 4 1 2 3 4
Description Course
of Study:
Honors Received
Describe specialized training, apprenticeship, skills, and extra-curricular activities. _______________________
State any additional information you feel may
be helpful to us in considering your application. __________
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not, and is not
intended to be a contract of employment.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge or other disciplinary action. I understand that if hired I am
required to abide by all rules and regulations of the Office of the Illinois State Treasurer. I understand that if hired I authorize the State of Illinois to conduct an investigation into all aspects of my
qualifications and background; any individual, organization, or agency that maintains records relating to me to provide these records upon request to any agency of the State Illinois conducting such as
investigation. This authorization is not limited to employment records,credit records, and criminal history records. I release any individual, organization, or agency from any and all liability incurred as a
result of providing such records. Proof of citizenship or immigration status will be required upon employment. If an adverse employment decision is made in whole or part regarding the information on
the credit report that is run by any duly authorized State of Illinois Agent procures, the Office of the State Treasurer will: 1. Give me a copy of the credit report; 2. Provide me with a summary of my
rights under the Fair Credit Reporting Act; 3. Provide me with the name of the credit reporting agency so that I may contact them if I choose to do so.
Signature of Applicant
Mail or hand deliver your completed Application for Employment to the
Office of the Illinois State Treasurer, Department of Human Resources,
James R. Thompson Center
100 West Randolph, Suite 15-600
Chicago, Illinois 60601
Illinois Business Center
400 West Monroe Street, Suite 401
Springfield, IL 62704
Click here to submit your resume electronically. You must include your electronic signature.
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