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City of Maroa
120 S Locust Street
Maroa, IL 61756
Phone: (217) 794-2206 / Fax: (217) 794-5125
APPLICATION FOR EMPLOYMENT
We consider applicants for all positions without regard to race, color, religion, creed, gender,
national origin, age, disability, marital or veteran status, or any other legally protected status.
(PLEASE PRINT)
Date of Application:
PERSONAL INFORMATION
Name:
Last First Middle
Current
Address:
Street City State Zip
Phone Number: Driver's License Number:
EMPLOYMENT DESIRED
Position(s) Applied For:
How Did You Learn About Us?
Advertisement Employment Agency Friend Inquiry Relative
Other:
Date You Can Start: Salary Desired:
Are You Employed Now: If So, May We Contact Your Employer:
Do any of your friends or relatives, other than your spouse, work here? Yes No
Part Time Temporary
Yes No
Yes No
If yes, state name, relationship, and position:
Are you available to work: Full Time
Can you travel if a job requires it?
Are you currently on temporary leave?
Are you subject to recall?
Yes No
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EDUCATION
School & Address: Graduated: GPA:
Elementary School: Yes No
High School: Yes No
College: Yes No
Degree:
Trade, Business, or Correspondence School: Yes No
Subjects of Special Study or Research Work:
WORK EXPERIENCE (List below last four employers, beginning with present or more recent.)
Starting Date:
Address:
Contact Name:
Ending Date:
Starting Date:
Address:
Contact Name:
Ending Date:
Starting Date:
Address:
Contact Name:
Ending Date:
Starting Date:
Address:
Contact Name:
Ending Date:
Employer:
Phone Number:
Starting Position:
Ending Position:
Reason for Leaving:
Employer:
Phone Number:
Starting Position:
Ending Position:
Reason for Leaving:
Employer:
Phone Number:
Starting Position:
Ending Position:
Reason for Leaving:
Employer:
Phone Number:
Starting Position:
Ending Position:
Reason for Leaving:
3
Additional Information: (Summarize special job related skills and qualifications acquired by employment or other experience.)
PERSONAL/PROFESSIONAL REFERENCE
(GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.)
Name: Phone Number:
Best Time to Call: Occupation:
Name: Phone Number:
Best Time to Call: Occupation:
Name: Phone Number:
Best Time to Call: Occupation:
In Case of Emergency, Notify:
Name:
Address: Phone Number:
I authorize investigation of all statements contained in this application. I understand that
misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and
agree that my employment is for no definite period and may, regardless of the date of payment of
my wages and salary, be terminated at any time without any previous notices.
Signature of Applicant Date
click to sign
signature
click to edit
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OFFICE USE ONLY:
Interviewed By: Date:
Remarks:
Neatness: Ability:
Hired: Yes No Start Date: Start Salary Wages:
Position: Full Time Part Time Temporary
For Dept.:
Approved:
Employment Manager Date:
Department Head Date: