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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