Fillable EMPLOYMENT APPLICATION The Village of Wauconda IS AN (Village of Wauconda)

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EMPLOYMENT APPLICATION The Village of Wauconda IS AN (Village of Wauconda)

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BROWSE VILLAGE OF WAUCONDA (IL) FORMS

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EMPLOYMENT APPLICATION
The Village of Wauconda IS AN EQUAL OPPORTUNITY EMPLOYER. Employment with the Village of
Wauconda is governed on the basis of merit, competence and qualifications and will not be influenced
in any manner by race, age, color, sex, religion, veteran status, national origin, marital status, mental or
physical disability or any other legal protected status.
All information contained in or connected with this application will be considered confidential and used only
in conjunction with possible employment with the Village of Wauconda. Please furnish complete information
as outlined in this application.
THOSE APPLICANTS REQUIRING REASONABLE ACCOMMODATION TO THE
APPLICATIONIINTERVIEW PROCESS SHOULD NOTIFY THE HUMAN RESOURCE OFFICE. ALL
APPLICATIONS SHOULD BE RETURNED TO THE VILLAGE OF WAUCONDA, HR OFFICE.
Date of Application: _______________
Applicantʼs Name
Last: ______________________________ First: __________________ Middle: ____________
Applicantʼs Address
Street: _________________________________ City: _______________ State: _______ Zip: ________
Home Phone#: ___________________ Cell Phone#: _____________________
Have you submitted an application to the Village in the past? ☐ Yes ☐ No If yes, give date: __________
Have you been employed with the Village in the past? ☐ Yes ☐ No If yes, give date: _______________
Are you currently employed? ☐ Yes ☐ No
May we contact your present employer? ☐ Yes ☐ No
Are you legally eligible for employment in this country? ☐ Yes ☐ No
Are you willing to work overtime as required? ☐ Yes ☐ No
Position Applying For: _________________________________
Date Available to begin work: ___________________________
Are you currently on "lay-off' status and subject to recall? ☐ Yes ☐ No
EDUCATIONAL BACKGROUND:
High School Name: ______________________________ City, State: ____________________________
Years Completed: _______________ Diploma? ☐ Yes ☐ No
College/University: _______________________________ City, State: ____________________________
Years Completed: _______________ Major: ______________ Diploma? ☐ Yes ☐ No
Other Education: _________________________________ City, State: ____________________________
Years Completed: _______________ Major: ______________ Diploma? ☐ Yes ☐ No
Other Education: _________________________________ City, State: ____________________________
Years Completed: _______________ Major: ______________ Diploma? ☐ Yes ☐ No
Other Education: _________________________________ City, State: ____________________________
Years Completed: _______________ Major: ______________ Diploma? ☐ Yes ☐ No
Other Training/Certifications: ____________________________ City, State: _______________________
Years Completed: _______________ Diploma/Certificate? ☐ Yes ☐ No
Other Training/Certifications: ____________________________ City, State: _______________________
Years Completed: _______________ Diploma/Certificate? ☐ Yes ☐ No
Other Training/Certifications: ____________________________ City, State: _______________________
Years Completed: _______________ Diploma/Certificate? ☐ Yes ☐ No
BACKGROUND:
The Village is required by law to obtain criminal conviction information concerning applicants, and shall
perform a criminal background check for applicants for all positions, including the position for which
you have applied. Applicants are not obligated to disclose sealed or expunged records of convictions.
Have you ever been convicted of a felony? ☐ Yes ☐ No
Have you ever been convicted of a misdemeanor involving dishonesty, criminal sexual conduct, assault or
battery, or any criminal drug statute? ☐ Yes ☐ No
If yes, describe:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
MILITARY SERVICE:
For the information you list below to be considered, you must supply a copy of your 00214.
Have you served in the U.S. Armed Forces - including National Guard or Reserves? ☐ Yes ☐ No
If yes, Branch of Service: _____________________________ Dates of Service:
_______________________
Applicable skills acquired:
___________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
WORK HISTORY (beginning with most recent employer):
Most Recent Employer: ____________________________________ Telephone: __________________
Address: ____________________________________ City: __________________________ State: _____
Date Started: __________________ Starting Position: _____________________________
Last Date Employed: ________________ Ending Position: __________________________
Name and Title of Supervisor: _____________________________________________________________
Description of Duties: ___________________________________________________________________
Reason for Leaving: ____________________________________________________________________
Employer: _______________________________________________ Telephone: __________________
Address: ____________________________________ City: __________________________ State: _____
Date Started: __________________ Starting Position: _____________________________
Last Date Employed: ________________ Ending Position: __________________________
Name and Title of Supervisor: _____________________________________________________________
Description of Duties: ___________________________________________________________________
Reason for Leaving: ____________________________________________________________________
Employer: _______________________________________________ Telephone: __________________
Address: ____________________________________ City: __________________________ State: _____
Date Started: __________________ Starting Position: _____________________________
Last Date Employed: ________________ Ending Position: __________________________
Name and Title of Supervisor: _____________________________________________________________
Description of Duties: ___________________________________________________________________
Reason for Leaving: ____________________________________________________________________
Employer: _______________________________________________ Telephone: __________________
Address: ____________________________________ City: __________________________ State: _____
Date Started: __________________ Starting Position: _____________________________
Last Date Employed: ________________ Ending Position: __________________________
Name and Title of Supervisor: _____________________________________________________________
Description of Duties: ___________________________________________________________________
Reason for Leaving: ____________________________________________________________________
Please list skills, licenses, training, etc. applicable to the position for which you are applying:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Note to Applicants: DO NOT answer this question unless you have been informed about the essential
requirements of the job for which you are applying. You may obtain a copy of the job description at the
Human Resource office at the Village Hall.
Are you capable or performing in a reasonable and safe manner, with or without reasonable
accommodation, the essential job duties for the job or position for which you have applied?
Yes  No
EMPLOYMENT REFERENCES:
Please list the following information for three references not related to you that we may contact:
Company ____________________________________________ Past Employer Other
Name: _________________________________________ Telephone: ____________________________
Address: _______________________________ City: _______________ State: ____ Zip Code: ________
For office use only: _____________________________________________________________________
_____________________________________________________________________________________
Company ____________________________________________ Past Employer Other
Name: _________________________________________ Telephone: ____________________________
Address: _______________________________ City: _______________ State: ____ Zip Code: ________
For office use only: _____________________________________________________________________
_____________________________________________________________________________________
Company ____________________________________________ Past Employer Other
Name: _________________________________________ Telephone: ____________________________
Address: _______________________________ City: _______________ State: ____ Zip Code: ________
For office use only: _____________________________________________________________________
_____________________________________________________________________________________
APPLICANT'S CERTIFICATION AND AGREEMENT:
I CERTIFY THAT ALL OF THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND
COMPLETE. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION FOR
EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION AND HEREBY
RELEASE AND WAIVE ANY CLAIM AGAINST THE VILLAGE OF WAUCONDA WHICH MAY ALLEGEDLY ARISE
FROM SUCH INVESTIGATION. I FURTHER UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS,
OR MISREPRESENTATIONS ARE EITHER CONTAINED IN MY APPLICATION OR GIVEN DURING ANY
INTERVIEW AND ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND IF I AM EMPLOYED,
MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. I AGREE TO CONFORM TO THE VILLAGE OF
WAUCONDA'S PERSONNEL POLICIES, PROCEDURES, RULES AND REGULATIONS. I AGREE THAT MY
EMPLOYMENT IS "AT-WILL" AND MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR
WITHOUT CAUSE, WITH OR WITHOUT NOTICE AND/OR BY COLLECTIVE BARGAINING AGREEMENT, AT ANY
TIME, AT EITHER MY OR THE VILLAGE'S OPTION.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any
applicant wishing to be considered for employment beyond this time period should inquire as to whether or
not applications are being accepted at that time.
I understand that if I am hired, I will be required to provide proof of identity and information for compliance
with the Immigration Reform and Control Act.
Applicant's Signature __________________________________ Date _______________________
FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE
Interview Scheduled: ☐ Yes ☐ No If yes, date: ______________________
Interviewed by: ___________________________________
Position Interviewed for: _________________________________________________
Hired: ☐ Yes ☐ No
Hired By: __________________________ Date: ________________
Are Pre-Employment Screenings Scheduled? ☐ Yes ☐ No
Position Starting Date: __________________________
Pay Rate/Salary: ________________ Department: __________________________________
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EMPLOYMENT APPLICATION The Village of Wauconda IS AN (Village of Wauconda)

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Completed 17 July 2020

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