Fillable EXAMINING/EMPLOYMENT APPLICATION (CMS100) (Illinois)

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EXAMINING/EMPLOYMENT APPLICATION (CMS100) (Illinois)

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CMS100 (Rev 7/2020)
Page of
STATE OF ILLINOIS
DEPARTMENT OF CENTRAL
MANAGEMENT SERVICES
EXAMINING/EMPLOYMENT APPLICATION
(CMS100)
CMS administers civil service testing for agencies under jurisdiction of the Governor; however, actual employment decisions are made by each
hiring agency. Information provided on the CMS100 application is used to determine your eligibility for appointment to a State of Illinois position
title. It is critical that all information requested be provided accurately and completely. Applications submitted without signature or with
omissions, inaccurate or inconsistent information will not be processed or returned to the applicant and may result in the issuance of an
ineligible grade for the position title.
A separate application is required for each position title and option for which a grade is being sought. It is preferred that all documents be
completed using a personal computing device. Use ink if completing this document by hand. Legible photocopies are accepted. Attachments
must be stapled to the back of this document. CMS cannot assume responsibility for unattached documents. Mail completed applications to:
CMS Bureau of Personnel, Examining & Counseling Division, Stratton Office Building, Room 500, Springfield IL, 62706.
1. Position Title Option
3. Last Name First Name MI
Address
City State
County
Zip
2. SSN
4. Birth Date (Opt.)
5. Main Phone Other Phone
6. Drivers License No. State Month/Year Expires
Restrictions
Non-CDL CDL ENDR
A B C D L M A B X N
7. County Choice
Select 1 or 2
2:1:
8. Availability
(Check one)
A. Available for permanent
employment; will not accept
temporary employment.
Trainee titles must choose A.)
B. Available for permanent
employment; will accept
temporary employment.
C. Available for temporary
employment only.
9. VETERANS PREFERENCE:
For assistance contact Veterans Outreach at 1-800-643-8138 or Illinois Relay Center at 1-800-526-0844.
I wish to claim Veterans Preference; attached is the most recent certified copy of my DD214/215. (If
claiming service-connected disability, also include a copy of U.S. Veterans Affairs award letter
issued within one year of the current date.)
I wish to claim Veterans Preference as an IL National Guard/Reservist. Attached is a letter from my
unit personnel indicating I am currently serving under honorable conditions or a copy of my NGB22
stating my discharge was under honorable conditions.
I wish to claim Veterans Preference as a surviving unremarried spouse or one parent of an
unmarried veteran who suffered a service-connected death or disability that prevents the veteran
from qualifying for civil service employment.
I have submitted required military documentation to CMS after January 01, 2000 and have already
established Veterans preference with CMS.
SIGNATURE SECTION
I understand that I may be required to submit proof of previous employment, education, military service or other statements in this application. I
authorize release of this and other information covering job-related factors for the purpose of verification and determination of suitability for state
employment. I state that I have not submitted an application for this written and/or performance examination within the last 30 days. I
certify that all the information on this application is true and accurate and understand that misrepresentation of any material fact may be
grounds for ineligibility or termination of employment.
Completing this application may result in your name being placed on an eligibility list. Names placed on an eligibility list may be released to the
public without further notice to the applicant.
Written Signature Required Date
For CMS Use Only
Exam Date
Mo
Day
Yr
Test Center
Print Form
Reset
Link to Cook Zoned Titles and Location Map
CMS100 (Rev 7/2020)
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10. If your answer to either or both of the following questions is “yes”, please provide a detailed explanation of the circumstances
in the space provided.
A. Have you ever been fired from a job? (Downsize/layoff is not applicable.)
Yes No
B. Are you currently in default on the repayment of any state educational loan?
Yes No
State law provides that any employee who is in default on the repayment of any education loan for a period of six months or
more and in the amount of $600 or more shall, as a condition of employment, make a satisfactory loan repayment
arrangement with the maker or guarantor of the loan.
11. HIGH SCHOOL
High School Graduate?
Yes No
Number of Years Completed
GED? Yes
No
12. BUSINESS, TRADE, CORRESPONDENCE SCHOOL
Business, Trade, Correspondence
School: Name and Address
From
MM/YYYY
To
MM/YYYY
Time
Full/Part
Subjects
Course
Length
Completed
Yes/No
13. TECHNICAL/PROFESSIONAL LICENSE
Technical/Professional License Number State Issued
Date Issued
MM/YYYY
Expiration Date
MM/YYYY
14. EDUCATION REPORT: List your education accurately and completely. A copy of college transcripts/degrees may be
required. The number of credit hours you have earned may be needed to meet the minimum requirements for some titles. This
information is also useful for career counseling purposes.
Name and Address (City &
State) of Colleges/Universities
Hours Earned Major Minor Dates Attended
Level and Date of
Degree Earned
Attended
SEM QTR
Do Not
Abbreviate
Do Not
Abbreviate
From
MM/YYYY
To
MM/YYYY
Level MM/YYYY
CMS100 (Rev 7/2020)
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* LIST UNDERGRADUATE AND GRADUATE HOURS SEPARATELY
* DO NOT INCLUDE COURSES MORE THAN ONCE
Fields Of Study
Undergrad
Hours
Graduate
Hours
Fields of Study
Undergrad
Hours
Graduate
Hours
Fields of Study
Undergrad
Hours
Graduate
Hours
List Actual Credit Hours
Earned
Sem Qtr Sem Qtr
List Actual Credit Hours
Earned
Sem Qtr Sem Qtr
List Actual Credit Hours
Earned
Sem Qtr Sem Qtr
Accounting Actuarial Science Afro-American Studies
Agriculture Agronomy Animal Science
Architecture Art Atmospheric Science
Audiovisual Instruction Bacteriology Biochemistry
Biology Biostatistics Botany
Business Admin/Mgmt Cell/Molecular Biology Chemistry
Computer Science Conservation Criminal Justice Admin
Criminology Demography Dietetics, Nutrition
Divinity/Theology Early Childhood Dev. Economics
Education (Specify) Engineering (Specify) Engineering Technology
Environmental Science English Entomology
Environmental Health Epidemiology Finance
Fire Science Fish Management Food Service Management
Foreign Language (Specify) Forensic Science Forestry
Geography Geology Genetics
Guidance and Counseling Health/Public Health History
Home Economics Humanities Human Services
Hydrology Industrial Arts Industrial Hygiene
Insurance Journalism Law (Specify)
Law Enforcement Library Science Limnology
Mgmt. Info. Systems Marketing Mathematics
Medical Records Medical Technology Medicine
Microbiology Nursing (Specify) Park Management
Pastoral Counseling Pharmacy Physics
Political Science/Govt Programming Psychology
Public Administration Radio - Television Recreation
Rehab Counseling/Admin Risk Assessment Secretarial Science
Social Work Sociology Soil Science
Speech and Drama Statistics Therapy (Specify)
Toxicology Urban Studies Wildlife Management
Zoology
Comment area to further specify the Fields of Study where noted in the previous table
Other:
Other:
Other:
Other:
Other:
Other:
Other:
Other:
CMS100 (Rev 7/2020)
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15. WORK HISTORY: Complete this section in detail. All fields MUST be completed to be considered for grading. Begin with
most recent position title and work backward. If you have an extensive work history with one employer, list each change in
position title separately including duties and dates associated with each. If additional space is needed, click the "Add Another
Employment Record" button or attach a separate sheet following the same format as below. Resumes submitted must be in same
format as the application. Attach additional sheets/resumes to the application.
INCLUDE THE FOLLOWING INFORMATION: • College internships/practicums successfully completed
• Military experience including dates, listing each change in rank and title
• Related volunteer experience including dates and hours worked
Current (or last) Employer
Street Address
City
State
Position Title
Average Number of Hours Worked Per Week
Dates of Employment
Month Year
To
Month Year
Total
Years Months
Supervisory Responsibility: If you supervised employees, record the number supervised in the following categories:
Manual/Trades AdministrativeClericalTechnical/Para-ProfessionalProfessional
Describe in detail the duties you performed in this position title: (Entry area expands to accommodate your response.)
Reason for Leaving:
Past Employer
Street Address City State
Position Title
Dates of Employment
Year Year
To
MonthsYears
Total
Month Month
Supervisory Responsibility: List the Number of Employees You Supervised in the Appropriate Fields Below
Manual/Trades AdministrativeClericalTechnical/Para-ProfessionalProfessional
Average Number of Hours Worked Per Week
Describe, in detail, the duties you performed in this position title: (Entry area expands to accommodate your response.)
Reason for Leaving:
CMS100 (Rev 7/2020)
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• State law requires that you furnish certain information about your child support obligations at the time you are hired. The possibility of
employment is not affected by a child support obligation or default in payment.
• As a condition of employment, state law requires that “every male born on or after January 1, 1960, and less than 27 years old, shall submit
documentation, at time of appointment, evidencing his registration with the Federal Selective Service System.”
• In compliance with the state and federal constitutions, the Illinois Human Rights Act, the U.S. Civil Rights Act, the Americans with Disabilities
Act, and Section 504 of the Federal Rehabilitation Act, the Department of Central Management Services does not discriminate in employment,
contracts, or any other activity. If you have a complaint, please contact the Department of Central Management Services at 217/782-7100
(voice) or the Illinois Relay Center at 800/526-0844.
• Pursuant to Public Act 93-0211, effective January 1, 2004, (20 ILCS 2630/12 (a)) and Public Act 93-0912, effective August 12, 2004, (705
ILCS 405/5-915 (8)(a)), respectively, applicants seeking employment with the State of Illinois are not obligated to disclose an arrest or
conviction record that has been expunged or sealed, nor an expunged juvenile record. Employers may not ask if an applicant has had records
expunged or sealed. Neither Public Act applies to law enforcement agencies, the Department of Corrections, State's Attorneys or other
prosecutors.
• Central Management Services requests disclosure of information that is necessary to accomplish its obligations, primarily the statutory
purposes outlined under the Personnel Code (20 ILCS 415). Disclosure of the information requested on this form is mandatory, and failure to
provide requested information may result in rejection of this form or delay in making a determination on eligibility or employment. Social
Security numbers are used in the application and employment processes to identify and differentiate between candidates and/or employees.
Confidentiality of Social Security numbers obtained through this application process will be preserved as prescribed by 5 ILCS 179 et seq.
16. This application may be utilized as the actual test for some titles. If the title for which you wish to test is a closed exam or an
exam based only on training and experience, mail completed application to:
CMS Bureau of Personnel
Examining and Counseling Division
Stratton Office Building, Room 500
Springfield, Illinois 62706.
Applications for a closed exam will be held on file until an agency requests that the test be administered or for a maximum of one
year from the date of receipt.
The following section is optional.
The State of Illinois is an Equal Opportunity Employer. To assist in the accomplishment of Affirmative Action goals, we invite
you to complete the following information. Completion of this information is not required. Check ONE box and, if applicable,
check the appropriate Disability box.
A
G
B
H
C J
D
K
E
L
P
Q
White not of Hispanic Origin. A person having origins in any of the original peoples of Europe, North Africa
or the Middle East.
American Indian or Alaska Native. A person having origins in any of the original peoples of North and
South America, including Central America, and who maintains tribal affiliation or community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent, including, but not limited to, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.
Black or African American not of Hispanic Origin. A person having origins in any of the black racial
groups of Africa.
Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish Culture or origin, regardless of race.
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands.
EthnicityFemale Male
Are you an Individual with a Disability?
Yes
No
17. Email Address (required for communication about opportunities):
Link to State of Illinois Assessment Centers, Testing and Career Counseling Information
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EXAMININGEMPLOYMENT APPLICATION (CMS100) (Illinois)

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Completed 14 July 2020

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