Application for Employment
Village of Niles
1000 Civic Center Drive
Niles, IL 60714
We consider all applicants for positions without regard to race, color, religion, sex, national origin, age,
disability, veteran/reserve/national guard or any other legally protected status. Those applicants requiring
accommodation to the application and/or interview process should notify the Human Resources Department.
Please type or print in ink.
Position(s) applied for: Date of Application:
Referral Source:
Advertisement Employee Relative School
Walk-in Private Employment Agency Other
Name of source (if applicable):
NAME
Last First Middle
ADDRESS
City State Zip
If you are under 18, can you furnish a work permit?
Yes No
Have you filed an application here before?
Yes
No
If yes, give date:
Have you ever been employed here before?
Yes
No
- An Equal Opportunity Employer -
If yes, give dates: From: To:
Do you have a current driver's license? Yes No
Are you legally eligible for employment in this country?
Yes No
Street
TELEPHONE #
EMAIL
(Proof of U.S. Citizenship or immigration status will be required upon employment.)
Date available for work:
Full-time Part-time
Type of employment desired:
Seasonal
Will you work overtime if required?
Yes
No
Employment History
List your last employers, assignments or volunteer activities including military experience,
starting with the most recent. Explain any gaps in employment in comments section below.
Employer
Dates Employed
From
To
Work Performed
Name
Address
Telephone
Job Title
Supervisor
Reason for Leaving
May we contact for reference?
Yes
No
Employer
Dates Employed
From
To
Work Performed
Name
Address
Telephone
Job Title
Supervisor
Reason for Leaving
May we contact for reference?
Yes
No
Employer
Dates Employed
From
To
Work Performed
Name
Address
Telephone
Job Title
Supervisor
Reason for Leaving
May we contact for reference?
Yes
No
Comments (including explanation of any gaps in employment):
Education
School
Name and
Address Course of Study
Circle last year
completed
Did you
graduate?
List diploma
or degree
High School
1 2 3 4
Yes
No
College
1 2 3 4
Yes
No
Other
(Specify)
1 2 3 4
Yes
No
List professional, trade, business, or civic associations and any offices held.
Skills and Qualifications - Summarize any special training, skills, licenses, certifications and/or characteristics that
may qualify you to perform job- related functions for the position for which you are applying:
Please provide any other information you think would be helpful to us in considering you for employment, such as
additional work experience, publications, activities, accomplishments, etc.
References
List name and telephone number of at least three references who are not related to you and are not previous
employers.
Name
Telephone
Years Known
I certify that information contained in this application is true and complete to the best of my knowledge.
I understand that any misrepresentation of fact, as stated or implied, given in my application, interview(s),
or other employment forms will be sufficient reason not to hire me and may result in my discharge if I am
hired.
I authorize investigation of all statements contained in this application as may be necessary to arrive at an
employment decision. I hereby release from liability the Village of Niles and its representatives for
seeking, gathering or using such information and all other persons, corporations or organizations for
furnishing such information.
I understand that the Village of Niles is in no way obligated to provide employment and that I am in no
way obligated to accept employment with the Village. Nothing in this application is intended to create
any contract of employment, expressed or implied, or to create any rights to the nature of a contract of
employment. This application does not bind either party for a specific period of time regarding
employment. I understand that no representative of the Village of Niles, other than the Village Manager,
has the authority to make any assurances to the contrary. Any such assurances to the contrary by the
Village Manager must be in writing. If I am hired, nothing shall restrict my right as an employee to
terminate my employment at any time, nor shall anything restrict the right of the Village to terminate my
employment at any time at the option of the Village.
I also understand that, if hired, I am required to abide by all rules, ordinances, and regulations of the
Village. The Village policies and procedures relating to conditions of employment are subject to
modification by the Village without notice.
Signature of Applicant Date
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