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APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer/Armative Action Employer
Illinois State Board of Education
Human Resources (S-202)
100 North First Street
Springeld, Illinois 62777-0001
Telephone: 217/782-6434 Fax: 217/524-0396 www.isbe.net
PLEASE ANSWER ALL QUESTIONS COMPLETELY. Type or print answers, using additional pages as needed.
Form must be dated and signed where indicated or application is not valid.
PERSONAL
NAME Last First Middle SOCIAL SECURITY NUMBER
(Last 4 digits only)
____ ____ ____ ____
ADDRESS Street HOME TELEPHONE
( )
City State Zip Code WORK TELEPHONE
( )
Yes No
Have you ever worked for the
Illinois State Board of Education
(not in a consulting position)?
E-MAIL ADDRESS CELL TELEPHONE
( )
How did your hear about us?
PLEASE NOTE: ISBE does not participate in E-verify or similar systems and will not sponsor students or potential employees where such
sponsorship is necessary for an employee to work lawfully in the United States.
Are you authorized to work lawfully in the United States?
CITIZENSHIP
Yes No
If applicable, Visa Type and Number Dates Valid
WORK PREFERENCES
Yes No Are you willing to relocate?
Yes No Are you willing to travel?
Yes No Do you have a valid driver’s license?
Yes No Do you have a car available for your use?
Yes No Will you accept temporary employment?
WORK LOCATION PREFERENCE
Chicago Springeld Other (Field Based)
If your answer to the following question is “yes,” please attach a signed detailed explanation.
Yes No Are you currently in default on the repayment of any state educational loan?
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.
POSITION
POSITION(S) APPLIED FOR INVENTORY # POSITION(S) APPLIED FOR INVENTORY #
1. 5.
2. 6.
3. 7.
4. 8.
EDUCATION
SCHOOL
INDICATE # OF
YEARS
COMPLETED
NAME OF SCHOOL CITY, STATE
MAJOR OR
FIELD
DIPLOMA OR
DEGREE
High School
College or
University
Graduate
Other
(Voc., Tech., etc.)
OTHER
OTHER LICENSES, CERTIFICATES, EXPERIENCES AND COMPUTER KNOWLEDGE
Indicate additional information regarding any education, related experiences, activities, special abilities and knowledge
you may possess.
ISBE USE ONLY
ISBE 61-08 (12/20)
Use your "Mouse" or "Tab" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click print button.
NAME OF EMPLOYER EMPLOYED FROM
Mo. Yr.
EMPLOYED TO
Mo. Yr.
ADDRESS
POSITION TITLE NAME/TITLE OF SUPERVISOR
DESCRIPTION OF DUTIES:
Was position supervisory? If yes, identify the number of staff
Yes No
you directed/evaluated. ____________
REASON FOR LEAVING
NAME OF EMPLOYER EMPLOYED FROM
Mo. Yr.
EMPLOYED TO
Mo. Yr.
ADDRESS
POSITION TITLE NAME/TITLE OF SUPERVISOR
DESCRIPTION OF DUTIES:
Was position supervisory? If yes, identify the number of staff
Yes No
you directed/evaluated. ____________
REASON FOR LEAVING
NAME OF EMPLOYER EMPLOYED FROM
Mo. Yr.
EMPLOYED TO
Mo. Yr.
ADDRESS
POSITION TITLE NAME/TITLE OF SUPERVISOR
DESCRIPTION OF DUTIES:
Was position supervisory? If yes, identify the number of staff
Yes No
you directed/evaluated. ____________
REASON FOR LEAVING
REFERENCES
Please do not list relatives. College students include faculty references.
NAME OF REFERENCE TITLE/INSTITUTION TELEPHONE
1.
2.
3.
SIGNATURE
I authorize the persons, schools, employers and other organizations named in the application to provide the Illinois State Board of Education any relevant
information that may be required to arrive at an employment decision.
I understand and agree that any material misrepresentation or deliberate omission of a fact in my application may be justication for voiding of my
application, or if employed, termination from the Illinois State Board of Education.
Did you: SIGN APPLICATION? INCLUDE COVER LETTER AND RESUME? ATTACH COPIES OF TRANSCRIPTS?
_________________________________________
Date
______________________________________________
Signature of Applicant
ISBE 61-08 (12/20)
WORK HISTORY
LAST OR PRESENT EMPLOYER EMPLOYED FROM
Mo. Yr.
EMPLOYED TO
Mo. Yr.
ADDRESS
POSITION TITLE NAME/TITLE OF SUPERVISOR
DESCRIPTION OF DUTIES:
Was position supervisory? If yes, identify the number of staff
Yes No
you directed/evaluated. ____________
REASON FOR LEAVING
Please complete all areas of work history in detail beginning with your current or last employer. All elds MUST be completed for consideration. If additional space
is needed, you may attach a separate sheet following the same format.
ISBE 61-08 (12/20)
VOLUNTARY RELEASE OF ETHNIC INFORMATION FOR EQUAL EMPLOYMENT OPPORTUNITY
The following section is optional.
The State of Illinois is an Equal Opportunity Employer. To assist in the accomplishment of Armative 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.
Female Male Ethnicity
White not of Hispanic Origin. A person having origins in any of the original peoples of Europe,
North Africa or the Middle East.
A G
Black or African American not of Hispanic Origin. A person having origins in any of the black
racial groups of Africa.
B H
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 aliation or
community attachment.
C J
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 Phillippine Islands, Thailand, and Vietnam.
D K
Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish Culture or origin, regardless of race.
E L
NativeHawaiianorOtherPacicIslander.A person having origins in any of the peoples o
Hawaii, Guam, Samoa, or other Pacic Islands.
P Q
Prefer Not to Answer
Z
Are you an Individual with a Disability? Yes No Prefer Not to Answer
Name: ______________________________________ Vacancy List #: _______________________________
Position #(s): _________________________________ Date: _______________________________________
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Completed 13 December 2020

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