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PROMOTIONAL EMPLOYMENT APPLICATION (CMS100B) (Illinois)

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CMS-100B (Rev. 9/2020)
Page 1 of 14
STATE OF ILLINOIS
DEPARTMENT OF CENTRAL
MANAGEMENT SERVICES
PROMOTIONAL EMPLOYMENT APPLICATION
(CMS100B)
Complete the application in detail. Previous applications will NOT be considered. Omissions, variances or misstatements of material facts may
cause forfeiture of rights to promotion in the service of the State of Illinois. Applications without necessary information or which are illegible will
not be processed. It is preferred that all documents be completed using a personal computing device. Use ink if completing this document by
hand. DO NOT USE THIS FORM TO APPLY FOR TRAINEE TITLES.
A separate application is required for each position title and option for which a grade is being sought. Attachments must be stapled to the back
of this document. CMS cannot assume responsibility for unattached documents. Submit completed applications to the contact listed on the
posting.
Beginning September 1, 2019, CMS will grade new promotional applications only if they are for a specific, posted vacancy.
Office Use Only
Leave Blank
Enter complete Position Title and Vacancy Posting Number applied for:
Vacancy Posting Number
Position Code Exam Date
Position Title Option
Last Name First Name MI
Address
City State
County
Zip
SSN
Main Phone Other Phone
Email Address (required for communication about opportunities)
Only State employees currently employed under the jurisdiction of the Illinois Personnel Code may apply. Do not use this form for Trainee titles. Appointments
from competitive promotional eligible lists may only be made for employees in a lesser title at the at the time of promotion. Indicate your current status by
checking only one of the boxes below.
I currently hold a position in which I am certified, or held certified status during my period of continuous service.
I am currently in Trainee status and received my appointment in accordance with open competitive standards.
Current Payroll Title (include Option if applicable) Current Agency
Office Use Only
Leave Blank
Agency
County
SIGNATURE SECTION
I understand that I may be required to submit proof of previous employment, education, or any other statements in this application. I authorize release of this and
other information covering job-related factors for the purpose of verification. 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.
Type your name to sign and agree to the statement above
Date
Official Use Only Leave Blank
Ed: A: B: C: Total:
Rej. Qual: Typing: By: Ed:Date:
Print Form
CMS-100B (Rev. 9/2020)
Page 2 of 14
HIGH SCHOOL
High School Graduate or GED?
Yes No
BUSINESS, TRADE, CORRESPONDENCE SCHOOL
Business, Trade, Correspondence
School: Name and Address
Number of
Years Attend
Time
Full/Part
Subjects
Course
Length
Completed
Yes/No
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.
All degrees and coursework will be validated using either a copy of the applicant's Official Transcripts or a copy of their diploma.
The applicant will be responsible for submitting either a copy of their Official Transcripts or a copy of their diploma.
Name and Address (City & State) of Colleges/
Universities
Hours Earned Major Minor
Number of
Years
Level of Degree
Earned
Attended
SEM QTR
Do Not
Abbreviate
Do Not
Abbreviate
Attended
CMS-100B (Rev. 9/2020)
Page 3 of 14
* 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:
CMS-100B (Rev. 9/2020)
Page 4 of 14
WORK HISTORY: LIST EACH CHANGE IN PAYROLL TITLE SEPARATELY AND THE DATES OF EMPLOYMENT FOR EACH
TITLE. Begin with your present position and work backwards, listing both State and non-State experience. Related volunteer
experience for which no salary was received may be given the same credit as equivalent paid experience. List the actual number
of hours worked per week or month and describe fully the duties performed so appropriate credit can be given. If you were
temporarily assigned to another State position title, verification of this assignment from the agency central human resources office
must be attached in order to receive experience credit. If reporting military experience, you must report each military rank held
(e.g., E-4; E-5; O-2; etc.).
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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 5 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 6 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 7 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 8 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 9 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 10 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 11 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 12 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 13 of 14
Past 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:
Reason for Leaving:
OFFICE USE - Leave Blank
Level: Amt:
CMS-100B (Rev. 9/2020)
Page 14 of 14
• 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.
This application may be utilized as the actual test for some titles. Completed application should be submitted to the contact listed on
the posting.
Drivers License No. State Month/Year Expires
Restrictions
Non-CDL CDL ENDR
A B C D L M A B X N
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
Z
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
Prefer Not to Answer
Prefer Not to Answer
Reset
Link to State of Illinois Assessment Centers, Testing and Career Counseling Information
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PROMOTIONAL EMPLOYMENT APPLICATION (CMS100B) (Illinois)

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Completed 11 December 2020

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