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The Village of Round Lake Beach EMPLOYMENT APPLICATION (Village of Round Lake Beach)

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File type: PDF

U.S.A. forms for Village of Round Lake Beach

BROWSE VILLAGE OF ROUND LAKE BEACH (IL) FORMS

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EMPLOYMENT APPLICATION
The Village of Round Lake Beach
1937 N Municipal Way
Round Lake Beach, IL 60073
847-546-2351
Equal Opportunity Employer
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process
should notify Human Resources. The Village of Round Lake Beach is an Equal Opportunity Employer and affords equal opportunity to all applicants for all positions
Position (s) applied for: _______________________________________________________ Date of application: _______ / ______ / ______
Name: ______________________________________________________________________ Email Address: __________________________
Last First Middle
Address: _____________________________________________________________________________________________________ Home Phone: ( )_______________
Street City State Zip Code
Cell /Other #: ( )_________________________ Referral Source: _______________________________________________________________________________
Are you a U.S. Citizen or do you have legal authorization to work in the U.S.? (circle one) YES NO Are you over 18 years of age? YES NO
Proof of eligibility and/or age may be required
Have you ever been employed with the Village of Round Lake Beach before? If yes, List dates and position held: ____________________________________
Date available for work: ________/_______/______ Desired Salary Range: $ ______________
Driver’s License # (If driving may be required for the position you are applying for); ______________________________________________________________________________ State: ____________
Type of employment desired: (circle all that apply) FULL TIME PART TIME TEMPORARY SEASONAL OTHER
Have you ever pleaded “guilty” or “ no contest” to, or been convicted of a felony? YES NO
Answering “Yes” to this question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.
NOTE: Your are not obligated to disclose the existence of any conviction or arrest records which have e been sealed or expunged pursuant to chapter 20, section 2630/12 of the IL Compiled Statutes.
Employment History: Start with your most recent employer, include the past 7 years , attach an additional sheet if necessary
AN EQUAL OPPORTUNI
TY EMPLOYER
Employer
Address
City, State, Zip Code
Telephone ( ) _________________________________
Dates Employed
From:
To:
Pay Information
Start:
Current:
Full Time _____ Other _____
Part Time _____
Job Title: Reason for leaving:
Supervisor:
Job Duties:
May we contact? (circle one) YES NO LATER
Employer
Address
City, State, Zip Code
Telephone ( ) _________________________________
Dates Employed
From:
To:
Pay Information
Start:
Current:
Full Time _____ Other _____
Part Time _____
Job Title: Reason for leaving:
Supervisor:
Job Duties:
May we contact? (circle one) YES NO LATER
Employer
Address
City, State, Zip Code
Telephone ( ) _________________________________
Dates Employed
Pay Information
Start:
To:
Full Time _____ Other _____
Part Time _____
From:
To:
Job Duties:
LATER
Supervisor:
Job Title: Reason for Leaving
May we contact? (circle one)
YES NO
FILL OUT FRONT AND BACK OF FORM
www.villageofroundlakebeach.org
List names
a
n
Skills and Qualifications
Summarize any special training, skills, licenses, and/or certificates that may assist you in performing the position for which you are applying.
Computer Skills: (Check the appropriate boxes. Include years of experience) Word Processing _____ Years Internet ____ Years
Microsoft Windows _____Years Accounts Payable/Receivable software ______ Years
Electronic Mail ____ Years
Microsoft Excel ______ Years
OTHER:
________________________________________________________________________________________________________________________________________________
Skills and Qualifications
Educational Background
High School: ______________________________________________________________ Years Completed: _________ Diploma: (circle one) Yes No GED Yes No
College: __________________________________________________________________ Years Completed: ________ Degree Yes No Type of Degree: ____________
College: __________________________________________________________________ Years Completed: ________ Degree Yes No Type of Degree: ____________
Technical or Certificate Programs: ______________________________________________ Type of Certificate earned: _____________________________________________
Technical or Certificate Programs: ______________________________________________ Type of Certificate earned: _____________________________________________
References: List 3 persons (not former employers OR relatives) who have knowledge of your qualifications for the position for which you are applying
NAME
CONTACT TELEPHONE NUMBER
YEARS KNOWN
RELATIONSHIP TO YOU
READ THE FOLLOWING APPLICANT STATEMENT CAREFULLY BEFORE SIGNING
I certify that all the information I have provided in order to apply for and secure work with The Village of Round Lake Beach is true, accurate and complete.
I expressly authorize, without reservation, The Village of Round Lake Beach, it’s representatives, employees or agents to contact and obtain information from all references
(personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in
this application, resume and/or job interview. I hereby waive any and all rights and claims I may have regarding the Village of Round Lake Beach, it’s employees, agents or
representatives, for seeking, gathering and using truthful information, in a lawful manner, in the employment process and all other persons, corporations or organizations for
furnishing such information about me. Misrepresentation or omission of facts contained in this employment application is cause for disqualification from employment
consideration or, if hired, for dismissal without notice or benefits.
I understand that The Village of Round Lake Beach does not lawfully discriminate in employment and no question on this application is used for the purpose of limiting or
eliminating any applicant from consideration for employment on any basis prohibited by local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the Village of Round Lake Beach and still wish to be
considered for employment, it may be necessary for me to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause, and with or without prior notice, and the Village of Round Lake Beach reserves the same right
to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or
contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the Village of Round Lake Beach is authorized to make
any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are signed by The Village of Round
Lake Beach Board of Trustees.
I also understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that Federal Immigration Laws require
me to complete an I-9 form in this regard.
I certify that I have read, fully understand and accept the terms of the forgoing Applicant Statement.
Signature of Applicant: ______________________________________________________________________ Date _______ / ______ / ______
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The Village of Round Lake Beach EMPLOYMENT APPLICATION (Village of Round Lake Beach)

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Completed 16 July 2020

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