Waukegan Civil Service Commission
Board of Fire Commissioners
Application for Employment
Full-Time Firefighter/EMT
The Board of Civil Service Commissioners for the Waukegan Fire Department, Waukegan, Illinois,
is seeking qualified applicants to establish a hiring eligibility list. Applications must be submitted on
or before 4:00 p.m. local time on August 28, 2020 using this form. Minimum eligibility requirements
have been established for this position by the Board of Civil Service Commissioners and/or
applicable State statutes:
Applicant must be at least 21 years of age at the time of hire.
Applicant must be under 35 years of age as of the date of the written exam, unless the
individual falls under one of the exceptions to the statutory maximum hiring age detailed in
70 ILCS
705/16.06 or 65 ILCS 5/10-2.1-6.
Applicant must possess a high school graduation diploma or GED equivalent.
Applicant must have a valid driver's license.
Applicants will be required to attend the following sessions, or be disqualified:
The 1.5 mile run to be held on Saturday, September 19, 2020 at 7:30 a.m. at Weiss Field
located 100 N Lewis Ave, Waukegan, IL 60085.
The obstacle course to be held on Saturday, September 26, 2020 at 7:30 a.m. at Lakes
Behavioral Health located 2615 Washington St, Waukegan, IL 60085. (parking garage)
Written examination to be held October 3, 2020 at 9:00 a.m. at Waukegan High School
located 1011 Washington St, Waukegan, IL 60085. (South parking lot)
Interviews before the Board of Fire Commissioners to be held in October, 2020 (time, day
and location to be announced).
Applicants must be of good moral character and meet all requirements of the Waukegan Civil
Service Commission Board and the State of Illinois. Applicants must successfully complete all
phases of testing to be placed upon the eligibility list. Placement upon the eligibility list does not
guarantee future employment with the Waukegan Fire Department.
Persons requiring assistance completing the application may telephone or visit the Waukegan Fire
Department Station #1 Administrative Offices: 1101 Belvidere Rd, Waukegan, Illinois
(847-249-5410), Monday through Friday between 8:00 a.m. and 4:00 p.m. Or email
fire@waukeganil.gov
Completed applications must be submitted to the Waukegan Fire Department Station #1 no later
than 4:00 p.m. on Friday, August 28, 2020.
The Waukegan Fire Department considers all applicants for employment without regard to race,
color, religion, sex, age, origin, handicap or disability in accordance with federal law. In addition, the
Waukegan Fire Department complies with applicable state and local laws prohibiting discrimination
in employment in every jurisdiction it maintains facilities.
This Application for Employment is the first step of the testing process. Please read each question
carefully before answering and answer each question accurately. The application is not the sole
criterion for hiring, various procedures are
utilized to verify the accuracy of the information that you
have provided. An applicant may be disqualified from further processing, employment, and/or
terminated after appointment for failing to complete this form, or if he/she intentionally makes a false
statement of material fact, practices, or attempts to practice, any deception or fraud in this
application, examination, hiring process or appointment.
THIS APPLICATION IS TO BE COMPLETED BY THE APPLICANT ONLY.
I have read and understand the
above statements:
Yes No
You must read and understand the above statements before continuing.
First Name Last Name Middle Name
Maiden name or other names, including nicknames or aliases, that you have used or have been
known by may be necessary to verify background information, previous employment and education:
Maiden names, other names or aliases:
E-mail Address (A receipt of this application will be sent to this address.)
Home Street Address Apt. #
City State Zip Code
How long at present address?
Less than 1 years
1 to 5 years
More than 5 years
Home Phone: Mobile Phone:
Past Address 1: From:
To:
Past Address 2: From: To:
Past Address 3: From: To:
Are you a United States
Citizen?
Yes No
Social Security # If naturalized citizen, give date
List three persons that you have known for at least five years. Do not list relatives or
former employers:
Name 1 Address
City: State: Zip Code: Phone Number:
Their Occupation Number of Years Known:
Name 2 Address
City: State: Zip Code: Phone Number:
Their Occupation Number of Years Known:
Name 3 Address
City: State: Zip Code: Phone Number:
Their Occupation Number of Years Known:
PERSONAL REFERENCES
Employer Supervisor
Address Telephone
Job Title From
To
Job Duties
Reason for Leaving
Employer Supervisor
Address Telephone
Job Title From
To
Job Duties
Reason for Leaving
Employer Supervisor
Address Telephone
Job Title From
To
Employment History
Starting with your present position, list all jobs held over the past ten years including part-time and
full-time employment and military experience.
Job Duties
Reason for Leaving
Employer Supervisor
Address Telephone
Job Title From
To
Job Duties
Reason for leaving
Please note any objections to our contacting any of the previously listed employers:
Are you engaged in any business as an owner or partner?
Yes No
If yes, please provide details:
Were you ever discharged or asked to resign from any employment?
Yes No
If yes, please provide details including dates:
Employment History (continued)
Have you had any garnishments, wage assignments or judgements against you?
Yes No
If yes, please provide details including dates:
Education and Training
Highest degree earned
High school GED Associates
Bachelors Masters Doctorate
High School Location
Graduate?
Yes No
Graduation Date:
OR
GED Date:
College/University Degree Program:
Degree Earned, if any: Date Earned:
College/University Degree Program:
Degree Earned, if any: Date Earned:
College/University Degree Program:
Degree Earned, if any: Date Earned:
College/University Degree Program:
Degree Earned, if any: Date Earned:
Describe any specialized training, experience, qualifications or skills which you feel make you
especially suited for this job:
Driver's License Information
Do you currently have a valid driver's license?
Yes No
State issued Number Expiration
During the last 10 years, has your license been suspended or revoked?
Yes No
When? For how long? Reason
Have you ever been convicted of driving under the influence of alcohol or drugs?
Yes No
Explain
Were you ever involved in any vehicular crashes?
Yes No
Describe details including dates
Were police reports completed for these crashes?
Yes No
List police agencies
U.S. Military Experience
Were you ever rejected from the Armed Forces?
Yes No
Describe the details
Have you ever served on active duty in the Armed Forces of the United States?
Yes No
Branch of service Length of service
Highest rank Discharge status
Date of discharge
Reserve status
Please attach a copy of your DD214 or service record.
Were you ever convicted in a court martial or were you subject of a summary court, or any other
disciplinary action?
Yes No
Describe the details including dates.
Please list any specialist schools while in the Armed Forces.
Please list any commendations and citations awarded to you as a member of the Armed Forces.
Have you ever been convicted of a misdemeanor or felony crime?
Yes No
Describe the details - indicate date, nature and place of offense and the sentence received.
Have you ever filed bankruptcy?
Yes No
Describe the details including dates.
Have you received any traffic citations in the past five years?
Yes No
List all convictions in the past five years.
Do you use, or have you ever used, narcotics, marijuana, barbiturates, amphetamines or other
illegal drugs?
Yes No
Describe the details.
Have you paid, promised to pay, or given any money or material services or consideration to
any person, directly or indirectly, toward procuring your appointment to this Department?
Yes No
Describe the details.
Please list any civic, professional or social organizations to which you belong.
General Information
Do you have any knowledge or information, in addition to the information specifically called for in the
preceding questions, which is or which may be relevant, directly or indirectly, in connection with an
investigation of your eligibility or fitness for appointment with a fire department, including but not
limited to employment, education, subversive activities, family, association, criminal
record, traffic violations, residences or otherwise, please list below:
Narrative
Why do you feel you are qualified for this position? (50 word minimum)
Certification
By signing this application below, I certify that all of my answers in this application are true
and correct. I agree to verification of all my statements and answers in this application before
any hiring decision is made. I authorize investigation of my past employment history as well as
any investigation into my criminal and driving history, credit and character.
I understand that part of the hiring process may include additional questionnaires, interviews, a
background check, psychological testing and polygraph, physical examination and a drug screening
test.
I further understand and agree that any false, misleading or incomplete information given in my
application, interviews or other pre-employment questionnaires and procedures, regardless of when
discovered by the Waukegn Fire Department, will be sufficient basis for my disqualification for
employment or if employed, the termination of my employment with the Waukegan Fire
Department. I agree the Waukegan Fire Department shall not be liable in any respect if I am not
hired or my employment is terminated as a result of providing such false, misleading or incomplete
information.
I hereby attest that I have personally read and answered each and every applicable question
herein, and do solemnly swear that each and every answer is full and correct in every respect. I
further acknowledge that I have read and understand all of the information above and agree to the
terms therein.
___________________________________ ___________________
Applicant's signature Date
Waukegan Civil Service Commission
100 N. Martin Luther King Jr Ave
Waukegan, Illinois 60085
Office: 847-599-2550
Authorization for Release of Information
I, _________________________________, hereby consent and authorize the Waukegan Civil Service
Commission, its representatives, or agents bearing this release to obtain any information in your files
pertaining to, but not limited to, my employment records, driving records, criminal records, civil case history. I also
consent to your release of any and all public information that you may have concerning me, my work
record, by background, my reputation, my criminal history records and personal references.
I hereby release any representative or agent of the Waukegan Fire Department from liability or damages
pursuant to any State
or Federal laws. I hereby release you as the custodian of such records and your
organization, City including its officers, employees, or other related personnel, both individually and
collectively, from any and all liability for damages of whatever kind, which, at any time, may result to me,
my heirs, family, or associates because of compliance with this authorization and request to release
information, or any attempt to comply with it.
I understand my rights under Title 5, Unites States Code, Section 552a, the privacy act of 1974, with regard
to access and to disclosure of records, and I waive those rights with the understanding that
information furnished will be used by the Waukegan Fire Department in conjunction with employment
procedures.
A photocopy or fax copy of this release will be valid as an original thereof, even though the said photocopy
or fax copy does not contain an original writing of my signature. This authorization will remain valid for six
months of the date of my signature.
Signature
Name(Printed
)
Address
Telephone
Date of Birth
Social Security No.
Date:
Robert Brown Charles Perkey Michael Jackson Hector Rodriguez Diane Verratti
Chairman Co-Chairman Commissioner Commissioner Commissioner
George Bridges, Jr. Gene Decker Brett Stickels
Fire Chief Deputy Fire Chief Training Battalion Chief
Please attach copies of the following required additional documents:
-Birth Certificate
-Driver's License
-High School Diploma or GED
-Other degrees if applicable
Print and submit the application above, with the required additional documents attached,
to the Waukegan Fire Department Station #1 at 1101 Belvidere Rd, Waukegan, IL 60085
M-F 8:30-4:00pm
The City or its assigned testing agent shall send written notice to qualified applicants on the
Initial Eligibility List of the opportunity to apply for preference points within 10 business
days of posting the Initial Eligibility List. Candidates will be permitted to submit Preference
Points between the hours of 8:00 a.m. and 4:00 p.m., Monday through Friday. Candidates
must use the forms located on the following five (5) pages to submit their points. All
submissions must include the Candidate Affidavit for Preference Points. All Preference
Points must be submitted to the Waukegan City Hall, Human Resources Dept, 100 N. Martin
Luther King Jr Ave, Waukegan, IL 60085
Preference Points Submission Process
******** KEEP THIS PAGE FOR YOUR RECORDS ********
Candidate Preparation Manuals
Includes detailed recommendations on important concepts, such as the most effective test-taking strategies and methods, specific information about CPS
HR test forms, and what to expect on the day of the test administration. Also includes several practice questions covering each section of the test, along
with helpful tools, like a sample answer sheet and template test instructions for candidates to prepare before the day of the test.
Practice Tests
Simulates full-length versions of CPS HR tests and have been designed to replicate the look and feel of test-day material. Contains practice items across
the same sections contained in our test forms. When candidates have completed the online practice exam, they will receive a breakdown of their scores
by section. (Candidates will not receive a list of the questions and answers.) In addition, candidates can re-take the exam one additional time at no cost.
https://secure1.cpshr.us/crcv/Default.aspx?ID=TR120378
Copy the above link to access study materials after submitting the application. The materials purchased are valid until October 3, 2020.
Candidate Affidavit for Preference Points
I, ________________________________________, being duly sworn on oath, state that the
information set forth in my Waukegan Fire Department Preference Point Claim Form(s) is true and
correct. I understand that misrepresentations, falsifications or material omissions may result in
my application no longer being considered by the Commission, removal from the hiring register and/or
dismissal from the Commission.
_________
______________________
Applicant’s Signature
FOR BOARD USE ONLY BELOW LINE
Date of Initial Eligibility Roster Posting: ___________________________
Date of Submission of Claim Form(s): ___________________________
Received by: ________________________
Waukegan Civil Service Commission
Board of Fire Commissioners
100 N. Martin Luther King Jr Ave
Waukegan, IL 60085
847-599-2550
Application for Military Preference Points
All persons who have at least one (1) year of active military service and who were honorably discharged
or remain on inactive service or reserve duty shall receive five (5) preference points.
Proof of such service must include a copy of Military Form DD-214 (long form) as proof of active service,
evidence of the honorable discharge.
To qualify for the military preference, applicants who are eligible for credit shall make such claim in writing
within ten (10) days after posting of the initial eligibility list, and provide documentation proving such
claim, or the claim will be waived.
I, __________
______________________________, do hereby wish to exercise my right to have credit
for Military Service preference points applied.
Branch of Se
rvice: ___________________________________________________
Dates of Service From: ___________________ to _______________________
(month/date/year)
Unit: ___
_________________________________________________
Rank: __
________________________________________
PLEASE AT
TACH A COPY OF YOUR MILITARY FORM DD-214 (LONG FORM).
_______________________________
Signature of Applicant
________________________________
Date
Waukegan Civil Service Commission
Board of Fire Commissioners
100 N. Martin Luther King Jr Ave
Waukegan, IL 60085
847-599-2550
Application for Bilingual Speaking (Spanish)
All persons who submit for bilingual Spanish speaking shall complete a proficiency exam upon request.
To qualify for the Bilingual speaking preference, applicants who are eligible for credit shall make such
claim in writing within ten (10) days after posting of the initial eligibility list, and provide
documentation proving such claim, or the claim will be waived.
I, ________________________________________, do hereby wish to exercise my right to have
credit for Bilingual Spanish Speaking.
________________________________
Signature of Applicant
_____________________________
___
Date
Waukegan Civil Service Commission
Board of Fire Commissioners
100 N. Martin Luther King Jr Ave
Waukegan, IL 60085
847-599-2550
Application for Residency Preference Points
All persons whose primary residence is within the City Of Waukegan, County of Lake, or been a
resident of Waukegan 5 or more years may receive preference points.
To qualify for the Residency Preference, applicants who are eligible for credit shall make such claim in
writing within ten (10) days after posting of the initial eligibility list, and provide documentation
proving such claim, or the claim will be waived.
I, ________________________________________, do hereby wish to exercise my right to have
credit for Residency preference points applied.
Primary Residence Address: __________________________________________________________
PLEASE ATTACH A COPY OF PROOF OF RESIDENCY (UTILITY BILL, TAX BILL, MORTGAGE, ETC.).
_____________
___________________
Signature of Applicant
________________________________
Date
Waukegan Civil Service Commission
Board of Fire Commissioners
100 N. Martin Luther King Jr Ave
Waukegan, IL 60085
847-599-2550
Application for Experience Preference Points
All persons who are or have been a fire cadet, volunteer, paid on call, or career firefighter, EMT-B, EMT-
I or EMT-P may be awarded preference points.
To qualify for the experience preference, applicants who are eligible for credit shall make such claim
in writing within ten (10) days after posting of the initial eligibility list, and provide documentation
proving such claim, or the claim will be waived.
A candidate may not receive all experience preference points if the amount of points awarded place
the candidate before a veteran on the eligibility list. In event of an equal number of points, the veteran
shall be given first preference.
I, ________________________________________, do hereby wish to exercise my right to have
credit for experience points applied.
Fire Cadet Hire Date: __________________________
Paid-On-Call Hire Date: _________________
Firefighter II Certification Date: ___________________
EMT-PCertificationDate:____________________
Firefighter III Certification Date: __________________
EMT- B or I Certification Date: ____________________
________________________________
Signature of Applicant
________________________________
Date
Waukegan Civil Service Commission
Board of Fire Commissioners
100 N. Martin Luther King Jr Ave
Waukegan, IL 60085
847-599-2550