PLAINFIELD PARK DISTRICT

APPLICATION FOR EMPLOYMENT

[Pre-Employment Questionaire] [An Equal Opportunity Employer]

PERSONAL INFORMATION (all fields In this Section Are required except those marked *)
           
Name:
last
first
middle *		  
           
  present address:
street
city
state
zip
           
  permanent address:
street
city
state
zip
           
  phone number:
(xxx) xxx-xxxx		   Are you 18 years or older?
yes no
         
  email Address :  
         
  Do you have a valid illinois drivers license?
yes no 		   
         
  Are you prevented from lawfully becoming employed in this country because of visa or immigration status? yes no
         
EMPLOYMENT DESIRED
           
position: Date you can start:
mM/dD/YYYY
           
  Salary Desired :

           
  Are You Currently Employed?
yes no
If so, May we contact Your current Employer?
yes no
         
  Have You ever Applied to the Plainfield Park district Before? (If so, where & when)
yes no
where		 when
         
  Referred By:
         
EDUCATION
           
  School Name & Location Yrs. Attended Did You Graduate? subjects studied
  Grammer School yes no
           
  High School yes no
           
  College yes no
           
  Trade, Business, Correspondence, or Military School
yes no
           
GENERAL
           
Subjects of Special study or Research Work:
           
  Special Skills or Training:
           
  Activities (Civic, Athletic, Etc.):
  (EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS)
   
  US Military or Naval Service:
 Rank:
           
  Present Membership in National Guard or Reserves:yes no
         
FORMER EMPLOYERS
  (LIST BELOW YOUR LAST THREE EMPLOYERS, STARTING WITH THE LAST ONE FIRST)
         
Dates: (Month & Year) Name & Address of Employer and Contact Person:
 

From: To:

         
 

Phone Number
Salary
Position
reason for leaving
 
         
Date: (Month & Year) Name & Address of Employer and Contact Person:
 

From: To:

         
 

Phone Number
Salary
Position
reason for leaving
 
         
Date: (Month & Year) Name & Address of Employer and Contact Person:
 

From: To:

         
 

Phone Number
Salary
Position
reason for leaving
 
  Which of These Jobs Did You Like Best?
   
  What Did You Like Most About This Job?
   
REFERENCES
  (GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN AT LEAST ONE YEAR)
           

name
Address
Phone Number 		Business
Yrs Acquainted
 
           

name
Address
Phone Number 		Business
Yrs Acquainted
 
           

name
Address
Phone Number 		Business
Yrs Acquainted
 
         
  In Case Of Emergency, Notify:
name
Address
Phone Number
         
 

 

By submitting this application, I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated with or without cause and with or without notice at any time at either my or the company’s option. I also understand and agree that the terms and conditions of my employment my be changed with or without cause and with or without notice at any time by the company. I understand that no company representative other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.

 

I Agree I DisAgree