Application for Employment

Application for Employment
Blue Island Park District

An Equal Opportunity Employer

For driving jobs ONLY: Do you have a valid Driver's License?

Yes No
Driver's License Number:
Class of License
Have you ever had your driver's license suspended or revoked in the last 3 years?

Yes No
If yes, give details:

List professional, trade, business or civic activities and offices held. *
Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, or other protected status. N/A if not applicable
List name and address of High School or GED *
Please include Number of Years Completed, Diploma/Degree/Certificate, & Subjects Studied. N/A if not applicable
List name and address of College or University
Please include Number of Years Completed, Diploma/Degree/Certificate, & Subjects Studied. N/A if not applicable
List name and address of Vocational or Technical
Please include Number of Years Completed, Diploma/Degree/Certificate, & Subjects Studied. N/A if not applicable
What skills or additional training do you have that relate to the job for which you are applying? *
N/A if not applicable
What machines or equipment can you operate that relate to the job for which you are applying? *
N/A if not applicable

List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supplu business references. Note: A job offer may be contingent upon acceptable references from current and former employers.
#1
Employer #1
Address

Street Address

Street Address Line 2

City State

Zip Code
Supervisor

First Name Last Name
Phone Number

Area Code Phone Number
Job Title and Duties
Dates of Employment (Mo/Yr)
Start
Dates of Employment (Mo/Yr)
End
Reason for Leaving:
Do you have more work experience?

Yes No
#2
Employer
Supervisor

First Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State

Zip Code
Job Title and Duties
Dates of Employment (Mo/Yr)
Start
Dates of Employment (Mo/Yr)
End
Reason for Leaving:
Do you have more work experience?

Yes No
#3
Employer
Supervisor

First Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State

Zip Code
Job Title and Duties
Dates of Employment (Mo/Yr)
Start
Dates of Employment (Mo/Yr)
End
Reason for Leaving:

Give three references, NOT relatives or former employers. ***
Reference #1
Name *

First Name Last Name
Relationship (not relatives or former employers) *
Address *

Street Address

Street Address Line 2

City State

Zip Code
E-mail
Phone Number *

Area Code Phone Number
Reference #2
Name *

First Name Last Name
Relationship *
Address *

Street Address

Street Address Line 2

City State

Zip Code
E-mail
Phone Number *

Area Code Phone Number
Reference #3
Name *

First Name Last Name
Relationship *
Address *

Street Address

Street Address Line 2

City State

Zip Code
E-mail
Phone Number *

Area Code Phone Number
How were you referred to us? *

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PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post employment drug screen as a condition of employment, if required. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.
I have read, understand and by my signature and submitting this application, I consent to these statements.
Signature *

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Application for Employment

Blue Island Park District