Application for Employment

Housing Authority of
Champaign County

2008 N. Market Street
Champaign, Illinois 61822
Phone : (217) 378-7100
Fax : (217) 378-7113
Application for Employment
General Information
Today's Date*

MonthDayYear
Position Applying For
Name

First NameLast Name
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
May we contact you at work?

YesNo
Date Available for Work

MonthDayYear
Were you previously employed by the Housing Authority of Champaign County?

YesNo
Position?
Dates Employed
If you are an individual with a disability and require assistance filling out this application or accommodations for pre-employment testing,
please contact the Administrative Services Department by phone at 217-378-7100 or by writing to Housing Authority of Champaign County, 2008 N. Market Street Champaign, Illinois 61822.

Resume and/or Cover Letter

Please upload your resume and, if applicable, your cover letter.
RESUME UPLOAD *

Browse Files
*MANDATORY Cancelof
COVER LETTER UPLOAD

Browse Files

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Employment Information

List your history. Start with your PRESENT or MOST RECENT job. Include both paid and job-related unpaid or volunteer experience.
Number of Employers

Employer 1
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Number

Area CodePhone Number
Dates Employed
Hours per Week
Job Title
Reason for Leaving
Your Job Duties

Employer 2
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Number

Area CodePhone Number
Dates Employed
Hours per Week
Job Title
Reason for Leaving
Your Job Duties

Employer 3
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Number

Area CodePhone Number
Dates Employed
Hours per Week
Job Title
Reason for Leaving
Your Job Duties

Employer 4
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Number

Area CodePhone Number
Dates Employed
Hours per Week
Job Title
Reason for Leaving
Your Job Duties

Employer 5
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name
Supervisor's Number

Area CodePhone Number
Dates Employed
Hours per Week
Job Title
Reason for Leaving
Your Job Duties

Section Stop
May we contact your employers?

YesNo
If not, state whom and why:
Have you ever worked under a different name?

YesNo
If so, please list any other names you have worked under:

Education

	Name of School	Address	Type of Course	Course Major	Did You Graduate?	Degree Received
High School
College
Graduate School
Trade School
Business School
Other

Military Experience
Do you have military experience?

YesNo
What Branch of the military?
Describe skills learned and duties performed:
Skills
In the space provided, list any skills, certificates, special licenses, or special training which relate to the position you are applying for:
References
Please provide two (2) business references and one (1) personal reference:

Other Information
Title VII of the Civil Rights Act prohibits discrimination of employment practices based on race, color, religion, sex, or national origin. Further, the Age Discrimination in Employment Act (ADEA) prohibits discrimination on the basis of age with respect to any individuals who are 40 years of age or older.

Title 1 of the Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability. These acts cover hiring and all terms, conditions, and privileges of employment.
Are you eligible to work in the United States?

YesNo
Are any of your relatives employed by the Housing Authority of Champaign County?

YesNo
Please state their name, their department, and your relationship:
For positions that list driving as an essential function, driver’s license and driving record information will be required at a later date.

PLEASE BE SURE TO SIGN THIS APPLICATION AND READ THE FOLLOWING STATEMENTS CAREFULLY:

I hereby affirm that the information provided on this application (an accompanying resume, if any) is true and complete to the best of my knowledge and agree that falsified information or significant omission may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorized the Housing Authority of Champaign County to verify this information to determine whether or not I am qualified for the position for which I am applying.

I hereby authorize all current and previous employers to release job-related information upon the request of the Housing Authority of Champaign County. However, I understand that if, in the Employment Information section, I have answered “No” to the question, “May we contact your employer?” contact with those particular employers will not be made without my specific authorization.

The Housing Authority of Champaign County is committed to providing a work environment that is free from drugs. I understand that any job offer made by the Housing Authority of Champaign County will be contingent upon successful completion of a drug-screening test.
Signature

HOUSING AUTHORITY OF CHAMPAIGN COUNTY

CONSENT TO RELEASE URINALYSIS RESULTS TO THE HOUSING AUTHORITY OF CHAMPAIGN COUNTY

The Housing Authority of Champaign County is committed to providing a work environment that is free from drugs. All job offers made by the Housing Authority of Champaign County will be contingent upon the successful completion of a drug screening test.

I do hereby voluntarily agree to undergo a urinalysis test for drugs. I so hereby give my consent to release the urinalysis drug testing results to the Housing Authority of Champaign County to be used as a part of my application process and understand that any job offer is conditional upon my successful completion of this test. The Housing Authority of Champaign County will not discriminate against applicants for employment because of past abuse of drugs and/or alcohol.
Signature of Applicant

Clear
Date

MonthDayYear
REFERENCE RELEASE STATEMENT

I do hereby give my consent to references, (employment and personal) to release pertinent information about my qualifications and fitness for the position, which I have applied with the Housing Authority of Champaign County.
Signature of Applicant

Clear
Date

MonthDayYear
APPLICANT’S STATEMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event that I am offered employment by the Housing Authority of Champaign County, I understand that any false or misleading information given in my application or interview may result in discharge.

I understand that neither this document not any offer of employment constitutes an employment contract.
Signature of Applicant

Clear
Date

MonthDayYear

The Housing Authority of Champaign County
Background Check Authorization

This notice is being given to you pursuant to the Fair Credit Reporting Act (FCRA) 15 U.S.C. 1861. The FCRA requires that HACC make a clear and conspicuous disclosure of its intent to conduct a check of your background that may affect your application for employment or employment status. This check may include driving record, Driver’s License verification, criminal background, employment, and education verification, but will NOT include a credit check.

From time to time, HACC will perform checks of driving records of any employee that may drive a HACC vehicle or drive a personal vehicle conducting HACC business.

Discovery of certain adverse information on the background or records check may be grounds for HACC to take action against an applicant or employee, including but not limited to: not hiring or withdrawal of a contingent job offer; suspension; reassignment; or termination of employment.

The purpose of this notice is to advise you that HACC will perform the above-noted checks at a frequency determined by HACC’s Administrative Services Department.

Your signature below indicates that you authorize HACC to perform the checks as part of the hiring process or at any time during the course of your employment. Your date of birth is required to complete the background check only and has no other bearing on the hiring process.
Signature
Name Printed
Date of Birth

MonthDayYear
State of Issuance
Soc. Sec. Number
Driver's License Number
Please verify that you are human*
Should be Empty:

Application for Employment

General Information

Resume and/or Cover Letter

Employment Information

Education

Military Experience

Skills

References

Other Information

PLEASE BE SURE TO SIGN THIS APPLICATION AND READ THE FOLLOWING STATEMENTS CAREFULLY:

HOUSING AUTHORITY OF CHAMPAIGN COUNTY

CONSENT TO RELEASE URINALYSIS RESULTS TO THE HOUSING AUTHORITY OF CHAMPAIGN COUNTY

REFERENCE RELEASE STATEMENT

APPLICANT’S STATEMENT

The Housing Authority of Champaign CountyBackground Check Authorization

The Housing Authority of Champaign County
Background Check Authorization