Application for Employment

Village of Skokie
APPLICATION FOR EMPLOYMENT

5127 Oakton Street
Skokie, IL 60077

We consider applications for all positions without regard to race, color, religion, sex, gender identity, sexual orientation,

pregnancy, national origin, age, disability, military/veteran status, marital status, genetic information, or any other legally

protected status. Applicants requiring a reasonable accommodation to the application and/or interview process should

notify the Human Resources Department.

Please type or print in ink.

Position(s) applied for: _______________________________________ _ Date of Application: ______________

NAME: __________________________________________________________________________________ _________
Last First Middle

ADDRESS: ____________________________________________________________________________ _________
Street City State Zip Code

HOME #: ( ) CELL #: ( )

EMAIL ADDRESS: _______________________________________________________

Have you ever been employed here before? Yes No If yes, give date and reason for leaving:
___________________________________ ____

Are you 18 years of age or older? Yes No Type of employment desired: Full Time Part Time

Date available for work: __________________________ ___

Do you presently have any relatives employed by the Village of Skokie? Yes No
If yes, name(s): _________________________________________________________ __

Are you authorized by the United States Citizenship and Immigration Services to work in the United States?
Yes No

Have you been convicted of a felony? Yes No

A criminal conviction will not automatically bar you from employment. When answering this question, do not include any conviction

information which has been sealed, expunged, pardoned, and/or impounded. Applicants are advised that they are not obligated to

disclose expunged juvenile records of adjudication or arrest. Once a determination has been made that an applicant is otherwise

qualified, the Village of Skokie will engage in an interactive assessment with any Applicant that may have a conviction that has a

substantial relationship to the position to which the Applicant applied and/or there is an “unreasonable risk” to property or to the

safety or welfare of individuals, or the general public. In accordance with applicable law, appropriate notifications will be provided.

If yes, please explain:

If driving a vehicle is a requirement of the job being applied for, please provide:

Driver’s License #: _________________________________________ __ Class: ________ State: ____________
August 2021

EDUCATION

School Name and Address Course of Last Year Did You List
Study Completed Graduate? Diploma or

Degree

High School
1 2 3 4 Yes

No
College

1 2 3 4 Yes

No
Graduate Work

1 2 3 4 Yes

No
Other
(Specify) 1 2 3 4 Yes

No

Skills and Qualifications – Summarize any special training, skills, licenses, certificates and/or characteristics of
yourself that may qualify you as being able to perform job related functions for the position you are applying.
______________________________________________________________________________________________________________________________
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List professional, trade, business, or civic associations and any offices held.
______________________________________________________________________________________________________________________________
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_________________________ __
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Please provide any other information you think would be helpful to us in considering you for employment, such as
additional work experience, publications, activities, accomplishments, etc.
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
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EMPLOYMENT HISTORY

List all jobs you have held for the last 10 years. Include any periods of unemployment. List most recent job first.
Attach a separate sheet if necessary.



Employer: ________________________________________ Dates Employed: From: ___________ To: ___________
Address: _______________________________________ _ _
City and State: ____________________________________ _
Job Title: ______________________________________ __ Full Time Part Time
Work Performed:
_____________________________________________________________________________________________ __
_____________________________________________________________________________________________ __
_____________________________________________________________________________________________ __

Reason for Leaving: ______________________________________________________________________________ __
Supervisor/Title: _________________________________________________ _ May we contact? __________________
Telephone:________________________________________________ _

Employer: _______________________________________ Dates Employed: From: ___________ To: ___________
Address: ______________________________________ _ _
City and State: ____________________________________ _
Job Title: ____________________________________ ____ Full Time Part Time
Work Performed:
_____________________________________________________________________________________________ __
_______________________________________________________________________________________ ________
_______________________________________________________________________ ________________________

Reason for Leaving: _____________________________________________________________________________ ____
Supervisor/Title: _______________________________________________ ___ May we contact? _________________
Telephone:____________________________________________________ _

Employer: _____________________________________ ___ Dates Employed: From: ___________ To: ___________
Address: _______________________________________ __ ___________
City and State: ___________________________________ __
Job Title: ______________________________________ __ Full Time Part Time
Work Performed:
____________________________________________________________________________________________ ___
___________________________________________________________________________________________ ____
_____________________________________________________________________________________________ __

Reason for Leaving: _______________________________________________________________________________ _
Supervisor/Title: ________________________________________________ __ May we contact? ________________
Telephone:_______________________________________________ ______

Please explain any gaps/periods of non-employment:

____________________________________________________________________________________________________________________________________
_______________________________________________________________ _
______________________________________________________________________________________________ ____
_____________________________________________________________________________________________ _____

REFERENCES

List name and telephone number of at least three references who are not related to you and not a direct
supervisor.



Name/Relationship Telephone Years Known

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IMPORTANT

PLEASE READ THE FOLLOWING CAREFULLY

I certify that all information provided by me on this Application is true and complete to the best of my

knowledge, and that I have not withheld any information that would, if disclosed, affect this application

unfavorably. I understand that if I have provided any false, misleading or incomplete information in this

application I may be denied employment or terminated from employment with the Village at any time,

including after any period of probation, regardless of when the Village discovers my false, misleading or

incomplete statement.

I specifically consent to the disclosure of information which may be covered by a settlement agreement or

other “confidentiality” provision entered into with my former employers, and I waive my rights to enforce

any such prior confidentiality agreement against my former employer with regard to this disclosure. I

agree to waive any claim or action in law or equity and release from any claim of liability by me

whatsoever, against the Village of Skokie, its officers, agents and employees and any of the persons or

entities listed by me on this application and their officers, agents and employees arising from the

investigation, verification, providing or use of information authorized or requested pursuant to my

application for employment with the Village.

I understand that I may be required as a condition of employment to submit to a pre-employment drug

and/or alcohol test, physical examination (depending on position sought) and/or a job-related ability

test(s), and I hereby consent to such tests as may be required to make a decision on my employment. I

understand that this application is not, nor is it intended to be, a contract of employment. I understand

that unless specifically provided by written agreement authorized and signed at the direction of the

Village Board, my employment with the Village is at-will, meaning that either I or the Village can

terminate employment at any time for any reason. If hired, I agree to abide by all applicable Village rules

and regulations which are subject to modification by the Village.

I hereby acknowledge that I have read the above Certification and Authorization and fully understand it

prior to affixing my signature below.

• By checking this box it acts as my signature; I acknowledge all the information contained herein is

__________________________________ _____ _____________________________________
Signature of Applicant Date