Application For Employment

Positions Applying For and Start Availability
the Position(s) you are applying for your Start Availability

Preferred Status:

Full-Time Part-Time Temporary Seasonal Intern

Desired Starting Salary:

Working schedule you will accept:

Days Evenings Nights Weekends Holidays

How did you learn about this job opening:

Internet Referred Job Fair County Website Other

Do you have any relatives who are currently employed in the department for which you are applying?

Yes No

If yes, please list relatives name/Department:

Have you ever applied here before:

Yes No

If Yes, when:

Were you ever employed by Kane County:

Yes No

If Yes, when:

From: To:

In which Department/Division?

Job Title:

Reason for leaving:

If relevant to the position, please list any other languages which you can speak or read:

Special Training/Educational History
High School High School Name Last Year of High School Completed High School Degree Earned
College/University College/University Name College Major Last Year of College Completed College Degree Earned Years Attended: Year Attended College From - Year Attended College To
Graduate Years Attended: -
Technical/Business/Trade School Years Attended: -
Military Service Dates: -
Other Years Attended: -

Please list any license, registration, certificate, etc., which you have obtained, and currently hold, that is required for the job you are applying for:

If you have not obtained a required license, registration, certification, etc., please list the anticipated date of receipt:

Have you ever had a license, registration, certificate, etc., related to the position you are applying for suspended, revoked, placed on probation or lasped for any reason?

Yes No

If yes, please explain:

Please list all current and previous employers, starting with your current employer. If you are not presently employed, start with your most recent employer.
Employment History
Company Name Company Phone Number
Address: Company Address Company City Company State Company Zip
Postion/Title Hours Worked Per Week Supervisor Name
Employment Dates: Employment Date From - Employment Date To

Are you currently working for this employer? Yes No If Yes, may we contact? Yes No

If no, please specify the reason for leaving:

List job responsibilities in the box below:
Job Responsibilities
Address:

Employment Dates: -

Are you currently working for this employer? Yes No If Yes, may we contact? Yes No

If no, please specify the reason for leaving:

List job responsibilities in the box below:
Address:

Employment Dates: -

Are you currently working for this employer? Yes No If Yes, may we contact? Yes No

If no, please specify the reason for leaving:

List job responsibilities in the box below:

Work Authorization
Are you legally authorized to work in the United States? Yes No
(Employment is subject to verification of U.S. citizenship or immigration status in accordance with the Immigration Reform & Control Act.)
If you are selected for an interview, please be prepared to complete paperwork which will authorize background checks which may include criminal and driving history as well as the status of applicable professional credentials. A conviction will not necessarily disqualify an applicant from further consideration.

Professional References
Please list three references that are familiar with your work history and experience.
1st Reference Name the Company Name of your 1st Reference the Phone Number of your 1st Reference the Job Title of your 1st Reference the Email of your 1st Reference
2nd Reference Name the Company Name of your 2nd Reference the Phone Number of your 2nd Reference the Job Title of your 2nd Reference the Email of your 2nd Reference
3rd Reference Name the Company Name of your 3rd Reference the Phone Number of your 3rd Reference the Job Title of your 3rd Reference the Email of your 3rd Reference

Additional Documents
Please upload any relevant documents such as Resume, Cover Letter, etc. (Files of type .pdf or .docx only)

PLEASE READ THE FOLLOWING BEFORE SIGNING
By checking this box it acts as my signature; I acknowledge that all the information contained herein is true and accurate to the best of my knowledge.

I hereby certify that all information contained in my resume and/or application is true, accurate, and complete to the best of my knowledge and belief. I agree and understand that any false statements, misrepresentations, or omissions of fact contained in this application, resume, and other employment documents or during my interview (if applicable) may cause rejection of my candidacy for employment and if employment has commenced, may be grounds for termination of employment with or without notice or benefits, regardless of how or when discovered.

I hereby authorize investigation of current and previous employment and education records and all pertinent information, personal or otherwise. I release Kane County from any and all liability that might result from conducting a background investigation. I further authorize all individuals and organizations named in this application to provide the County with all information relative to such verification and release all parties from all liability for any damage that may result from furnishing the same. I understand that Kane County reserves the right to verify criminal records information through the appropriate local, state, or federal law enforcement agencies.

I understand that Kane County is not obligated to provide employment, nor am I obligated to accept employment. Nothing in this application, or in any prior or subsequent oral or written statement, is intended to create any contract of employment. I understand that all candidates hired are subject to satisfactorily completing a probationary period. In addition, if accepted for employment, I agree to abide by the rules and policies of Kane County set forth in the employee handbook and/or any policy and procedure manual or other communications to employees. I understand that the County reserves the right to modify policies and procedures at any time, without notice.

I understand that if I am offered employment, it is contingent upon the results of my background check, as well as, receiving a medically acceptable evaluation for my post offer physical and/or passing a pre-employment drug and alcohol screening if a post offer physical or pre- employment screening is required for the position which I am applying for. I authorize the release of the final results of any background check, post offer physical, and/or pre-employment drug and alcohol screening, and the use of those results, to Kane County.

I hereby acknowledge that I have read, understand and agree with all of the above stated information.