Employment Application

2
SECTION I—Employment Information:
Child support obligations: State law requires that you provide certain information about child support obligations at the time of
hire. The possibility of employment is not affected by a child support obligation or default in payment.
Selective Service Registration: As a condition of employment, state law requires that “every male born on or after January 1,
1960, and less than 27 years old, shall submit documentation, at time of appointment, evidencing his registration with the Federal
Selective Service System.”
Disclosure of Information: The Office of the Secretary of State requests disclosure of information that is necessary to
accomplish the statutory purpose as outlined under 15 ILCS 310/10. Disclosure of this information is REQUIRED; failure to
provide any information may result in rejection of this form.
SECTION II—Experience Report:
Fully describe ALL of your work experience beginning with your present position. If you held several positions with one employer, list each
position separately. Incomplete information may negatively affect your grade for examinations consisting of training and experience.
Resumé format is not acceptable, but additional sheets may be attached. Additional sheets MUST include all information requested below.
( ) -
Failure to fully complete the following information will result in no credit given for this work experience.
Name, Address and Phone Number of Employer: Payroll Title:
If this position was supervisory, indicate number of employees supervised for each type:
Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial
Failure to fully complete the following information will result in no credit given for this work experience.
Dates of Employment: Monthly Salary:
From: Mo Yr To: Mo Yr Starting: Ending:
Total: Years: Months: Average hours worked per week:
Describe your duties and responsibilities. Be specific.
Office Use Only
Reason for leaving: Level Amount
( ) -
Failure to fully complete the following information will result in no credit given for this work experience.
Name, Address and Phone Number of Employer: Payroll Title:
If this position was supervisory, indicate number of employees supervised for each type:
Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial
Failure to fully complete the following information will result in no credit given for this work experience.
Dates of Employment: Monthly Salary:
From: Mo Yr To: Mo Yr Starting: Ending:
Total: Years: Months: Average hours worked per week:
Describe your duties and responsibilities. Be specific.
Office Use Only
Reason for leaving: Level Amount
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