Employment Application

6
EDUCATION:
Qual Approved ________ Rejected _________
By __________________ Date ____________
Entry Date:
Exam Date (MM/DD/YR) Center
EDUCATION ________________
A ________________
B ________________ ________________
C ________________ ________________
TOTAL ________________
VET POINTS ________________
FINAL GRADE ________________
Remarks:
DEPARTMENT OF PERSONNEL USE ONLY
Title Code Written Keyboarding Vet Points Final Grade
SECTION VI—Foreign Language:
I am proficient (speak, write and translate) in the following languages (do not include English):
___________________________
____________________________
___________________________
1234
Name, Address and Phone Hours Earned: Major: Minor: Dates Attended: Degree Earned:
Number of College/University Sem Qtr Mo/Yr Mo/Yr Level Date: Mo/Yr
Undergraduate:
/ / / 
/ / /        
Graduate:      
/ / /        
Years Completed:
High School Graduate: YES NO OR GED: YES NO
SECTION V—Education Report:
List college/university education accurately and completely. Proof of education claimed may be required during the hiring
process. A copy of a certified transcript/degree MUST be submitted to obtain credit for educational achievement for
training and experience evaluated titles.
Name, Address and Phone Number of From: To: Course Length:
Subject(s)
Certificate
Business, Trade, Technical or other School Mo/Yr Mo/Yr Hours/Days/Weeks Earned
/ / /     /
/ / /     /
SECTION IV—Business, Trade, Technical or Other Coursework:
List below coursework or classes taken that cannot be credited toward a college or university degree program. Failure to indicate
course length may result in no credit given.
Type: Certification Number: Date Issued: Expiration Date: State Issued In:
Mo Yr Mo Yr
Mo Yr Mo Yr
Mo Yr Mo Yr
SECTION III—Professional/Technical Licensure or Certification:
Law enforcement applicants should provide ILETSB Certification and Status.
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