Application for Employment/Pre-Employment Questionnaire


Addison Park District

120 East Oak Street
Addison, Illinois 60101
(630) 833-0100

 

Employment with the Addison Park District is governed on the basis of merit, competence and qualifications and will not be influenced in any manner by race, age, color, sex, religion, veteran status, national origin, marital status, mental or physical disabilities.

 

NOTE: Fields marked with * below are the minimum requirements to submit your application! But you should fill out the form as completely as possible to ensure we can fully consider your application.

Personal Information
           
Name: *
Last

First

Middle
 
           
  Address: *
Street

City

State

Zip
           
  Home Phone:
(xxx) xxx-xxxx
Cell Phone:
(xxx) xxx-xxxx
           
  Email Address: *
           
  Are you at least 18 years of age? * Yes No
           
  Are you at least 16 years of age? If hired, proof will be required. * Yes No
           
  Do you have transportation? * Yes No
           
  Are you legally eligible for employment in the United States? *
Proof of citizenship or immigration status will be required.
Yes No
         
           
Type of Employment Desired: * Full-Time Part-Time Seasonal
           
  Date you can Start:   
  mm/dd/yyyy
Requested Salary:  
           
Type of Position Desired (i.e. Camp Counselor, KEEP, Lifeguard, etc.): *
         
  Have you ever been employed by us before? *    Yes No  
           
    Approx date(s):
           
    Position:
           
    Supervisor:
         
  Do you have any special skills, qualifications, licenses, or certifications that would make you uniquely qualified for employment here?       Yes No
           
If yes, please list:
         
  Have you ever been convicted of a felony? *Yes No
         
  If yes, please explain. Conviction may not necessarily disqualify application from employment:
         
  Type of Offense          Date Occurred
     
  Please state circumstances
         
Educational Background
             
Education Name City/State Years
Completed
Course of
Study
Diploma
or Degree
  High School
             
  College
             
  Other
     
  Describe any specialized training, apprenticeships, or extra-curricular activities completed or honors received or additional information that will be helpful to us on considering your application.
             
Employment History
(Start with the most recent)

   
Company Name  
 
Address             Telephone  
 
Date Started           Starting Wage           Starting Position  
 
Date Ended           Ending Wage           Ending Position  
 
Name of Supervisor                May We Contact?    Yes No
   
Responsibilities
   
Reason for Leaving
   

 
Company Name  
 
Address             Telephone  
 
Date Started           Starting Wage           Starting Position  
 
Date Ended           Ending Wage           Ending Position  
 
Name of Supervisor                May We Contact?    Yes No
   
Responsibilities
   
Reason for Leaving
   

 
Company Name  
 
Address             Telephone  
 
Date Started           Starting Wage           Starting Position  
 
Date Ended           Ending Wage           Ending Position  
 
Name of Supervisor                May We Contact?    Yes No
   
Responsibilities
   
Reason for Leaving
References
List three people not related to you who are sufficiently familiar with your work qualifications.
         

Name

Address

Phone
Occupation
Yrs. Known
 
         

Name

Address

Phone
Occupation
Yrs. Known
 
         

Name

Address

Phone
Occupation
Yrs. Known