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Employment Application

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Steps

1. Personal Information This section is complete This section is incomplete
2. Position Information This section is complete This section is incomplete
3. Education This section is complete This section is incomplete
4. Employment History This section is complete This section is incomplete
5. References This section is complete This section is incomplete
6. Disclaimer & Signature This section is complete This section is incomplete

Personal Information

First Name*
Last Name*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
Do you have a valid drivers license?*
1. Yes
1. No
Are you eligible to work in the United States?*
1. Yes
1. No
Upload Your Resume*
PDF OR MS WORD ONLY
Upload Your Cover Letter
PDF OR MS WORD ONLY
Continue

Position Information

Which position are you applying for?*
How did you hear about the position?*
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Education

High School
Address
Graduate?
1. Yes
2. No
College
Address
Degree
Other
Address
Degree
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Employment History

(From Most Recent)
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
Company
Position
Supervisor
Phone Number
May we contact your previous supervisor for a reference?
1. Yes
1. No
Address
Responsibilities
Employed From - To (Date)
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References

Please list three professional references.
Full Name*
Relationship*
Company*
Phone Number*
Email Address
Full Name*
Relationship*
Company*
Phone Number*
Email Address
Full Name*
Relationship*
Company*
Phone Number*
Email Address
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Disclaimer & Signature

I certify that information contained in this application is true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission of any facts, as stated or implied, given in my application, interview(s), or other employment forms will be sufficient reason not to hire me and shall be grounds for immediate discharge if I am hired. I further understand that this application is not intended to be a contract of employment.
I authorize investigation of all statements in this application for the purpose of employment or retention of employment. This might include, but is not limited to, criminal conviction records, motor vehicle driving records, previous employment history and education verification. I understand I am not obligated to disclose expunged juvenile records of adjudication, conviction, or arrest. I hereby release from liability the Village of Roselle and its representatives for seeking, gathering, or using such information and all other persons, corporations, or organizations for furnishing such information.
I also understand that, if hired, I am required to abide by all rules, policies, ordinances, and regulations of the Village. The Village policies relating to conditions of employment are subject to modification by the Village without notice.
Applicant Signature*

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Email address

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Village of Roselle
31 S. Prospect St.
Roselle, IL 60172
Email Village of Roselle
Ph: (630) 980-2000
Village Hall Hours:
Mon., Tu., Th., & Fri. 8:30am-5pm;
Wed. 8:30am-1pm

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