Summer Employment Application Form - Illinois Department Of Agriculture - 2016

Download a blank fillable Summer Employment Application Form - Illinois Department Of Agriculture - 2016 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Summer Employment Application Form - Illinois Department Of Agriculture - 2016 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

This form can be

* INCOMPLETE APPLICATIONS MAY NOT BE CONSIDERED FOR EMPLOYMENT.*

completed on-line,

ILLINOIS DEPARTMENT OF AGRICULTURE

saved and printed.

2016 SUMMER EMPLOYMENT APPLICATION

Social Security Number

IL DL or ID#

Date of Birth/Age (Optional)

Last Name

First Name

A/C

Phone Number

2nd Phone Number

Mailing Address

City

State

Zip

County

High School

GED

College - University

Circle No.

Years Completed 0 1 2 3 4 Graduated

YES

NO Received GED Cert.

YES

0 1 2 3 4 5 6 7 8 Grad.

YES

VETERANS PREFERENCE: For assistance contact Veterans Outreach at 1-800-643-8138 or Illinois Relay Center at 1-800-526-0844 (TTY only).

CITIZENSHIP: check box below:

U.S. Citizen

Non-Immigrant Alien

I wish to claim Veterans Preference: attached is the most recent certiﬁ ed copy of my DD214/215. (If claiming service-connected disability,

also include a copy of U.S. Veterans Affairs award letter.)

Permanent Resident Alien Visa Type: ___________

I wish to claim Veterans Preference as an IL National Guard/Reservist. Attached is a letter from my unit personnel indicating I am currently

reg. no.:_______________

serving under honorable conditions or a copy of my NGB22 stating my discharge was under honorable conditions.

Selective Service:

I wish to claim Veterans Preference as a surviving unremarried spouse or one parent of an unmarried veteran who suffered a service-

Are you currently registered with the Selective Service

connected death or disability that prevents the veteran from qualifying for civil service employment.

System:

Yes

I have submitted required military documentation to CMS after January 01, 2000 and have already established Veterans Preference with

Reg. # ____________________________________

CMS.

Required for males age 18 - 26

The State of Illinois is an Equal Opportunity Employer. We invite you to complete the following. Completion of this information is not required. Circle ONE letter.

FEMALE

MALE

White not of Hispanic Origin. A person having origins in any of the original peoples of Europe, North Africa or the Middle East.

African American not of Hispanic Origin. A person having origins in any of the black racial groups of Africa.

Native American. A person having origins in any of the original peoples of North America, and who maintains cultural identiﬁ cation through tribal afﬁ liation or community.

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Paciﬁ c Islands. This area includes, for example, China,

Japan, Korea, the Philippine Islands and Samoa.

Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish Culture or origin, regardless of race.

Native Hawaiian or Other Paciﬁ c Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Paciﬁ c Islands.

If your answer to any of the following questions is “yes”, attach a detailed statement.

Desired work Locations:

Have you ever been discharged from a job?

YES

(please check all that apply)

Are you currently in default on the repayment of any State educational loan?

YES



Pari-mutuel (must be 18)



**State Law provides that any employee who is in default on the repayment of any education loan for a period

(Horse Racing Windows)

of 6 months or more and in the amount of $600.00 or more shall, as a condition of employment, make a



Security (must be 18)

satisfactory loan repayment arrangement with the maker or guarantor of the loan.



Day Security (DuQuoin Only)



Night Security (DuQuoin Only)

Are you a member of the State Employees’ Retirement System of Illinois?

YES



Maintenance

Or have credit in a system which is considered under the Retirement System’s Reciprocal Act?



Name of System __________________________________________

Day

Are you receiving State of Illinois Retirement Beneﬁ ts?

YES



Night (must be 18)

Are you presently working for the State of Illinois?

YES



Ofﬁ ce/Clerical

Name of Department__________________________________________



Restrooms (Springﬁ eld Only)



Parking (DuQuoin Only)

Available for work from: ______________________________

_______________________________



Ushers (DuQuoin Only)

month/day

Are you available to work the two (2) weeks of the Fair? Yes No

______Springﬁ eld (8/11-21) ______DuQuoin (8/26 - 9/5)

I authorize release of this and other information covering job-related factors for the purpose of veriﬁ cation and determination of suitability for state employment.

I certify that the information on this application is true and accurate and understand that misrepresentation of any material fact may be grounds for ineligibility

or termination of employment.

Date

Written Signature

(over)

IL406-1313 (Rev. 1-16)