Civilian Employment Application DuPage County Sheriff s Office 501 N. County Farm Rd. Wheaton, IL 60187 630-407-2000 We appreciate your interest in our organization. Your help in providing us with a clear understanding of your background, education, work experience and skills will better enable us to determine whether you are qualified candidate for the position for which you are applying. We are an equal opportunity employer and do not lawfully discriminate on the basis of race, color, ancestry, national origin, religion, age, sex, martial status, or physical or mental disabilities unrelated to your ability to perform essential job functions with or without reasonable accommodations.
Personal Information Name: Date of Birth: Last First Middle Address: Street/Apt. No. City State Zip Code County Home Phone: Work Phone: Cell Phone: Social Security # - - Drivers License # Chronologically list ALL residences in the past 3 years. Date From Date To Street Address City State Positions Applied For and Availability Job Title Job Title Available start date: Desired Starting Salary: Preferred Status : Full-time Part-time Temporary Summer Working schedule you will accept: Days Evenings Nights Weekends Holidays Rotating Have you ever applied here before: Yes No If Yes, when: Were you ever employed by DuPage County:Yes No If Yes, when: In which Dept/Division Job Title If relevant to the position, please list any other languages which you can speak or read?
Special Training/Educational History Circle Highest High School College Post Graduate Grade Completed 9 10 11 12 13 14 15 16 1 2 MA PhD School Name Yrs attended From Yrs attended To Graduate Degrees/ Certs Majors High School College Post Graduate Other Other Military Miscellaneous Have you ever worked under a different name? Please list: Are you a United States citizen? Yes No Are you authorized to work in the United States? Yes (Employment is subject to verifications of U.S. citizenship or immigration status in accordance with the Immigration Reform & Control Act.) Have you ever been convicted of crime? Yes No If Yes, list dates, place, court action taken: (A prior conviction does not necessarily mean that you cannot be employed. All circumstances will be considered) No On the next page, please list all current and previous employers, starting with your current employer. If you are not presently employed, start with your most recent employer. If you have more than three (3) employers please include them on a separate sheet of paper.
Company Name: Phone # Street City/State Zip Position Title: Supervisors Name & Title: Employment dates: From To Beginning Salary $ Ending Salary $ Are you currently working for this employer? If yes, may we contact them? If no, please specify the reason for leaving: Company Name: Phone # Street City/State Zip Position Title: Supervisors Name & Title: Employment dates: From To Beginning Salary $ Ending Salary $ Are you currently working for this employer? If yes, may we contact them? If no, please specify the reason for leaving: Company Name: Phone # Street City/State Zip Position Title: Supervisors Name & Title: Employment dates: From To Beginning Salary $ Ending Salary $ Are you currently working for this employer? If yes, may we contact them? If no, please specify the reason for leaving:
Personal References Give three (3) references ( NOT relatives, former / present employers, or fellow employees) who are responsible adults of reputable standing in their communities who you have known well for at least five years, preferably those you have had contact with during the past five years. If retired, give former occupation. Last Name First Name Middle Years acquainted Home address City State/Zip Phone number Secondary number Occupation Last Name First Name Middle Years acquainted Home address City State/Zip Phone number Secondary number Occupation Last Name First Name Middle Years acquainted Home address City State/Zip Phone number Secondary number Occupation PLEASE READ THE FOLLOWING BEFORE SIGNING My signature on this application indicates that I agree to the following conditions: 1. I hereby certify that all information contained in my resume and/or application is true to the best of my knowledge. I agree and understand that any false statements contained herein may cause rejection of my candidacy for employment or termination of employment without notice or benefits. 2. I hereby authorize a investigation of current and previous employment and education records and all pertinent information, personal or otherwise and release all parties from liability for any damage that may result from furnishing the same. 3. DuPage County reserves the right to verify criminal records information I have provided through appropriate local, state, or federal law enforcement agencies. I also understand that any misrepresentation, false statement, omission of facts or failure to provide requested information on this application may cause rejection of my candidacy for employment or termination of employment without notice or benefits. In addition, if accepted for employment, I agree to abide by the rules and policies of DuPage County. Signature Date
JAMES MENDRICK APPROVAL FOR BACKGROUND INVESTIGATION, CRIMINAL HISTORY AND DRIVERS LICENSE CHECK I do hereby certify that I am applying for a position with the DuPage County Sheriff s Office. I further declare that questions answered by me on the application are true and correct and I understand that any discrepancy will result in my application not being accepted. I further realize a full background investigation will be done and hereby authorize individuals contacted to supply pertinent information. I will hold no one liable who supplies information regardless of whether or not I am hired. List ALL names you have ever used ( including maiden name ) beginning with the most recent: Name: (Print) Last First Middle Name: (Print) Last First Middle Name: (Print) Last First Middle City: State: Zip: Date of Birth: Social Security : Drivers License: Sex: Race : Position Applying for: Signature : Date: Witness : Sign Print
Skills Accounting Accounts Payable / Receivable Admissions Animal Care Assessment Auditing Automotive Benefits Bilingual Blue Prints Bookkeeping Building Maint. Carpenter CNA Chemistry Civil Engineer Clerical Client Assessment Computer Repair Computer Software Construction Cook Counseling Crisis Intervention Custodian Customer Service Database Mgmt Data Entry Dietary Electrician Engineering Engineering Tech Environment Engineer Field Inspection Flood Plain Ordinance Gerontologist Grant Accounting Groundskeeping Highway/Roadway Housekeeping Housing Outreach HVAC Intake Lead Worker LPN Educational / Skills History Circle all of your skills, majors and all that apply Skills Manual Labor Microfilm Multi-Lingual Museum Network Admin Office Manager Painter Payroll Pharmacy Physical Therapy Planning-Urban Plumber Presentation Preventative Maint. Programming Public Speaking Purchasing Recordkeeping Rec. Therapy Recruitment RN Secretarial Security Snow Plowing Social Work Stormwater Supervision Surveying Tech Support Training Typing Vocational Counseling Waste Water Treatment Welder Zoning Computer Software Microsoft Access Microsoft Excel Microsoft Word Microsoft Outlook Microsoft Publisher Microsoft PowerPoint Visual Basic Windows XP Majors Accounting Architecture Art Auditing Automotive Body Shop Business Business Administration Chemistry Clinical Psychology Communication Computer Science Cosmetology Criminology Data Processing Drafting Engineering - Civil Engineering-Electrical Engineering-Hydraulic Engineering -Mechanic English Environmental Finance Foreign Language General Science Geography Geographic Info System Heating/Refrigeration Historical Hospital Administration Human Resources Journalism Management Marketing Medical Technology Music Nursing Paralegal Pharmacology Planning Psychology Public Admin Public Health Public Relations Real Estate Recreation Majors Recreation Secretarial Social Service Social Work Sociology Surveying System Analysis Theology Therapy - Occupation Therapy Physical Therapy Recreation Therapy Rehab Urban Geography Urban Planning Degrees GED Associates Bachelors Certificate Doctorate/PhD J.D. License Masters License/ Certification Assess Officer BSN C.A.D.C. C.S.A.D.C. Class A Water Operator Class B Water Operator Class C Water Operator Class I Waste Water Class II Waste Water Class III Waste Water Class IV Waste Water CNA LPN Paralegal PERC Prof. Engineer PT RN Stationary Engineer