Form Center

Step One

Applicant Information:
First Name*
Last Name*
Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
Date available to begin work:*
Date available to begin work:
Date available to begin work:
Position being applied for:*
Desired salary:*
Are you authorized to work in the United States?*
1. Yes
2. No
Have you ever worked for the City of Chicago Heights?*
1. Yes
2. No
If so, when?
Have you ever been convicted of a felony?*
1. Yes
2. No
If yes, explain?
*You are not obligated to disclose expunged juvenile records of adjudication or arrest. Unless you are applying for a position within the City of Chicago Heights Police Department, you are not obligated to disclose sealed or expunged records of adult arrest(s) or conviction(s).
Education:
High School:*
High School Address:*
Years Attended:*
Did you graduate?*
1. Yes
2. No
College:*
College Address:*
Years Attended:*
Did you graduate?*
1. Yes
2. No
Other:
Other Address:
Years Attended:
Did you graduate?
1. Yes
2. No
Continue

Step Two

References:
Please list three professional references.
1.
Name:*
Email Address
Company Name:*
Phone Number*
Address
City
State
Zip Code
Relationship:*
2.
Name*
Email Address
Company Name:*
Phone Number*
Address
City
State
Zip Code
Relationship:*
3.
Name*
Email Address
Company Name:*
Phone Number:*
Address
City
State
Zip Code
Relationship:*
Continue |Go Back

Step Three

Previous Employment:
1.
Company:*
Phone Number:*
Address:*
City:
State:*
Zip Code:*
Supervisor:*
Job Title:*
Starting and Ending Salary:*
Dates Employed:*
Dates Employed: Start Date
Dates Employed: Start Time
—
Dates Employed: End Date
Dates Employed: End Time
Responsibilities:*
Reason for Leaving:*
May we contact your previous supervisor for a reference?*
1. Yes
2. No
2.
Company:*
Phone Number:*
Address:*
City:*
State:*
Zip Code:*
Supervisor:*
Job Title:*
Starting and Ending Salary:*
Dates Employed:*
Dates Employed: Start Date
Dates Employed: Start Time
—
Dates Employed: End Date
Dates Employed: End Time
Responsibilities:*
Reason for Leaving:*
May we contact your previous supervisor for a reference?*
1. Yes
2. No
Continue |Go Back

Step Four

Military Service:
Branch:
Dates of Service:
Dates of Service: Start Date
Dates of Service: Start Time
—
Dates of Service: End Date
Dates of Service: End Time
Rank at Discharge:
Type of Discharge:
If other than Honorable, please explain:
*Applicant is not required to disclose dates of service. The facts of the discharge will be considered. Dishonorable discharge shall not be an absolute bar to Employment.
Disclaimer:
The City of Chicago Heights welcomes you as an applicant for employment. Your application will be reviewed without regard to race, color, religion, sex, age, national origin or disability. All information contained in or involved with this application will be considered personal and confidential and used only in conjunction with your possible employment with the City of Chicago Heights. Falsifying any information may be reasons for disqualification or dismissal.
Authority for Release of Information:
I have completed this statement with the knowledge and understanding that any or all items contained herein may be subject to investigation and I consent to the release of information concerning my capacity and fitness by employers, educational institutions, law enforcement agencies, and other individuals and agencies, to duly accredited investigators, personnel staffing specialists, and other authorized employees as designated by the City of Chicago Heights.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date:*
Date:
Date:

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit Submit and Print | Go Back

Search Forms:

Employment Application

Steps

Step One

Step Two

Step Three

Step Four

Reaching New Heights