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2. 
3. Village of Homer Glen Application for Employment

   Instructions: Thank you for your interest in the Village of Homer Glen. Please fill out this application completely and accurately. If a question does not apply to you, insert "N/A" in the answer space. If you are an individual with a disability and require assistance or accommodation in filling out this application, please contact Karen Heatherly, Human Resource at 708-301-0632. all information contained in or connected with this application will be considered personal and confidential and used only in connection with your possible employment by the Village of Homer Glen.

   It is the policy and intent of the Village of Homer Glen to provide equal employment opportunity in employment to all persons. This policy applies to all types of full-time, part-time, temporary and seasonal employment.

5. GENERAL INFORMATION
7. Position Applying for:
8. Date:
   Date:
10. Type of Employment

    1. Full-time
    2. Part-time
    3. Seasonal
    4. Internship
11. Date available to begin work?
    Date available to begin work?
12. Salary/Hourly rate desired:
14. How did you hear about this position?
    -- Select One --Village of Homer Glen WebsiteIndeedLinkedInFacebookGovHR
15. Name of person who referred you?
19. PERSONAL INFORMATION
21. First Name
22. Last Name
24. Address1
26. Address2
28. City
29. State
30. Zip
32. Personal email:
34. Phone Number
    -- Select One --Cell PhoneHome Phone
35. Please enter a valid phone number: including area code
37. Have you ever been employed by the Village of Homer Glen?

    1. No
    2. Yes
39. Do you have family members or relatives currently working for the Village of Homer Glen?

    1. Yes
    2. No
41. Are you legally authorized to work in the United States?

    1. Yes
    2. No

    (Proof that you are authorized to work in the United States will be required upon employment) 

45. EDUCATION AND TRAINING
47. Education Level

    1. High School/GED
    2. College/University
    3. Post-Graduate School
49. High School
50. Address1
52. City
53. State
54. Zip
56. Check last year completed

    1. 1
    2. 2
    3. 3
    4. 4
57. Degree Earned

    1. Yes
    2. No
58. If yes, indicate degree:
62. College
63. Address
65. City
66. State
67. Zip
69. Check last year completed

    1. 1
    2. 2
    3. 3
    4. 4
    5. Post-/Graduate
70. Degree Earned

    1. Yes
    2. No
71. If yes, indicate degree:
73. Do you have a valid Driver's License?

    1. Yes
    2. No
74. Do you have a valid CDL License?

    1. Class A
    2. Class B
    3. Class C

    (check all that apply) 

76. Please list any certifications, licenses, training, qualifications or skills you have that are relevant to the position for which you are applying
78. Please list any equipment or machinery relevant to the position for which you are applying that you are capable of operating
84. EMPLOYMENT HISTORY

    Please begin with your present or most recent employer and provide all the information requested.

86. 1. Company Name
87. Title
89. Address1
91. City
92. State
93. Zip
95. Supervisor's Name
96. Supervisor's Phone Number
98. Start Date
    Start Date
99. End Date
    End Date
101. May we contact employer?

     1. Yes
     2. No
103. Please explain reason(s) for leaving:
105. Duties:
109. 2. Company Name
110. Title
112. Address1
114. City
115. State
116. Zip
118. Supervisor's Name
119. Supervisor's Phone Number
121. Start Date
     Start Date
122. End Date
     End Date
124. May we contact employer?

     1. Yes
     2. No
126. Please explain reason(s) for leaving
128. Duties:
132. 3. Company Name
133. Title
135. Address1
137. City
138. State
139. Zip
141. Supervisor's Name
142. Supervisors Phone Number
144. Start Date
     Start Date
145. End Date
     End Date
147. May we contact employer?

     1. Yes
     2. No
149. Please explain reason(s) for leaving
151. Duties:
155. MILITARY SERVICE
157. Military Service

     Have you ever served or are you currently serving in the US Armed Forces or National Guard?

     1. Yes
     2. No
159. If yes, please provide dates of duty:
161. Type of Discharge:
165. PROFESSIONAL REFERENCES

     Please list three references that are familiar with your work history and experience. Do not list relatives, friends, or personal references.

167. Professional Reference #1
168. Years Known
170. Relationship
     -- Select One --Co-workerPeerSupervisor
171. Email
175. Professional Reference #2
176. Years Known
178. Relationship
     -- Select One --Co-workerPeerSupervisor
179. Email
183. Professional Reference #3
184. Years Known
186. Relationship
     -- Select One --Co-workerPeerSupervisor
187. Email
191. Upload Resume (optional)
192. Upload Letter of Intent (optional)
194. PLEASE READ CAREFULLY

     I hereby certify that the information contained in this application is true and correct to the best of my knowledge, and understand that making false or incomplete statements on this application in any item or detail is grounds for disqualification from further consideration for employment, or for dismissal.

     I understand that all candidates hired are subject to satisfactory completion of a probationary period, drug screen and background investigation. I authorize the investigation of all statements and information contained in this application. I release the Village of Homer Glen from any and all liability that might result from conducting a background investigation. I also release from liability anyone supplying information pursuant to such investigation.

     I agree to conform to the rules and regulations of the Village of Homer Glen and understand that my employment and compensation are at-will and can be terminated at any time, with or without cause, and with or without notice, at the option of either the Village of Homer Glen or me. I further understand that no representative of the Village of Homer Glen, other than the Village Manager, has any authority to offer me employment for any specified period of time.

196. Signature (Print Name):
197. Date:
     Date:
Leave This Blank:


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

     This field is not part of the form submission.

201. Submit Submit and Print

* indicates a required field