1939 W. 13th STREET, SUITE 300 CHICAGO, ILLINOIS (312)

Transcription

1 1939 W. 13th STREET, SUITE 300 CHICAGO, ILLINOIS (312) Application for Employment Updated May, 2016

2 APPLICATION FOR EMPLOYMENT EQUAL OPPORTUNITY EMPLOYER AN EQUAL OPPORTUNITY EMPLOYER does not discriminate in hiring or terms and conditions of employment because of an individual s race, creed, color, sex, age, national origin, marital status or disability. Please answer all questions as completely as possible. All information will be kept in strict confidence. PERSONAL DATA Today s Date: / / Name: Social Security No.: - - Address: City: State: Zip: ( ) - Alternate Phone: ( ) - If employed, can you provide proof of U.S. Citizenship or status that allows you to work in the U.S.? YES NO POSITION APPLYING FOR: Title: Would you accept any other positions? YES NO Date available to work: / / Rate of Pay desired: List any days/hours you are unable to work: Schedule Desired: FULL-TIME ARE YOU WILLING TO WORK: YES NO PART-TIME TEMPORARY Over 40 hours per week? Irregular Shifts? Saturdays or Sundays? Holidays? Please identify any physical or mental condition which would affect your ability to perform the job for which you have applied and any accommodations you might require: REFERRAL/PREVIOUS SOURCE: Walk-In College Placement Office Private Employment Agency Ad Response Friend Minority Referral Agency State Employment Agency Have you ever applied for employment with us? YES NO If yes, please note Month and Year? Were you previously employed by ESMC? YES NO Date: / / Position: Dept.: Supervisor: Are any of your relatives currently working for ESMC: YES NO Name, Relationship, and Department in which they work:

3 EDUCATION: High School: College: Major: Graduated? YES NO Degree Received? YES NO Vocational Technical, Military: KNOWLEDGE, SKILLS, & ABILITIES: Summarize special skills and abilities acquired from employment or other experiences that may qualify you for work with ESMC: EMPLOYMENT HISTORY/MILITARY HISTORY: List your last three employers, assignments, or volunteer activities, including military experience. Begin with your most recent employer (Attach additional sheets if needed): I. II. / / To: / /

4 III. IV. WORK/PROFESSIONAL REFERENCES: Name: Address: Phone: # of Yrs Known:

5 It is understood and agreed upon that any misrepresentations by me in this application will be sufficient cause for cancellation of this application and/or separation from ESMC s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, ESMC reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of ESMC, other than the President, has the authority to make any assurances to the contrary. I give ESMC the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability ESMC and its representative(s) for seeking such information and all persons, corporations, or organizations for furninishing such information. Applicant s Signature / / Date