APPLICATION FOR EMPLOYMENT

BARRINGTON PARK DISTRICT

235 Lions Drive, Barrington, Illinois, Phone 847 381-0687, Fax 847 381-8794

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, marital status, veteran or other legally protected status. If assistance is needed in preparing this application, please ask. Alternative formats can be provided.

NOTE: Fields marked with * below are the minimum requirements to submit your application! But you should fill out the form as completely as possible to ensure we can fully consider your application.

Educational Background


Education	Name	City/State	Years Completed	Course of Study	Diploma or Degree
High School

College

Other

Describe any specialized training, apprenticeships, or extra-curricular activities completed or honors received or additional information that will be helpful to us on considering your application.

Employment History

(Start with the most recent)


Company Name

Address Telephone

Date Started Starting Wage Starting Position

Date Ended Ending Wage Ending Position

Name of Supervisor May We Contact? Yes No

Responsibilities

Reason for Leaving




Company Name

Address Telephone

Date Started Starting Wage Starting Position

Date Ended Ending Wage Ending Position

Name of Supervisor May We Contact? Yes No

Responsibilities

Reason for Leaving




Company Name

Address Telephone

Date Started Starting Wage Starting Position

Date Ended Ending Wage Ending Position

Name of Supervisor May We Contact? Yes No

Responsibilities

Reason for Leaving

References

List three people not related to you who are sufficiently familiar with your work qualifications.

Name	Address	Phone	Occupation	Yrs. Known


Name	Address	Phone	Occupation	Yrs. Known


Name	Address	Phone	Occupation	Yrs. Known


Name: *	Last	First	Middle

Address: *	Street	City	State	Zip

Home Phone:	(xxx) xxx-xxxx	Cell Phone:	(xxx) xxx-xxxx

Email Address: *

Are you at least 18 years of age? *				Yes No

Are you at least 16 years of age? If hired, proof will be required. *				Yes No

Do you have transportation? *				Yes No

Are you legally eligible for employment in the United States? * Proof of citizenship or immigration status will be required.				Yes No


Type of Employment Desired: *		Full-Time Part-Time Seasonal

Date you can Start:	mm/dd/yyyy	Requested Salary:

Type of Position Desired (i.e. Camp Counselor, KEEP, Lifeguard, etc.): *

Have you ever been employed by us before? * Yes No

	Approx date(s):

	Position:

	Supervisor:

Do you have any special skills, qualifications, licenses, or certifications that would make you uniquely qualified for employment here?				Yes No

If yes, please list:

Have you ever been convicted of a felony? *Yes No

If yes, please explain. Conviction may not necessarily disqualify application from employment:

Type of Offense Date Occurred

Please state circumstances