EMPLOYMENT OBJECTIVES - AVAILABILITY
SHIFT OR HOURS YOU CAN WORK:
NAME AND LOCATION OF SCHOOL
COURSE OF STUDY
NO. OF YEARS COMPLETED
DID YOU GRADUATE?
DEGREE OR DIPLOMA
College DID YOU GRADUATE?
PROFESSIONAL LICENSES AND/OR CERTIFICATIONS
Please give accurate, complete full-time and part-time employment record. Start with present or most recent employer.
We may contact the employers listed above unless you indicate those you do not want us to contact.
List at least three professional/work references who are not relatives:
PLEASE COMPLETE THIS PAGE
Are you over the age of 18?
Are you legally eligible for employment in the United States?
Other than for minor traffic violations, have you ever been convicted of a crime, pleaded guilty or “no contest” to a criminal charge, or entered into an agreement setting forth conditions for the eventual dismissal of a criminal case? If “yes” please describe below, using more space if necessary.
Note: you are not required to disclose sealed or expunged records of conviction.
Has there ever been a substantiated determination of abuse and/or neglect of a child and/or adult made against you?
Have you ever lived or worked in a state other than Illinois?
If so, when and where
Have you applied for any benefit, or enrolled in any program, with the Illinois Department of Employment Security, or similar agency, within the past twelve months?
Are you currently an active participant?
Are you eligible to receive a Weekly Benefit Amount (WBA) from the Illinois Department of Employment Security, or similar agency?
Are you presently receiving a WBA?
Please complete this section as it applies to the position for which you are applying.
Position that involves work with children:
Are you over the age of 21?
Position in which driving is considered a primary aspect of the job description:
Do you possess a valid Illinois Drivers License?
Has your driver's license been suspended or revoked during the past three years?
The answers given by me to all of the questions on this application are, to the best of my knowledge and belief, true and correct. I have not knowingly withheld any facts or circumstances that would adversely affect my position. I understand that any misrepresentation of facts may result in my discharge. I also understand that I will be required to successfully pass various background checks and/or medical examinations based on the requirements of the position for which I am applying. This agreement does not bind either party for any specific period regarding employment, and I recognize that employment at TCRC, Inc. is at will and can be terminated with or without cause by either the employee or TCRC unless there exists a specific written Agreement to the contrary.
I further agree to work a shift or shifts other than the one to which I will be assigned at the time of employment, if it becomes necessary for the efficiency of TCRC.