VILLAGE OF SKOKIE
APPLICATION FOR SUMMER EMPLOYMENT

NAME:
LAST FIRST MIDDLE

HOME
ADDRESS:

NUMBER AND STREET CITY STATE ZIP CODE

HOME PHONE: (_) CELL PHONE: (_)

EMAIL ADDRESS:

WHEN WILL YOU BE AVAILABLE FOR EMPLOYMENT? FROM (mo/day) THRU (mo/day)

PER VILLAGE POLICY APPLICANTS MUST BE AT LEAST 18 YEARS OF AGE.

Are you 18 years of age or older? D Yes No

Have you previously been employed by the Village ofSkokie: D Yes D No

If yes, list dates and departments):

Are you a citizen or an alien authorized by the U.S. Citizenship and Immigration Services to work in the United
States? D Yes D No

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

(Such conviction will not automatically bar you from employment.)

If yes, please explain:

The majority of summer positions require some drivmg. Please provide the following:

Driver's Licensed State Expu'ation

183233

• AN EQUAL OPPORTUNITY EMPLOYER

EDUCATIONAL RECORD

School Name and Address Course of Last Year Did You Diploma or
Study Completed Graduate? Degree

High School 1234 Yes

No

College 1234 Yes

No

Graduate Work 1 234 Yes

No

Other 1234 Yes
(Specify)

No

BELOW IS A BRIEF DESCRIPTION OF THE SUMMER EMPLOYMENT OPPORTUNITIES.
PLEASE CHECK THE DEPARTMENT(S) WHERE YOU ARE INTERESTED IN WORKING.

PUBLIC WORKS
Job duties may include: Assisting on refuse trucks collecting garbage, litter control, landscape maintenance, tree
trimming and removal, asphalt streets maintenance, weed control, installing temporary street sweeping signs,

building maintenance projects, reading water meters, inlet cleanmg, dead animal removal/pickup, catch basin

cleaning, sewer cleaning, traffic counts, painting curbs and sign posts, washing street lamp refractors, re-lamping

street lights, installation of traffic signs, trimming hedges that cause obstructions, taking measurements for quantities,
and other work-related tasks as assigned.

FIRE
Job duties may include: Checking fire hydrant operations, performing required flushing, related computer data entry,
and other work-related tasks as assigned.

ENVIRONMENTAL HEALTH
Job duties may include: Community outreach & education aimed at reducing rat populations and re-infestatlon,

installing and maintammg signage notifying residents of rat activity, etc., assist with issuing warning notices, and

other work-related tasks as assigned.

FINANCE
Job duties may include: Sellmg vehicle stickers and pet licenses, accepting payments for parking tickets and water
bills, and other work-related tasks as assigned.

OTHER
Employment opportunities maybe available in Departments or Divisions not listed above, including Community
Development, Public Health, and Engineering. Job duties will vary, based on the needs of the Department or
Division.

183233

Please list any work experience that may be relevant to the position that you are applying for (e.g., outdoor work, office work, etc.)

EMPLOYMENT HISTORY

With most recent job first, list alt jobs you have previously held. Attach a second sheet if necessary.

Employer: Dates Employed: From: To:

Address: Telephone:

City and State:
Job Title:
Work Performed:

Reason for Leaving:

Supervisor/Title: May we contact?

Employer: Dates Employed: From: To:

Address: Telephone:
City and State:
Job Title:
Work Performed:

Reason for Leaving:

Super visor/Title. May we contact?

Employer: Dates Employed: From: To:

Address: Telephone;
City and State:
Job Title:
Work Performed:

Reason for Leaving

Supervisor/Title: May we contact?

183233

Please explain any gaps/periods ofnon-employment:

183233

REFERENCES

List name and telephone number of at least three references excluding relatives and direct supervisors.

Name/ReIationship Telephone Years Known

IMPORTANT

PLEASE READ THE FOLLOWING CAREFULLY

I certify that all information provided by me on this Application is true and complete to the best of my
knowledge, and that I have not withheld any information that would, if disclosed, affect this application
unfavorably. I understand that if I have provided any false, misleading or incomplete information in this
application I may be denied employment or terminated from employment with the Village at any time,
including after any period of probation, regardless of when the Village discovers my false, misleading or
incomplete statement.

I specifically consent to the disclosure of information which may be covered by a settlement agreement or
other "conj&dentiality" provision entered into with my former employers, and I waive my rights to enforce
any such prior confidentiality agreement against my former employer with regard to this disclosure. I
agree to waive any claim or action in law or equity and release from any claim of liability by me
whatsoever, against the Village of Skokie, its officers, agents and employees and any of the persons or
entities listed by me on this application and their officers, agents and employees arising from the
investigation, verification, providing or use of information authorized or requested pursuant to my
application for employment with the Village.

I understand that I may be required as a condition of employment to submit to a pre-employment drug
and/or alcohol test, physical examination (depending on position sought) and/or a job-related abihty
test(s), and I hereby consent to such tests as may be required to make a decision on my employment. I
understand that this application is not, nor is it intended to be, a contract of employment. I understand
that unless specifically provided by written agreement authorized and signed at the direction of the
Village Board, my employment with the Village is at-will, meaning that either I or the Village can
terminate employment at any time for any reason. If hired, I agree to abide by all applicable Village rules
and regulations which are subject to modification by the Village.

I hereby acknowledge that I have read the above Certification and Authorization and fully understand it

prior to affixing my signature below.

Q By checking this box, it acts as my signature; I acknowledge aU the information contained herein is

true and accurate to the best of my knowledge.

NOTE: ALL APPLICANTS WILL BE REQUIRED TO PASS A POST OFFER DRUG SCREENING PRIOR TO
BEGINNING EMPLOYMENT.

(SIGNATURE OF APPLICANT) (DATE)