APPLICATION FOR EMPLOYMENT
Please Return To:
 
CITY OF BATAVIA
Human Resources
100 North Island Avenue
Batavia, IL 60510
Received
 
Date:
 
By:

We welcome you as an applicant for employment with the City. Your application will be considered with others in competition for the position in which you are interested. It is the policy and intent of the City of Batavia to provide equal opportunity in employment to all persons. This policy prohibits discrimination because of race, color, religion, national origin, political affiliation, gender, sexual orientation, age, marital status, veteran status, or physical or mental disability. This policy applies to all phases of full, part-time, temporary and seasonal employment.

All information contained in or connected with this application will be considered personal and confidential and used only in conjunction with your possible employment by the City of Batavia. Please furnish us with complete information as outlined in this application. You are encouraged to attach any additional information, which you believe qualifies you for the position for which you are applying. If you have any questions about the status of your application please call Human Resources at (630) 454-2070.

1. Name:  
   (Last)  (First)  (Middle)
2. Address:  
   (Street)  (City)(State)(ZIP)
  E-Mail:     
3. Type of work or title of job you are seeking:
4. Telephone Number:  
   (Days)  (Evenings)
5. Type of Employment Desired: Full Time    Part Time    Seasonal
6. Times Available: Days    Evenings    Nights    Weekends    Holidays
7. Presently Employed? Yes    No
   If yes, may we contact your employer? Yes    No
8. Do you possess a valid Illinois Drivers License? Yes    No
   If applicable, do you have a valid Illnois Commercial Drivers License? Yes    No
CDL Class:
9. Are you legally authorized to work in the United States? Yes    No
10. Have you ever been convicted of a felony? Yes    No
   If yes, please explain:
   
In answering this question, you are not obligated to disclose sealed, annulled or expunged convictions, or convictions that were pardoned by the Governor.
 
A criminal conviction will not necessarily be a bar to employment; rather, such information is only relevant in determining whether the conviction is directly related to the job for which you are applying. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. Failure to honestly answer these questions will result in discontinued consideration of the application or termination of employment.
11. Are you presently working for the City? Yes    No
   If yes, position:
12. Have you previously worked for the City? Yes    No
   If yes, position:    From:    To:
13. Do you have any relatives who work for the City? Yes    No
   Name:    Relationship:
   Name:    Relationship:
14. If hired, when will you be able to begin work?   
15. Military Service:   Branch:      From:    To:
   Duties:
16. Education and Training:
Please indicate the last three schools that you have attended:
School NameYears
Completed
Degree or
Diploma
GPA/Class RankCourse of Study
17. Employment Information:
Begin with your present employer and work back. Account for all time during the past ten years, including periods of unemployment. List any other work experience that may qualify you for this position.
Employer:
Address:
Supervisor:
Your Title:
Duties:
From Month / Year:
To Month / Year:
Total Years / Months:
Full Time    Part Time
Hours Per Week:
Last Salary:
Reason for Leaving:
Employer:
Address:
Supervisor:
Your Title:
Duties:
From Month / Year:
To Month / Year:
Total Years / Months:
Full Time    Part Time
Hours Per Week:
Last Salary:
Reason for Leaving:
Employer:
Address:
Supervisor:
Your Title:
Duties:
From Month / Year:
To Month / Year:
Total Years / Months:
Full Time    Part Time
Hours Per Week:
Last Salary:
Reason for Leaving:
18. Please list any job-related special qualifications, training, or experience which you have and feel should be considered in reviewing your application.
   
19. Emergency Contact: In case of emergency, please notify:
   Name:    Address:
   Phone:    Relationship:
20. Professional References: Please list the names of three supervisors/co-workers who you have known for at least one year:
NameAddressCity / StateTelephone
21. Referral Source: How did you hear about this job?
 
Please Read Carefully Before Signing: I certify that all the statements in this application are accurate to the best of my knowledge. I understand that any false statements on this application shall be considered sufficient cause for dismissal.
 
I authorize the City of Batavia to investigate any of the information contained herein, including the contacting of my references. I also authorize the Batavia Police Department to disclose and/or release any information on any conviction listed on file under my name and release the Batavia Police Department from any and all liability for damages for the furnishing of any information concerning me.
 
If I receive a conditional offer of employment from the City, I agree to submit to a physical examination, which includes a pre-employment drug test, which I will be required to pass before being finally accepted for employment.
 
I further agree to comply with all the rules and regulations of the City of Batavia now in force or any that may be established.
 
Applicant's Signature: (enter your full name)     Date:
 
Thank You for Applying

 I have read the statements above and fully understand and agree.
The application cannot be submitted unless this box is checked.