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? Yes No
Have you previously been employed by the Village of Skokie: Yes No

If yes, list dates and department(s):

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

Have you ever been convicted of a felony? Yes No

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

If yes, please explain: __________________________________________________________________________________________

__________________________________________________________________________________________________

_____________________________________________________________________________________________________

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

Driver’s License # _____________________________________ State Expiration

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 1 2 3 4 Yes
No

College 1 2 3 4 Yes

No

Graduate Work 1 2 3 4 Yes

No

Other 1 2 3 4 Yes
(Specify)

No

BELOW IS A BRIEF DESCRIPTION OF THE SUMMER EMPLOYMENT OPPORTUNITIES.
PLEASE CHECK DEPARTMENT(S) THAT 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 cleaning, 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 tasks as assigned.

_____ FIRE
Job duties may include; checking fire hydrant operations, performing required flushing, related computer data entry

and other tasks as assigned.

_____ FINANCE
Job duties may include; selling vehicle stickers and pet licenses; accepting payments for parking tickets and water

bills.

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

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

183233

EMPLOYMENT HISTORY

With most recent job first, list all 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: ______________________________________________________________________________
Supervisor/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?________________
Please explain any gaps/periods of non-employment:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

183233

REFERENCES

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

Name/Relationship 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 “confidentiality” 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 ability
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.

• By checking this box it acts as my signature; I acknowledge all the information contained herein is