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Employment Form

View our printable employment application form here. Or, you may submit your application online, below. If you have any questions about this application, please contact our Talent Acquisition Department at 847-245-6142 or Careers@allendale4kids.org.

"*" indicates required fields

Step 1 of 3

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Positions Applied For*

Type of Employment Desired*

Referral Source*

Name of source, if applicable

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Home phone number*

If necessary, the best time to call you at home is?

May we contact you at work?*

Yes

Work phone number

If necessary, the best time to call you at work is?

Email*

Enter Email Confirm Email

If you are under 18, can you furnish a work permit?*

Yes

Have you ever filed an application here before?*

Yes

If yes, give date

MM slash DD slash YYYY

Have you ever been employed here before?*

Yes

If yes, give dates

Driver's License Number*

Driver's License State*

Are you legally eligible for employment in this country?*

Yes

(Proof of identity and legal work authorization will be required upon employment.)

Date available for work*

MM slash DD slash YYYY

Are you on a lay-off and subject to recall?*

Yes

Would you travel if job requires it?*

Yes

Are there any restrictions on the days or hours that you are available to work?*

Yes

Will you work overtime, if required?*

Yes

Will you undergo a post-offer, pre-employment physical?*

Yes

(Under Illinois law, for certain positions we are mandated to do a criminal background check. Passing it will be required for those positions before a final job offer.)

List your last four (4) employers, assignments or volunteer activities, starting with most recent, including military experience. Explain any gaps in employment in comments section below.

Employment History 1*

Employer

Address

Phone

Dates Employed

Job Title

Immediate Supervisor & Title

May we contact for reference?*

Yes

Later

Summarize the nature of the work performed and responsibilities.*

Reason for leaving?*

Employment History 2

Employer

Address

Phone

Dates Employed

Job Title

Immediate Supervisor & Title

May we contact for reference?

Yes

Later

Summarize the nature of the work performed and responsibilities.

Reason for leaving?

Employment History 3

Employer

Address

Phone

Dates Employed

Job Title

Immediate Supervisor & Title

May we contact for reference?

Yes

Later

Summarize the nature of the work performed and responsibilities.

Reason for leaving?

Employment History 4

Employer

Address

Phone

Dates Employed

Job Title

Immediate Supervisor & Title

May we contact for reference?

Yes

Later

Summarize the nature of the work performed and responsibilities.

Reason for Leaving?

Comments*

Include explanation of any gaps in employment. If none, enter N/A (not applicable).

Skills and Qualifications*

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our agency. If none, enter N/A (not applicable).

List last (3) schools attended, starting with the last one. List number of years completed. List major and minor field of study (if applicable). Indicate degree or diploma earned, if any.

Education (enter most recent first)*

School

Number of Years Completed

Major/Minor

Degree/Diploma

Click the plus (+) button at the end of the row to add more Education.

List three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

References*

Name

Address

Relationship

Phone

Years Known

Click on the plus (+) button at the end of the row to add another reference. Please include 3 references.

List Licenses and/or Certifications that may qualify you as being able to perform job-related functions in the position for which you are applying. If none, enter N/A (not applicable).

Licenses/Certifications*

Name of License/Certification

Expiration/Renewal Date

Click on the plus (+) button at the end of the row to add more Licenses/Certifications.

Accomplishments/Publications/Awards*

List special accomplishments, publications, awards. If none, enter N/A (not applicable). (Exclude information which would reveal sex, race, national origin, age, ancestry, handicap or other protested status.)

Additional Information*

List any additional information you would like us to consider. If none, enter N/A (not applicable).

Upload your resume and cover letter

Drop files here or

Max. file size: 512 MB.

Employment Acknowledgement Waiver

It is understood and agreed that a misrepresentation by me in this application will be sufficient cause for cancellation of the application and/or separation from the employer’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I give the Employer the right to investigate all references and to secure additional information about me, if job related to verify the accuracy of the information contained in the application, resume and/or other information submitted by me for the Employer’s consideration. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. The Employer is an equal opportunity employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant’s consideration for employment on a basis prohibited by local, state or federal law. I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions. I agree*

Yes

Name:*

Date*

MM slash DD slash YYYY

Voluntary Self-Identification Affirmative Action Program Applicant Information Form

The Allendale Association is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as a disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose: (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please complete the information requested below. Thank you for your cooperation.

Name

Position Applied For

Race or Ethnic Identity

Hispanic or Latino

White (not Hispanic or Latino)

Black or African American (not Hispanic or Latino)

Made of Hawaiian or Pacific Islander (not Hispanic or Latino)

Asian (not Hispanic or Latino)

American Indian or Alaskan Native (not Hispanic or Latino)

Two or More Races (not Hispanic or Latino)

Please check all that apply. (See link below for descriptions.)

Gender

Male

Female

Veteran Status

Vietnam Era Veteran

Special Disabled Veteran

Other Eligible Veteran

(Please see link below for descriptions.)

Check here if you do not wish to Self-Identify

I do NOT wish to Self-Identify

View our Self-Identification Category Descriptions

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In This Section...

Careers
Open Positions
Employee Benefits
Why Work at Allendale
Employment Form

Programs & Services

About

Ways to Support

Employment Form

Employment Acknowledgement Waiver

Voluntary Self-Identification Affirmative Action Program Applicant Information Form

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