Form Cms100 - Examining/employment Application - Illinois Department Of Central Management Services

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EXAMINING/EMPLOYMENT
EXAMINING/EMPLOYMENT
EXAMINING/EMPLOYMENT APPLICA
APPLICA
APPLICATION (CMS100)
APPLICA
TION (CMS100)
TION (CMS100)
TION (CMS100)
EXAMINING/EMPLOYMENT
EXAMINING/EMPLOYMENT
APPLICA
TION (CMS100)
CMS administers civil service testing for agencies under the jurisdiction of the Governor; however, actual employment decisions are made by
the hiring agencies. Pencil or fax copies of applications will not be accepted. Legible photocopies are accepted.
PLEASE PRINT LEGIBLY OR TYPE INFORMATION.
1. POSITION TITLE
1. POSITION TITLE
1. POSITION TITLE
OPTION
OPTION
OPTION
LEA
LEA
LEAVE BLANK
VE BLANK
VE BLANK
VE BLANK
1. POSITION TITLE
1. POSITION TITLE
OPTION
OPTION
LEA
LEA
VE BLANK
2. LAST NAME
2. LAST NAME
2. LAST NAME
2. LAST NAME
2. LAST NAME
FIRST NAME
FIRST NAME
FIRST NAME
FIRST NAME
FIRST NAME
MI
MI
MI
MI
MI
3. SOCIAL SECURITY NUMBER
3. SOCIAL SECURITY NUMBER
3. SOCIAL SECURITY NUMBER
3. SOCIAL SECURITY NUMBER
3. SOCIAL SECURITY NUMBER
STREET ADDRESS
STREET ADDRESS
STREET ADDRESS
STREET ADDRESS
STREET ADDRESS
COUNTY
COUNTY
COUNTY
COUNTY
COUNTY
4. BIR
4. BIR
4. BIR
4. BIR
4. BIRTHDA
THDA
THDA
THDA
THDATE (OPTIONAL)
TE (OPTIONAL)
TE (OPTIONAL)
TE (OPTIONAL)
TE (OPTIONAL)
CITY
CITY
ST
STA A A A A TE
ST
TE
TE
ZIP
ZIP
CODE
CODE
5. HOME
5. HOME
TELEPHONE
TELEPHONE
WORK TELEPHONE
WORK TELEPHONE
CITY
CITY
CITY
ST
ST
TE
TE
ZIP
ZIP
ZIP CODE
CODE
CODE
5. HOME
5. HOME
5. HOME TELEPHONE
TELEPHONE
TELEPHONE
WORK TELEPHONE
WORK TELEPHONE
WORK TELEPHONE
(
(
)
)
(
(
)
)
(
(
(
)
)
)
(
(
(
)
)
)
6. DRIVERS LICENSE NUMBER
6. DRIVERS LICENSE NUMBER
6. DRIVERS LICENSE NUMBER
ST
ST
STA A A A A TE
TE
TE
TE
MO/YR ISSUED
MO/YR ISSUED
MO/YR ISSUED
CURRENT
CURRENT
CURRENT
REST
REST
REST
NON-CDL
NON-CDL
NON-CDL
CDL
CDL
CDL
ENDR
ENDR
ENDR
6. DRIVERS LICENSE NUMBER
6. DRIVERS LICENSE NUMBER
ST
ST
TE
MO/YR ISSUED
MO/YR ISSUED
CURRENT
CURRENT
REST
REST
NON-CDL
NON-CDL
CDL
CDL
ENDR
ENDR
/ / / / /
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
A B C D L M
A B C D L M
A B C D L M
A B C D L M
A B C D L M
A B
A B
A B
A B
A B
X N
X N
X N
X N
X N
7. COUNTY CHOICE
7. COUNTY CHOICE
7. COUNTY CHOICE
7. COUNTY CHOICE
7. COUNTY CHOICE
COUNTY
COUNTY
COUNTY
COUNTY
COUNTY
COOK/ZONE
COOK/ZONE
COOK/ZONE
COOK/ZONE
COOK/ZONE
LEA
LEA
LEA
LEA
LEAVE BLANK
VE BLANK
VE BLANK
VE BLANK
VE BLANK
COUNTY
COUNTY
COUNTY
COUNTY
COUNTY
COOK/ZONE
COOK/ZONE
COOK/ZONE
COOK/ZONE
COOK/ZONE
LEA
LEA
LEA
LEA
LEAVE BLANK
VE BLANK
VE BLANK
VE BLANK
VE BLANK
(Select one or two)
8. 8. 8. 8. 8. A A A A A V V V V V AILABILITY
AILABILITY
AILABILITY
A.
Available for permanent employment;
B.
Available for permanent employment;
C.
Available for temporary
AILABILITY
AILABILITY
(Check one)
will not accept temporary employment.
will accept temporary employment.
employment only.
(Trainee titles must choose A.)
9. If your answer to any of the following questions is “yes” please attach a signed detailed explanation.
9. If your answer to any of the following questions is “yes” please attach a signed detailed explanation.
9. If your answer to any of the following questions is “yes” please attach a signed detailed explanation.
LEA
LEA
LEAVE BLANK
VE BLANK
VE BLANK
VE BLANK
9. If your answer to any of the following questions is “yes” please attach a signed detailed explanation.
9. If your answer to any of the following questions is “yes” please attach a signed detailed explanation.
LEA
LEA
VE BLANK
1. Have you ever been fired from a job? (Downsize/layoff is not applicable.)
YES
NO
2. Have you ever pled guilty to or been convicted of any criminal offense other than
YES
NO
a minor traffic violation?
3. Are you currently in default on the repayment of any state educational loan?
YES
NO
State law provides that any employee who is in default on the repayment of any education loan for a period of six months or more
and in the amount of $600 or more shall, as a condition of employment, make a satisfactory loan repayment arrangement with
the maker or guarantor of the loan.
10.
10.
10.
10.
10. VETERANS PREFERENCE: For
VETERANS PREFERENCE: For
VETERANS PREFERENCE: For
VETERANS PREFERENCE: For
VETERANS PREFERENCE: For assistance contact
assistance contact
assistance contact
assistance contact
assistance contact V V V V V eterans Outr
eterans Outr
eterans Outr
eterans Outr
eterans Outreach at 1-800-643-8138 or
each at 1-800-643-8138 or
each at 1-800-643-8138 or
each at 1-800-643-8138 or
each at 1-800-643-8138 or Illinois Relay Center
Illinois Relay Center
Illinois Relay Center
Illinois Relay Center
Illinois Relay Center
at 1-800-526-0844 (TDD/TTY only).
at 1-800-526-0844 (TDD/TTY only).
at 1-800-526-0844 (TDD/TTY only).
at 1-800-526-0844 (TDD/TTY only).
at 1-800-526-0844 (TDD/TTY only).
I wish to claim Veterans Preference; attached is the most recent certified copy of my DD214/215. (If claiming service-connected
service-connected
service-connected
service-connected
service-connected
, also include a copy of U.S. Veterans Affairs award letter.)
disability
disability
disability
disability
disability, also include a copy
, also include a copy
, also include a copy
, also include a copy
I wish to claim Veterans Preference as an IL
IL IL
IL IL National Guard/Reservist. Attached is a letter from my unit personnel indicating I am
currently serving under honorable
honorable
honorable
honorable conditions or a copy of my NGB22 stating my discharge was under honorable
honorable
honorable
honorable
honorable
honorable conditions.
LEA
LEA
VE BLANK
VE BLANK
LEA
LEA
LEAVE BLANK
VE BLANK
VE BLANK
I wish to claim Veterans Preference as a surviving unremarried spouse or one parent of an unmarried veteran who suffered a service-
connected death or disability that prevents the veteran from qualifying for civil service employment.
I have submitted required military documentation to CMS after Januar
y 01, 2000 and have already established Veterans
Januar
Januar
Januar
January 01, 2000
y 01, 2000
y 01, 2000
y 01, 2000
Preference with CMS.
1 1 1 1 1
1. HIGH SCHOOL
1. HIGH SCHOOL
1. HIGH SCHOOL
1. HIGH SCHOOL
1. HIGH SCHOOL GRADUA
GRADUA
GRADUA
GRADUA
GRADUATE
TE
TE
TE
TE
YES
NO
NUMBER OF YRS COMPLETED
GED
YES
NO
0
1
2
3
4
12. BUSINESS, TRADE, CORRESPONDENCE
12. BUSINESS, TRADE, CORRESPONDENCE
12. BUSINESS, TRADE, CORRESPONDENCE
12. BUSINESS, TRADE, CORRESPONDENCE
12. BUSINESS, TRADE, CORRESPONDENCE
FROM
FROM
FROM
FROM
FROM
TO
TO
TO
TO
TO
TIME
TIME
TIME
TIME
TIME
SUBJECTS
SUBJECTS
SUBJECTS
SUBJECTS
SUBJECTS
COURSE
COURSE
COURSE
COURSE
COURSE
COMPLETED
COMPLETED
COMPLETED
COMPLETED
COMPLETED
SCHOOL: NAME AND ADDRESS
SCHOOL: NAME AND ADDRESS
SCHOOL: NAME AND ADDRESS
SCHOOL: NAME AND ADDRESS
SCHOOL: NAME AND ADDRESS
MO
YR
MO YR FULL PART
LENGTH
LENGTH
YES
NO
LENGTH
LENGTH
LENGTH
13. TECHNICAL/PROFESSIONAL LICENSE
13. TECHNICAL/PROFESSIONAL LICENSE
13. TECHNICAL/PROFESSIONAL LICENSE
NUMBER
NUMBER
NUMBER
ST
ST
STA A A A A TE ISSUED
TE ISSUED
TE ISSUED
TE ISSUED
DA
DA
DATE ISSUED EXPIRA
TE ISSUED EXPIRA
TE ISSUED EXPIRA
TE ISSUED EXPIRATION DA
TION DA
TION DA
TION DATE
TE
TE
TE
13. TECHNICAL/PROFESSIONAL LICENSE
13. TECHNICAL/PROFESSIONAL LICENSE
NUMBER
NUMBER
ST
ST
TE ISSUED
DA
DA
TE ISSUED EXPIRA
TION DA
TE
MO
YR
MO
YR
FOR CMS USE ONLY
EXAM DATE
TEST CENTER
CMS 100 (rev. 5/00)
IL 401-0090
Printed on Recycled Paper
MONTH
DAY
YEAR

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