Summer Employment Application Form - Illinois Department Of Agriculture - 2016 Page 2
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4* INCOMPLETE APPLICATIONS MAY NOT BE CONSIDERED FOR EMPLOYMENT.*
IN CASE OF EMERGENCY, NOTIFY
1.
Name
Address
Phone Relationship
2.
Name
Address
Phone Relationship
SECTION II - EXPERIENCE REPORT - If no experience, please indicate N/A.
List and describe your work experience. Begin with your present position and work backwards. Include title changes resulting in promotions. List pertinent military
experience. Omissions or misstatements of material facts may cause forfeiture of rights to employment
VOLUNTEER EXPERIENCE: Related volunteer experience for which no salary was received will be given the same credit as equivalent paid experience. List the actual
number of hours worked per week or month, and describe fully the duties performed so appropriate credit can be given.
PREVIOUS DEPARTMENT OF AGRICULTURE EMPLOYMENT MUST BE INCLUDED IN WORK HISTORY
CURRENTLY (OR LAST)
EMPLOYED BY: _______________________________________________ DATES OF EMPLOYMENT
FROM _______________ TO _______________
MO/YR
MO/YR
ADDRESS ____________________________________________________ TOTAL:
YEARS ____________ MONTHS _____________
_____________________________________________________________ HOURS WORKED PER WEEK ______________
PAYROLL TITLE: _______________________________________________ MONTHLY SALARY:
STARTING ______________ ENDING _____________
IF YOU HAD SUPERVISORY RESPONSIBILITY FOR ANY OF THE FOLLOWING ON A CONTINUING BASIS, INDICATE IN THE APPROPRIATE BOX THE NUMBER
OF EMPLOYEES INVOLVED.
MANUAL/TRADES
CLERICAL/TECHNICAL
PROFESSIONAL
ADMINISTRATIVE
LIST AND DESCRIBE YOUR DUTIES AND RESPONSIBILITIES:
LEAVE BLANK
Level ____________ Amount___________
REASON FOR LEAVING
EMPLOYED BY: _______________________________________________ DATES OF EMPLOYMENT
FROM _______________ TO _______________
MO/YR
MO/YR
ADDRESS ____________________________________________________ TOTAL:
YEARS ____________ MONTHS _____________
_____________________________________________________________ HOURS WORKED PER WEEK ______________
PAYROLL TITLE: _______________________________________________ MONTHLY SALARY:
STARTING ______________ ENDING _____________
IF YOU HAD SUPERVISORY RESPONSIBILITY FOR ANY OF THE FOLLOWING ON A CONTINUING BASIS, INDICATE IN THE APPROPRIATE BOX THE NUMBER
OF EMPLOYEES INVOLVED.
MANUAL/TRADES
CLERICAL/TECHNICAL
PROFESSIONAL
ADMINISTRATIVE
LIST AND DESCRIBE YOUR DUTIES AND RESPONSIBILITIES:
LEAVE BLANK
Level ____________ Amount ____________
REASON FOR LEAVING
Return completed application to:
Human Resource Offi ce
IL Department of Agriculture • State Fairgrounds, P. O. Box 19281 • Springfi eld, IL 62794-9281 • Phone: 217/785-5099 • Fax 217/557-5887
OR
DuQuoin State Fair • 655 Executive Drive • DuQuoin, IL 62832 • Phone: 618/542-1515 • Fax 618-542-1541
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