Non-Cdl Veterans Affairs
Resume:
PRINT OR TYPE ONLY
County of Residence
Work Co. or Cook Co. Zone Preference
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2.
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OFFICE USE
TEST MONITOR
OFFICE USE DRIVERʼS LICENSE n PHOTO ID n
State Issued: Class Rating — Non-CDL: Class Rating — CDL: Driverʼs License Number: Date Expires: MO DY YR
DEPARTMENT OF PERSONNEL USE ONLY
VETERANS POINTS AND PREFERENCE
This application is for permanent, intermittent or temporary employment only. Complete this application in detail. A separate application is required for each title that requires a training and experience evaluation; previous applications will not be reconsidered. Mail completed applications for training and experience testing to: Secretary of State, Department of Personnel, 196 Howlett, Springfield, IL 62756 or 17 N. State St., Ste. 1300, Chicago, IL 60602. Incomplete applications may be rejected. Bring a completed application and photo identification with each visit to a test site if this application is used for written/performance examinations.
I wish to claim Veterans Preference: Attach U.S. Veterans Affairs award letter or a legible copy of a certified DD214/215.
I wish to claim Veterans Preference as a member of the Illinois National Guard or U.S. Armed Forces Reserves: Attach letter from unit personnel indicating service under honorable conditions or a legible copy of a certified NGB 22.
I have already established Veterans Preference with the Office of the Secretary of State. To claim Veterans Preference as a surviving spouse or parent of an unmarried veteran who suffered service-connected death or disability, attach completed Spouse/Parent Eligibility for Veterans Preference form. Title of Position Applied For I will accept: Intermittent n Temporary n Social Security Number Date of Birth (optional)
Last Name First Name M.I.
Street Address
City State ZIP Code
Primary Telephone Number Alternate Telephone Number EMAIL
Driverʼs License
APPLICATIONS WILL NOT BE ACCEPTED UNLESS ALL QUESTIONS ARE ANSWERED AND REQUIRED ATTACHMENTS ARE SUBMITTED
If your answer to question 1 is “YES,” please provide an explanation of the circumstances in the space provided. 1. Have you ever been discharged from a job? Layoff/downsizing does not apply. YES NO Explanation: 2. Are you currently in default on repayment of any state education loan?* YES NO 3. Is any member of your family employed by the Office of the Secretary of State?** YES NO
(If “YES,” Name of Employee Dept. Relationship )
* State law requires an employee in default on repayment of any education loan for 6 months or more and in the amount of $600 or more shall, as a condition of employment, make satisfactory repayment arrangements with the maker or guarantor of the loan. Educational Loan Default Act, 5 ILCS 385/2(b).
** Family Member includes a person who has established a party to a civil union or parties to a marriage pursuant to the law. Office of the Secretary of State
Department of Personnel
Employment Application
Written Signature of Applicant (signature required) Date THE OFFICE OF THE SECRETARY OF STATE IS AN EQUAL OPPORTUNITY EMPLOYER. Printed by authority of the State of Illinois. April 2023 — 1 — Per D 81.24-web
I understand that I may be required to submit proof of previous employment, education or any other statement(s) in this application. I hereby authorize the release of this and associated information covering job-related factors for purposes of verification and determination of suitability for state employment by means of a background check. I affirm, under penalty of perjury, that the information on this application is true and accurate to the best of my knowledge. I understand that misrepresentation of any information herein may result in ineligibility, be grounds for discipline, up to and including discharge, as well as administrative, civil and/or criminal actions against me. Checking the box and typing my name will serve as my electronic signature. 2
SECTION I—Employment Information:
Child support obligations: State law requires that you provide certain information about child support obligations at the time of hire. The possibility of employment is not affected by a child support obligation or default in payment. Selective Service Registration: As a condition of employment, state law requires that “every male born on or after January 1, 1960, and less than 27 years old, shall submit documentation, at time of appointment, evidencing his registration with the Federal Selective Service System.”
Disclosure of Information: The Office of the Secretary of State requests disclosure of information that is necessary to accomplish the statutory purpose as outlined under 15 ILCS 310/10. Disclosure of this information is REQUIRED; failure to provide any information may result in rejection of this form. SECTION II—Experience Report:
Fully describe ALL of your work experience beginning with your present position. If you held several positions with one employer, list each position separately. Incomplete information may negatively affect your grade for examinations consisting of training and experience. Resumé format is not acceptable, but additional sheets may be attached. Additional sheets MUST include all information requested below. Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount -
3
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount -
4
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount -
5
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount
Failure to fully complete the following information will result in no credit given for this work experience. Name, Address and Phone Number of Employer: Payroll Title: If this position was supervisory, indicate number of employees supervised for each type: Manual/Trades Clerical/Office Technical/Paraprofessional Professional Administrative/Managerial Failure to fully complete the following information will result in no credit given for this work experience. Dates of Employment:
From: Mo Yr To: Mo Yr
Total: Years: Months: Average hours worked per week: Describe your duties and responsibilities. Be specific. Office Use Only
Reason for leaving: Level Amount
* Any additional employment descriptions must include all information requested. -
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EDUCATION:
Qual Approved Rejected
By Date
Entry Date:
Exam Date (MM/DD/YR) Center
EDUCATION
A
B
C
TOTAL
VET POINTS
FINAL GRADE
Remarks:
DEPARTMENT OF PERSONNEL USE ONLY
Title Code Written Keyboarding Vet Points Final Grade SECTION VI—Foreign Language:
I am proficient (speak, write and translate) in the following languages (do not include English): 1 2 3 4
Name, Address and Phone Hours Earned: Major: Minor: Dates Attended: Degree Earned: Number of College/University Sem Qtr Mo/Yr Mo/Yr Level Date: Mo/Yr Undergraduate:
/ / /
/ / /
/ / /
Graduate:
/ / /
Years Completed:
High School Graduate: YES NO OR GED: YES NO SECTION V—Education Report:
List college/university education accurately and completely. Proof of education claimed may be required during the hiring process. A copy of a certified transcript/degree MUST be submitted to obtain credit for educational achievement for training and experience evaluated titles.
Name, Address and Phone Number of From: To: Course Length: Subject(s) Certificate Business, Trade, Technical or other School Mo/Yr Mo/Yr Hours/Days/Weeks Earned
/ / / /
/ / / /
SECTION IV—Business, Trade, Technical or Other Coursework: List below coursework or classes taken that cannot be credited toward a college or university degree program. Failure to indicate course length may result in no credit given.
Type: Certification Number: Date Issued: Expiration Date: State Issued In: Mo Yr Mo Yr
Mo Yr Mo Yr
SECTION III—Professional/Technical Licensure or Certification:
Contact this candidate