Name (Last, First, Middle)
Phone
Email (optional)
Address

I am (Check a Box) & will provide necessary documentation to validate that I am

Position(s) Applying For

Illinois Educator Identification Number (IEIN) (if applicable)

Have you ever worked for this ROE before?

If yes, when & where?

Date available to Start

Are you available to Work

List any days or hours you are unable to work

List Any Friends or Relatives working here

(Name and Relationship)

Please indicate your source of referral

Name(s)

United States Military Service

Do you have United States Military Experience?

Branch

Date Entered

Date Discharged

Rank at Time of Discharge

Special Skills or Training from Service

Present Military Status

Education & Training

Please list educational institutions (high school, technical schools, college) attended beginning with the most recent.

School 1

Name & Location of School

Number of Years Completed

Degree Earned/Major

School 2

Name & Location of School

Number of Years Completed

Degree Earned/Major

School 3

Name & Location of School

Number of Years Completed

Degree Earned/Major

Work Experience

List below your previous employers, starting with the most current one.

Employer 1

Name

Address

Position

Date - From

Date - To

Supervisor - Name and Title

Phone

Reason for Leaving

Employer 2

Name

Address

Position

Date - From

Date - To

Supervisor - Name and Title

Phone

Reason for Leaving

Employer 3

Name

Address

Position

Date - From

Date - To

Supervisor - Name and Title

Phone

Reason for Leaving

Are there any other places you have worked in addition to those listed above?

Additional Experience

Please list any additional experience

Professional References

Include three professional references who supervised your previous work (principals, supervisors, superintendents).

Reference 1

Name

Address, City, State

Position

Phone Number

Reference 2

Name

Address, City, State

Position

Phone Number

Reference 3

Name

Address, City, State

Position

Phone Number

THIS SECTION MUST BE COMPLTED AS PART OF THE APPLICATION PROCESS. PLEASE MAKE CERTAIN THAT YOU ANSWER ALL OF THE QUESTIONS TRUTHFULLY. OMISSION OR FALSIFICATION OF ANY CRIMINAL INFORMATION WILL BE GROUNDS FOR IMMEDIATE DISMISSAL.
Have you ever been convicted of an offense other than a minor traffic violation?

If YES, when, where, and disposition of the conviction:

Note: An applicant for employment is not obligated to disclose sealed or expunged records of conviction or arrest. You are also not obligated to disclose expunged juvenile records of adjudication or arrest.
Have you ever been convicted of, had adjudication withheld, pled no contest to, or entered a pretrial intervention program for a misdemeanor or felony criminal charge?

(IF YES, EXPLAIN ON SEPARATE SHEET)

Have you ever been the subject of an indicated report by DCFS or similar state agency?

(IF YES, EXPLAIN ON SEPARATE SHEET)

Have you ever been suspended without pay, or dismissed from employment, or resigned while an investigation was in progress for possible disciplinary action?

If YES, WHERE

and WHEN

By signing below, I understand that the information provided is true and correct, and that any misstatements or omission of material facts in the application or the hiring process may result in discontinuing of the hiring process or termination of employment, no matter when discovered. I agree that the ROE shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application.

I authorize the ROE to analyze the truthfulness of all statements made on this application, complete reference checks from my current and formers employers, and others that may provide information regarding my education and experiences. I also authorize a criminal background, sex offender, and other checks required by Federal and State government and the school code. I acknowledge that consideration for employment is contingent on the results of these background check(s). In addition, I give my consent for all contacted persons including current and former employers to provide information concerning this application, and I release each such person from liability for providing information to the ROE.

I hereby attest that all statements made by me above are true to the best of my knowledge, and I agree to the terms noted above.

Type your name below and click the box to acknowledge that you are submitting complete and accurate information. The checked box will count as your signature.

Date

Applicant Signature