Employment Application
“Be a Part of History at Starved Rock Lodge”
PO Box 570 Utica, IL 61373 Fax: (815) 220-7345
Personal DataName: Last / First / Middle
Telephone Number / Alternate Phone Number / How did you hear about us?
Street Address
City, State, Zip
Have you ever been employed at Starved Rock Lodge: If yes, dates and position held:
YES
NO
Within the past five years, have you ever been convicted of a crime other than a minor traffic violation? If yes, please list nature and disposition of conviction:(Conviction of a crime will not automatically disqualify you from employment)
YES
NO
Are you a Citizen of the United States or have a legal right to work in the US?
(Offer of employment is condition upon completing form I-9 & providing documents establishing identity & work authorization)
YES
NO
Are you 21 years or older? If no, please supply your date of birth:
YES
NO
Positions Applying for
1st Choice / 2nd Choice / 3rd Choice
Availability
Date Available / Wage Expectation / Type of employment applying for (FT, PT or seasonal)
Available Hours
Day / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Starting Time
Ending Time
Education
School / Name and Location / # of Years completed / Graduate?
Yes or No / Major
High School
GED
Business/Trade/Technical
College
Graduate
Other Accomplishments
Please list any other job-related accomplishments, professional distinctions, certificates, or verifiable volunteer work
Professional References
Name / Company / Telephone Number / Email Address
Employment History: (Enter most recent position first)
Company Name / Telephone
Address / Name of Supervisor
State job title and describe duties and responsibilities
Reason for Leaving:
Dates Employed / Hourly Pay / May we contact this employer?
From:______
To:______ / Starting:______
Ending:______ / YES
NO
Company Name / Telephone
Address / Name of Supervisor
State job title and describe duties and responsibilities
Reason for Leaving:
Dates Employed / Hourly Pay / May we contact this employer?
From:______
To:______ / Starting:______
Ending:______ / YES
NO
Company Name / Telephone
Address / Name of Supervisor
State job title and describe duties and responsibilities
Reason for Leaving:
Dates Employed / Hourly Pay / May we contact this employer?
From:______
To:______ / Starting:______
Ending:______ / YES
NO
I certify that any information that I have given above is true and correct to the best of my knowledge and understand that any misrepresentation or omission of information requested on this form and during the interview is ground for rejection of my application and reasonable justification for termination of employment with Starved Rock Lodge. I authorize any reference source to provide Starved Rock Lodge with any and all information concerning my previous records. Illinois law states that you are not obligated to disclose sealed or expunged records of conviction or arrest, not if they exist. I understand that any offer of employment is contingent on successful completion of a pre-employment drug test and the completion of a Criminal Conviction background check. Inconsideration of my employment, I agree to conform to all policies, procedures, rules, and regulations of Starved Rock Lodge.
Signature of Applicant / DateStarved Rock Lodge is an equal opportunity employer. Starved Rock Lodge does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state, or federal law.