This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage, to the extent permitted by law.

**Under Illinois law, for certain positions we are mandated to do a criminal background check. Passing it will be required for those positions before the final job offer.

EMPLOYMENT EXPERIENCE

APPLICANT STATEMENT

If hired, I agree to conform to the Agency’s rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either express or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the Agency’s option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at any time by the Agency. I understand that no Agency representative, other than its Executive Director, and then only when in writing and signed by the Executive Director, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using truthful and nondefamatory information, in lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

I also understand that, if I am hired I will be required to provide proof of identity and legal authorization to work in the United States as required by federal immigration laws.

This Agency does not tolerate unlawful discrimination or harassment based on sex, race color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal state or local law. No question on this application is used to limit or exclude an applicant from employment consideration on any basis prohibited by applicable, federal, state or local law.

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