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Who to Call?review our directory Frequently Asked Questions FAQget help with your questions City Resources - Phone numbers and links City Resourcesphone numbers and links Employment ApplicationSubmit your application - be sure to list the name of the position you are applying for on your application Employer Cost & Participation InformationFrom the Illinois Municipal Retirement Fund Macomb, IllinoisEmployment Application "*" indicates required fields City of Macomb Application for EmploymentWe consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.Application Date* MM slash DD slash YYYY What position are you applying for? Personal InformationApplicants Name* First Middle Last Have you ever been known by or used any other name? If yes, what was that name? Present Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Prior Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Residency dates (from - to) Prior Address (continued) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Residency dates (from - to) Do you have a valid driver’s license? yes no Have you received a high school diploma or GED? yes no Have you ever applied with the City before? yes no If yes, what position? Are you currently employed? yes no If employed, may we inquire with your employer? yes no Are you currently on “lay-off” status and subject to recall? yes no Are you at least 18 years of age? yes no Are you legally eligible to work in the United States? yes no (Proof of citizenship will be required upon employment.)Military ServiceBranch From - to Discharge Date Duties Preformed EMPLOYMENT EXPERIENCE Please list your last four employers, starting with the most recent.Employer Phone Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Job Title Supervisor Work Preformed Reason for Leaving Employer PhoneStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Title Supervisor Work Preformed Reason for Leaving Employer PhoneStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Title SupervisorWork Preformed Reason for Leaving Employer PhoneStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Title Supervisor Work Preformed Reason for Leaving SPECIAL SKILLS AND QUALIFICATIONS Summarize job-related skills & qualifications from employment or other experience.PROFESSIONAL REFERENCES List three persons not related to you, whom you have known professionally for at least one year.Name First Last PhoneBusiness Years Known Relationship Name First Last PhoneBusiness Years Known Relationship Name First Last PhoneBusinessYears KnownRelationshipEducationHigh School / GED Did you Graduate? yes no Major/ Minor Subjects Studied College Did you Graduate? yes no Major/ Minor Subjects Studied College Did you Graduate? yes no Major/ Minor Subjects Studied Other Training Did you Graduate? yes no Major/ Minor Subjects Studied Are you an IMRF retiree? yes no If you are an IMRF retiree, it is suggested you review General Memo 688 and the return-to-work rules for IMRF retirees. Your retirement status will have no effect on this application.Your RightsPlease note that the information provided regarding your driving history and driving-related employment will be investigated to determine your safety performance history, in accordance with our prioritized emphasis on safety as well as the Department of Transportation requirements listed in paragraphs (b) through (i) of 49 CFR part 40.25. Your previous employer(s) will be contacted. If any of your Department of Transportation-regulated employment was within the past 3 years, you have the following rights regarding the investigative information that will be provided to us by your previous employer(s): • The right to review the information provided by your previous employer(s); • The right to have errors in the information corrected by the previous employer(s) and for the previous employer(s) to re-send the corrected information to us; • The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and you cannot agree on the accuracy of the information. If any of your Department of Transportation-regulated employment was within the past 3 years, and if you wish to review previous employer-provided investigative information, you must submit a written request to us. This may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. We must provide this information to you within five (5) business days of receiving your written request. If we have not yet received the requested information from your previous employer(s), then the five-business days deadline will begin when we receive the requested safety performance history information. If you have not arranged to pick up or receive the requested records within thirty (30) days of the date when we make them available, we may consider that you have waived your request to review the records. Your CertificationApplicant Signature*This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.Date* MM slash DD slash YYYY PLEASE SUBMIT COMPLETED APPLICATION TO: employment@cityofmacomb.comRelease FormIn connection with my application for employment with the City of Macomb, I understand and agree that investigative inquiries are to be made on myself which may include, but not limited to: consumer credit, criminal convictions, motor vehicle history, educational transcripts, and other reports of any nature and type, including information in the public domain. These reports will include information as to my character, work, habits, performance, and experience together with reasons for termination of past employment. I understand and agree that the City of Macomb may request information from various federal, state, and other agencies that maintain records concerning my past activities related to my driving, credit, criminal, education, and other experiences. I authorize without reservations all corporations, companies, municipalities, credit agencies, persons, educational institutions, law enforcement agencies, and former employers to release information they may have about me, and release them from any liability and responsibility for doing so. This authorization, in original copy, or facsimile form, shall be valid for this and any future reports that may be requested. I hereby authorize investigation of all statements made by me with no liability arising there from. Name* First Last Date* MM slash DD slash YYYY Signature*I, the undersigned, affirm that the information given by me on this application is true and correct and I hereby acknowledge that falsification of any part of this application may result in denial of employment or discharge after employment. I understand a physical examination and drug screen may be required prior to beginning employment and that I may be required to undergo drug testing if deemed necessary by supervisory personnel. I also understand that upon commencing employment, I will be required to maintain permanent residence within the boundary lines of McDonough County, Illinois. Social Security Number* CAPTCHAData SummaryThe City of Macomb compiles summary data from its applicants regarding characteristics related to equal employment opportunity. For the purpose of statistical analysis only, we are requesting that you complete and return this form. This is voluntary information, if provided, will neither enhance nor detract from your opportunity for employment. Return of this form is optional. Thank you.Position applied for Department Name First Last Sex Male Female Other Citizenship Native USA Naturalized Non-USA Citizen EEO Class American Indian/ Alaskan Native Black White Asian or Pacific Islander Hispanic Other Are you a veteran? Yes No Advertisement Score? Publication Name Applicant Signature*Date* MM slash DD slash YYYY City of Macomb Business Office 309-836-8218 | Po Box 377 Macomb IL 61455 | employment@cityofmacomb.comCommentsThis field is for validation purposes and should be left unchanged. Employment ApplicationSubmit your application - be sure to list the name of the position you are applying for on your application Employer Cost & Participation InformationFrom the Illinois Municipal Retirement Fund
