Copper Fire Application for Employment Important Legal Notice: We are an equal opportunity employer. An employer may not use any information provided by a job applicant in a way which results in illegal discrimination against the job applicant under applicable federal, state, or local law. For example, an employer may be subject to legal liability for denying a job opportunity to an applicant on the basis of information provided by the applicant regarding his or her educational background unless the information is reasonably related to the applicant’s ability to perform the job or there is an otherwise legitimate business reason. Personal Information: First Name (Required): Last Name (Required): Middle Name: Your Email (Required): Address, City, State and Zipcode. (Required) Phone Number: Are you legally authorized to work in the US?: YesNo Position Desired: What position are you applying for? (Required): Salary/Wages Expected? (Required) Date you can start: (Required) Are you employed now?: YesNo Can we question your present employer: YesNo Have you ever applied to this company before?: YesNo Where did you apply before? When did you apply before? Important Notice To Applicants: Under Illinois law, job applicants are not obligated to disclose sealed or expunged records of conviction or arrest or expunged juvenile records of conviction or arrest. Employment History Employer 1 Employer #1 : Supervisor: Employer's Address : Job Title / Description of Duties: Employer 2 Employer #2: Supervisor: Employer's Address: Job Title / Description of Duties: Employer 3 Employer #3: Supervisor: Your Title: Employer's Address: Job Title / Description of Duties: Employer 4 Employer #4: Supervisor: Your Title: Employer's Address: Job Title / Description of Duties: Education School #1 School #1 Name: Location: Course/Degree: School #2 School #2 Name: Location: Course/Degree: School #3 School #3 Name: Location: Course/Degree: Training or Special Study Describe your training or special study areas: References Reference 1 Reference #1: Reference #1 Phone: Reference #1 Address: Reference #1 Occupation: Reference #1 Years Known: Reference 2 Reference #2: Reference #2 Phone: Reference #2 Address: Reference #2 Occupation: Reference #2 Years Known: Reference 3 Reference #3: Reference #3 Phone: Reference #3 Address: Reference #3 Occupation: Reference #3 Years Known: BY SUBMITTING THIS APPLICATION 67I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT. All Information provided on this form by the job applicant or employer is provided voluntarily. The Illinois Department of Employment Security (“IDES”) does not investigate or validate this information, nor does IDES assume any legal liability or responsibility as to the accuracy, currency, quality or validity of this information, nor does IDES make any warranties or guarantees, express or implied, with respect to this information. By using this form, job applicants and employers agree to hold IDES and its officers, employees and agents harmless from any cause of action which might arise as a result of the job applicant’s or employer’s use of this form. Job applicants and employers assume the risk of use of, and reliance on information provided through, this form. Neither IDES nor its officers, employees or agents shall be liable under any theory, legal or equitable, for any claims or damages related to a job applicant’s or employer’s use of this form.