Cms 100 Application PDF Details

The CMS 100 Application form serves as a crucial step for individuals seeking employment or examination opportunities within agencies under the governor's jurisdiction in the State of Illinois. Managed by the Department of Central Management Services (CMS), this form facilitates the process of civil service testing, while the hiring decisions ultimately rest with the respective agencies. Applicants are advised to fill out the form with clear, legible handwriting or type their information to ensure accuracy and avoid application rejection. Essential details required include personal information, job preferences, availability for work, and any veterans' preference claim, with necessary documentation for verification. It is mandatory for applicants to acknowledge the accuracy of the information provided, with a reminder that misrepresentations may lead to disqualification or termination. Educational backgrounds, certification details, and a comprehensive work history must be supplied, highlighting the applicant's qualifications and experiences relevant to the position applied for. By completing the CMS 100, candidates take a vital step towards potential employment with the state, engaging in a process that demands transparency, accuracy, and a thorough presentation of one's professional qualifications and credentials.

QuestionAnswer
Form NameCms 100 Application
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namescms 100 application, cms 100 employment application rev 9 2020, illinois cms 100 application, illinois cms 100

Form Preview Example

EXAMINING/EMPLOYMENT APPLICATION
(CMS100)

STATE OF ILLINOIS

DEPARTMENT OF CENTRAL

MANAGEMENT SERVICES

CMS administers civil service testing for agencies under the jurisdiction of the Governor;

Mail completed application to:

 

 

 

 

 

 

however, actual employment decisions are made by the hiring agencies. Pencil copies of

CMS Bureau of Personnel

 

 

 

 

 

 

applications will not be accepted. Legible photocopies are accepted. Unsigned or

 

 

 

 

 

 

Examining and Counseling Division

incomplete applications will be returned.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stratton Office Building, Room 500

PLEASE PRINT LEGIBLY OR TYPE INFORMATION.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Springfield, Illinois 62706

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Position Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Option

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leave Blank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Last Name

 

 

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MI

 

3. SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Birthdate (Opt.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

State

Zip

 

 

 

 

 

5. Main Phone

 

 

 

 

 

 

 

 

 

 

Other Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Drivers License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

 

 

 

Month/Year Expires

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-CDL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CDL

 

 

 

 

 

 

 

 

ENDR

 

 

 

 

 

 

 

 

 

Restrictions

 

 

 

 

 

 

A

B

 

 

 

C

D

 

 

L

 

 

 

M

 

 

 

A

 

 

B

 

 

 

 

 

X

 

 

N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. County Choice

 

 

 

 

 

 

 

 

 

 

Cook

 

 

 

 

 

Leave Blank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cook

 

 

 

Leave Blank

1:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Select 1 or 2

 

 

 

 

 

 

 

 

Zone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Zone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

See the included Cook County Zoned Titles and Location Map

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. Availability

A. Available for permanent

 

 

B. Available for permanent

 

 

 

C. Available for temporary

 

 

 

 

 

 

employment; will not accept

 

 

employment; will accept

 

 

 

 

 

 

 

 

 

employment only.

 

 

 

 

 

 

(Check one)

temporary employment.

 

 

temporary employment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Trainee titles must choose A.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. VETERANS PREFERENCE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For assistance contact Veterans Outreach at 1-800-643-8138 or Illinois Relay Center at 1-800-526-0844 (TTY only).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I wish to claim Veterans Preference; attached is the most recent certified copy of my DD214/215. (If

 

 

 

 

 

 

Leave Blank

 

claiming service-connected disability, also include a copy of U.S. Veterans Affairs award letter.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I wish to claim Veterans Preference as an IL National Guard/Reservist. Attached is a letter from my

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

unit personnel indicating I am currently serving under honorable conditions or a copy of my NGB22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

stating my discharge was under honorable conditions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I wish to claim Veterans Preference as a surviving unremarried spouse or one parent of an

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

unmarried veteran who suffered a service-connected death or disability that prevents the veteran

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

from qualifying for civil service employment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have submitted required military documentation to CMS after January 01, 2000 and have already

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

established Veterans preference with CMS.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE SECTION

I understand that I may be required to submit proof of previous employment, education, military service or other statements in this application. I authorize release of this and other information covering job-related factors for the purpose of verification and determination of suitability for state employment. I state that I have not submitted an application for this written and/or performance examination within the last 30 days. I certify that all the information on this application is true and accurate and understand that misrepresentation of any material fact may be grounds for ineligibility or termination of employment.

Completing this application may result in your name being placed on an eligibility list. Names placed on an eligibility list may be released to the public without further notice to the applicant.

Written Signature Required

Date

For CMS Use Only

Exam Date

Month

Day

Year

 

 

 

Test Center

CMS100 (Rev 12/2013)

10.If your answer to either or both of the following questions is “yes”, please provide a detailed explanation of the circumstances in the space provided.

A. Have you ever been fired from a job? (Downsize/layoff is not applicable.)

Yes No

B. Are you currently in default on the repayment of any state educational loan?

Yes No

State law provides that any employee who is in default on the repayment of any education loan for a period of six months or more and in the amount of $600 or more shall, as a condition of employment, make a satisfactory loan repayment arrangement with the maker or guarantor of the loan.

11. HIGH SCHOOL

 

 

 

 

High School Graduate? Yes

No

Number of Years Completed

GED? Yes

No

12. BUSINESS, TRADE, CORRESPONDENCE SCHOOL

 

 

Business, Trade, Correspondence

School: Name and Address

From

MM/YYYY

To

MM/YYYY

Time

Full/Part

Subjects

Course Length

Completed

Yes/No

13. TECHNICAL/PROFESSIONAL LICENSE

Technical/Professional License

Number

State Issued

Date Issued

Expiration Date

MM/YYYY

MM/YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.EDUCATION REPORT: LIST YOUR EDUCATION ACCURATELY AND COMPLETELY. A copy of college transcripts/ degrees may be required. The number of credit hours you have earned may be needed to meet the minimum requirements for some titles. This information is also useful for career counseling purposes.

Name and Address of Colleges/

Hours Earned

Major

Minor

Dates Attended

Level and Date of

Universities Attended

 

 

 

 

 

 

Degree Earned

Indicate

SEM

QTR

Do Not

Do Not

From

To

Level

MM/YYYY

Undergraduate(U)/Graduate(G)

Abbreviate

Abbreviate

MM/YYYY

MM/YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CMS100 (Rev 12/2013)

*LIST UNDERGRADUATE AND GRADUATE HOURS SEPARATELY

*DO NOT INCLUDE COURSES MORE THAN ONCE

Fields Of Study

Undergrad

Graduate

Hours

Hours

 

 

 

 

 

 

List Actual Credit Hours

Sem

Qtr

Sem

Qtr

Earned

 

 

 

 

 

 

 

 

 

Accounting

 

 

 

 

 

 

 

 

 

Agriculture

 

 

 

 

 

 

 

 

 

Architecture

 

 

 

 

 

 

 

 

 

Audiovisual Instruction

 

 

 

 

 

 

 

 

 

Biology

 

 

 

 

 

 

 

 

 

Business Admin/Mgmt

 

 

 

 

 

 

 

 

 

Computer Science

 

 

 

 

 

 

 

 

 

Criminology

 

 

 

 

 

 

 

 

 

Divinity/Theology

 

 

 

 

 

 

 

 

 

Education (Specify)

 

 

 

 

 

 

 

 

 

Environmental Science

 

 

 

 

 

 

 

 

 

Environmental Health

 

 

 

 

 

 

 

 

 

Fire Science

 

 

 

 

 

 

 

 

 

Foreign Language (Specify)

 

 

 

 

 

 

 

 

 

Geography

 

 

 

 

 

 

 

 

 

Guidance and Counseling

 

 

 

 

 

 

 

 

 

Home Economics

 

 

 

 

 

 

 

 

 

Hydrology

 

 

 

 

 

 

 

 

 

Insurance

 

 

 

 

 

 

 

 

 

Law Enforcement

 

 

 

 

 

 

 

 

 

Mgmt. Info. Systems

 

 

 

 

 

 

 

 

 

Medical Records

 

 

 

 

 

 

 

 

 

Microbology

 

 

 

 

 

 

 

 

 

Pastoral Counseling

 

 

 

 

 

 

 

 

 

Political Science/Govt

 

 

 

 

 

 

 

 

 

Public Administration

 

 

 

 

 

 

 

 

 

Rehab Counseling/Admin

 

 

 

 

 

 

 

 

 

Social Work

 

 

 

 

 

 

 

 

 

Speech and Drama

 

 

 

 

 

 

 

 

 

Toxicology

 

 

 

 

 

 

 

 

 

Zoology

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fields of Study

Undergrad

Graduate

Hours

Hours

 

 

 

 

 

 

List Actual Credit Hours

Sem

Qtr

Sem

Qtr

Earned

 

 

 

 

 

 

 

 

 

Actuarial Science

 

 

 

 

 

 

 

 

 

Agronomy

 

 

 

 

 

 

 

 

 

Art

 

 

 

 

 

 

 

 

 

Bacteriology

 

 

 

 

 

 

 

 

 

Biostatistics

 

 

 

 

 

 

 

 

 

Cell/Molecular Biology

 

 

 

 

 

 

 

 

 

Conservation

 

 

 

 

 

 

 

 

 

Demography

 

 

 

 

 

 

 

 

 

Early Childhood Dev.

 

 

 

 

 

 

 

 

 

Engineering (Specify)

 

 

 

 

 

 

 

 

 

English

 

 

 

 

 

 

 

 

 

Epidemiology

 

 

 

 

 

 

 

 

 

Fish Management

 

 

 

 

 

 

 

 

 

Forensic Science

 

 

 

 

 

 

 

 

 

Geology

 

 

 

 

 

 

 

 

 

Health/Public Health

 

 

 

 

 

 

 

 

 

Humanities

 

 

 

 

 

 

 

 

 

Industrial Arts

 

 

 

 

 

 

 

 

 

Journalism

 

 

 

 

 

 

 

 

 

Library Science

 

 

 

 

 

 

 

 

 

Marketing

 

 

 

 

 

 

 

 

 

Medical Technology

 

 

 

 

 

 

 

 

 

Nursing (Specify)

 

 

 

 

 

 

 

 

 

Pharmacy

 

 

 

 

 

 

 

 

 

Programming

 

 

 

 

 

 

 

 

 

Radio - Television

 

 

 

 

 

 

 

 

 

Risk Assessment

 

 

 

 

 

 

 

 

 

Sociology

 

 

 

 

 

 

 

 

 

Statistics

 

 

 

 

 

 

 

 

 

Urban Studies

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fields of Study

Undergrad

Graduate

Hours

Hours

 

 

 

 

 

 

List Actual Credit Hours

Sem

Qtr

Sem

Qtr

Earned

 

 

 

 

 

 

 

 

 

Afro-American Studies

 

 

 

 

 

 

 

 

 

Animal Science

 

 

 

 

 

 

 

 

 

Atmospheric Science

 

 

 

 

 

 

 

 

 

Biochemistry

 

 

 

 

 

 

 

 

 

Botany

 

 

 

 

 

 

 

 

 

Chemistry

 

 

 

 

 

 

 

 

 

Criminal Justice Admin

 

 

 

 

 

 

 

 

 

Dietetics, Nutrition

 

 

 

 

 

 

 

 

 

Economics

 

 

 

 

 

 

 

 

 

Engineering Technology

 

 

 

 

 

 

 

 

 

Entomology

 

 

 

 

 

 

 

 

 

Finance

 

 

 

 

 

 

 

 

 

Food Service Management

 

 

 

 

 

 

 

 

 

Forestry

 

 

 

 

 

 

 

 

 

Genetics

 

 

 

 

 

 

 

 

 

History

 

 

 

 

 

 

 

 

 

Human Services

 

 

 

 

 

 

 

 

 

Industrial Hygiene

 

 

 

 

 

 

 

 

 

Law (Specify)

 

 

 

 

 

 

 

 

 

Limnology

 

 

 

 

 

 

 

 

 

Mathematics

 

 

 

 

 

 

 

 

 

Medicine

 

 

 

 

 

 

 

 

 

Park Management

 

 

 

 

 

 

 

 

 

Physics

 

 

 

 

 

 

 

 

 

Psychology

 

 

 

 

 

 

 

 

 

Recreation

 

 

 

 

 

 

 

 

 

Secretarial Science

 

 

 

 

 

 

 

 

 

Soil Science

 

 

 

 

 

 

 

 

 

Therapy (Specify)

 

 

 

 

 

 

 

 

 

Wildlife Management

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comment area to further specify the Fields of Study where noted in the previous table

CMS100 (Rev 12/2013)

15.WORK HISTORY: Complete this section in detail. All fields MUST be completed to be considered for grading. Begin with most recent position title and work backward. If you have an extensive work history with one employer, list each change in position title separately including duties and dates associated with each. If additional space is needed, attach a separate sheet following the same format as below. Resumes submitted must be in same format as the application. Attach additional sheets/ resumes to the application.

INCLUDE THE FOLLOWING INFORMATION:

College internships/practicums successfully completed

Military experience including dates, listing each change in rank and title

Related volunteer experience including dates and hours worked

Current (or last) Employer

Street Address

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Number of Hours Worked Per Week

 

Current/Last Salary $

Salary Period

 

 

 

 

Dates of Employment

 

 

 

 

 

 

To Month

 

 

 

Total Years

 

 

 

Month

Year

 

Year

 

Months

Supervisory Responsibility: List the Number of Employees You Supervised in the Appropriate Fields Below

 

 

 

 

Manual/Trades

 

Professional

 

 

 

Technical/Para-Professional

 

 

 

Clerical

 

Administrative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the Duties and Responsibilities for Each Title Separately:

Reason for Leaving:

Past Employer

Street Address

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Number of Hours Worked Per Week

 

Current/Last Salary $

Salary Period

 

 

 

 

Dates of Employment

 

 

 

 

 

 

To Month

 

 

 

Total Years

 

 

 

Month

Year

 

Year

 

Months

Supervisory Responsibility: List the Number of Employees You Supervised in the Appropriate Fields Below

 

 

 

 

Manual/Trades

 

Professional

 

 

 

Technical/Para-Professional

 

 

 

Clerical

 

Administrative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the Duties and Responsibilities for Each Title Separately:

Reason for Leaving:

CMS100 (Rev 12/2013)

15. WORK HISTORY (continued):

Past Employer

Street Address

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Number of Hours Worked Per Week

 

Current/Last Salary $

Salary Period

 

 

 

 

Dates of Employment

 

 

 

 

 

 

To Month

 

 

 

Total Years

 

 

 

Month

Year

 

Year

 

Months

Supervisory Responsibility: List the Number of Employees You Supervised in the Appropriate Fields Below

 

 

 

 

Manual/Trades

 

Professional

 

 

 

Technical/Para-Professional

 

 

 

Clerical

 

Administrative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the Duties and Responsibilities for Each Title Separately:

 

 

 

 

 

 

 

 

 

 

 

Reason for Leaving:

Past Employer

Street Address

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Number of Hours Worked Per Week

 

Current/Last Salary $

Salary Period

 

 

 

 

Dates of Employment

 

 

 

 

 

 

To Month

 

 

 

Total Years

 

 

 

Month

Year

 

Year

 

Months

Supervisory Responsibility: List the Number of Employees You Supervised in the Appropriate Fields Below

 

 

 

 

Manual/Trades

 

Professional

 

 

 

Technical/Para-Professional

 

 

 

Clerical

 

Administrative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the Duties and Responsibilities for Each Title Separately:

 

 

 

 

 

 

 

 

 

 

 

Reason for Leaving:

CMS100 (Rev 12/2013)

State law requires that you furnish certain information about your child support obligations at the time you are hired. The possibility of employment is not affected by a child support obligation or default in payment.

As a condition of employment, state law requires that “every male born on or after January 1, 1960, and less than 27 years old, shall submit documentation, at time of appointment, evidencing his registration with the Federal Selective Service System.”

In compliance with the state and federal constitutions, the Illinois Human Rights Act, the U.S. Civil Rights Act, the Americans with Disabilities Act, and Section 504 of the Federal Rehabilitation Act, the Department of Central Management Services does not discriminate in employment, contracts, or any other activity. If you have a complaint, please contact the Department of Central Management Services at 217/782-7100 (voice) or 800/526-0844 (TTY Only).

Pursuant to Public Act 93-0211, effective January 1, 2004, (20 ILCS 2630/12 (a)) and Public Act 93-0912, effective August 12, 2004, (705 ILCS 405/5-915 (8)(a)), respectively, applicants seeking employment with the State of Illinois are not obligated to disclose an arrest or conviction record that has been expunged or sealed, nor an expunged juvenile record. Employers may not ask if an applicant has had records expunged or sealed. Neither Public Act applies to law enforcement agencies, the Department of Corrections, State's Attorneys or other prosecutors.

Central Management Services requests disclosure of information that is necessary to accomplish its obligations, primarily the statutory purposes outlined under the Personnel Code (20 ILCS 415). Disclosure of the information requested on this form is mandatory, and failure to provide requested information may result in rejection of this form or delay in making a determination on eligibility or employment. Social Security numbers are used in the application and employment processes to identify and differentiate between candidates and/or employees. Confidentiality of Social Security numbers obtained through this application process will be preserved as prescribed by 5 ILCS 179 et seq.

16.This application may be utilized as the actual test for some titles. If the title for which you wish to test is a closed exam or an exam based only on training and experience, mail completed application to:

CMS Bureau of Personnel Examining and Counseling Division Stratton Office Building, Room 500 Springfield, Illinois 62706.

Applications for a closed exam will be held on file until an agency requests that the test be administered or for a maximum of one year from the date of receipt.

The following section is optional.

The State of Illinois is an Equal Opportunity Employer. To assist in the accomplishment of Affirmative Action goals, we invite you to complete the following information. Completion of this information is not required. Check ONE box and, if applicable, check the appropriate Disability box.

Female Male

AG

BH

CJ

DK

EL

P Q

Ethnicity

White not of Hispanic Origin. A person having origins in any of the original peoples of Europe, North Africa or the Middle East.

Black or African American not of Hispanic Origin. A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can also be used in addition to “Black” or “African American”.

American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment.

Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, but not limited to, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin, regardless of race.

Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Are you an Individual with a Disability?

Yes

No

See the included State of Illinois Assessment Centers, Testing and Career Counseling Information sheet.

CMS100 (Rev 12/2013)

STATE OF ILLINOIS ASSESSMENT CENTERS

CHAMPAIGN (by appointment only)

ROCKFORD (by appointment only)

MARION (by appointment only)

Central Management Services

Central Management Services

Central Management Services

State Regional Office Building

E. J. “Zeke” Giorgi Center

State Regional Office Building

2125 South First Street

200 South Wyman Street

2309 West Main Street, Suite 126

Champaign, Illinois 61820

Rockford, Illinois 61101

Marion, Illinois 62959

Phone: 217-278-3435

Phone: 815-987-7004

Phone: 618-993-7005

Illinois Relay Center:

Illinois Relay Center:

Illinois Relay Center:

800-526-0844 (TTY only)

800-526-0844 (TTY only)

800-526-0844 (TTY only)

CHICAGO

SPRINGFIELD

Central Management Services

Central Management Services

James R. Thompson Center - Suite 3-300

Capital City Center

100 W. Randolph Street

130 West Mason Street

Chicago, Illinois 60601

Springfield, IL 62702

Phone: 312-793-3565

Phone: 217-557-6885

312-814-4458 (TTY only)

217-524-1383 (TTY only)

Walk in test centers are located in Springfield and Chicago. Office hours are Monday-Friday 8 a.m. - 5 p.m.

Chicago and Springfield multiple choice automated testing is held Monday, Tuesday, Wednesday and Thursday. Check in time for clerical and non-clerical tests is anytime between 8 a.m. and 1:30 p.m. in Chicago and 8 a.m. and 2 p.m. in Springfield. You must arrive and be ready to test no later than 12:30 p.m. for Data Processing Administrative Specialist, Data Processing Specialist, HR Assistant, HR Associate, Insurance Analyst II, Revenue Tax Specialist Trainee, Telecommunicator Trainee and Dictation exams.

IDENTIFICATION IS REQUIRED AT THE TIME OF TESTING AT ALL ASSESSMENT CENTERS.

Visit our website for more information at http://work.illinois.gov

or for general information regarding testing and career counseling contact

CMS Examining and Counseling Division, Room 500 Stratton Building, Springfield, IL 62706

(217) 782-7100 (voice) (800) 526-0844 (TTY Only)

Career Services Career counselors are available at all of the assessment center locations by appointment only. A completed CMS application is required at the time of the appointment for review by the counselor. After reviewing your completed application and discussing your education and work experiences, the counselor will recommend job titles and provide descriptions of the job requirements. Call in advance to make an appointment. Phone numbers are listed above for the specific locations.

Testing Information There are approximately 950 position titles used by the state agencies under the jurisdiction of the Governor. To be considered as an eligible applicant for one of these titles, the applicant must participate in either an automated multiple-choice test (AT); or submit the application for a review of the training and experience (TX) listed on the application. A grade is given for each of these exam types. The position titles are separated into Group A and Group B.

Group A - titles are tested for continuously. The Group A titles requiring an automated multiple-choice exam (AT) are administered at any of the assessment centers listed above. The Group A titles requiring review of the applicant’s training and experience (TX) should be sent to CMS, Examining and Counseling Division, Room 500 Stratton Office Building, Springfield, IL, 62706, for grading.

Group B - titles are closed exams. Send applications for any Group B title to CMS, Examining and Counseling Division, Room 500 Stratton Office Building, Springfield, IL, 62706. Applications for a Group B closed exam will be maintained until an agency requests that the test be administered or for a maximum of one year.

Information on the position titles may be obtained from any Assessment Center or by viewing the Web site.

NOTE: A separate application is usually required for each title and option for which you test. Some exceptions: You may use one application to apply for a TX grade for multiple options for Public Service Administrator (PSA) and Senior Public Service Administrator (SPSA). Use one application for all selected options for each title for the Information Services Specialist (ISS) and the Information Systems Analyst (ISA).

Many AT tests in the same series require only one application. Check with any assessment center for details.

Veterans Preference is awarded to veterans after CMS receives appropriate documentation and verifies eligibility. For more information contact the Veterans Outreach Office at 800-643-8138; Illinois Relay Center 800-526-0844 (TTY only).

Highway Maintainer Examination requires the possession of a valid commercial drivers license, Class “A,” with endorsements of “N” (Tankers) or “X” (Tankers with hazardous materials) and non-restrictive air brakes, before an applicant can participate in the examination.

Automotive Mechanic Examination (All Options) and Maintenance Equipment Operator Examination require the possession of a valid Class “A” or “B” commercial drivers license before an applicant can participate in the examination.

If you are an individual with a disability and need accommodated testing assistance, please contact the Disabled Workers Program in Springfield at (217) 524-7514 (voice) or (217) 524-1383 (TTY only) before the date of the test.

APPLICANT INFORMATION CONCERNING COOK COUNTY ZONES

Cook County is divided into five zones for the position titles listed below for the purpose of administering eligible lists. To explain the zones, the map is an outline of Cook County with central and northern portions of the City of Chicago shown crosshatched. A more detailed map is available on our website at www.work.illinois.gov under Frequently Asked Questions.

The open competitive position titles to which Cook County zones apply are:

Automotive Mechanic

Highway Maintainer Lead Worker

Office Clerk

Child Development Aide

Laborer (Maintenance)

Security Officer

Cook I

Licensed Practical Nurse I and II

Stores Clerk

Heavy Construction Equipment Operator

Office Aide

Storekeeper I

Highway Maintainer

Office Assistance

Support Service Worker

Zone 1 is the area within the city limits of Chicago between North Avenue and 95th Street.

Zone 2 is the area within the city limits of Chicago north of North Avenue.

Zone 3 is Cook County and the area including the City of Chicago which his south of 95th street.

Zone 4 is Cook County outside the City of Chicago between North Avenue and 95th Street.

Zone 5 is Cook County outside the City of Chicago north of North Avenue.

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cms 100 employment application For CMS Use Only, CMS Rev, Exam Date, Test Center, Month, Day, and Year blanks to complete

The Business Trade Correspondence, From MMYYYY, To MMYYYY, Time FullPart, Subjects, Course Length, Completed YesNo, TECHNICALPROFESSIONAL LICENSE, TechnicalProfessional License, Number, State Issued, Date Issued MMYYYY, Expiration Date MMYYYY, EDUCATION REPORT LIST YOUR, and Name and Address of Colleges field will be the place to insert the rights and obligations of both parties.

cms 100 employment application Business Trade Correspondence, From MMYYYY, To MMYYYY, Time FullPart, Subjects, Course Length, Completed YesNo, TECHNICALPROFESSIONAL LICENSE, TechnicalProfessional License, Number, State Issued, Date Issued MMYYYY, Expiration Date MMYYYY, EDUCATION REPORT LIST YOUR, and Name and Address of Colleges blanks to insert

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