Cms100 Application Form PDF Details

The CMS100 Application form plays a crucial role for individuals seeking employment within the state-run departments of Illinois, emphasizing the importance of providing accurate and detailed information to facilitate civil service testing and employment processes. Managed by the Central Management Services (CMS), the form serves as the initial step for applicants under the jurisdiction of the Governor, aiming to streamline the recruitment for various positions while ensuring a fair and efficient assessment. It's important for applicants to complete the form with care, as it requires comprehensive personal and professional details, including education, work history, and specific qualifications like driver's license information, veterans' preference, and any necessary licensure. With sections dedicated to assessing eligibility and preference for types of employment—permanent or temporary—and capturing a detailed employment history and educational background, the form also sensibly addresses legal obligations, such as child support and Selective Service registration, and adherence to non-discrimination policies. Notably, the application sets the stage for possibly being the actual test for certain titles, highlighting its significance in the hiring process. To avoid any delays or issues, applicants are advised against submitting pencil-written copies, ensuring all information is legibly printed or typed, thereby underscoring the expectations for clarity and precision in the application process.

QuestionAnswer
Form NameCms100 Application Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namescms 100 employment application, illinois cms100, cms100 No Download Needed, cms 100 application 2021

Form Preview Example

EXAMINING/EMPLOYMENT APPLICATION (CMS100)

CMS administers civil service testing for agencies under the jurisdiction of the Governor; however, actual employment decisions are made by the hiring agencies. Pencil copies of applications will not be accepted. Legible photocopies are accepted.

PLEASE PRINT LEGIBLY OR TYPE INFORMATION.

1.

POSITION TITLE

 

 

 

 

 

 

 

 

 

 

 

OPTION

 

LEAVE BLANK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

LAST NAME

 

 

FIRST NAME

 

 

MI

3. SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS

 

 

 

 

 

 

 

COUNTY

4. BIRTHDATE (OPTIONAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

STATE

ZIP CODE

5. HOME TELEPHONE

 

 

 

OTHER TELEPHONE

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

DRIVERS LICENSE NUMBER

STATE

 

MO/YR EXPIRES

 

RESTRICTIONS

 

 

 

NON-CDL

 

CDL

ENDR

 

 

 

 

 

 

/

 

 

 

 

 

 

A B C D L M

 

A B

X N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

COUNTY CHOICE

COUNTY

 

COOK/ZONE

 

LEAVE BLANK

 

COUNTY

 

 

COOK/ZONE

 

LEAVE BLANK

 

 

 

 

 

(Select one or two)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. AVAILABILITY

A.

(Check one)

 

Available for permanent employment;

B.

will not accept temporary employment.

 

(Trainee titles must choose A.)

 

Available for permanent employment;

C.

will accept temporary employment.

 

Available for temporary employment only.

9. If your answer to any of the following questions is “yes” please attach a signed, detailed explanation.

 

YES

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

 

B. Have you ever pled guilty to or been convicted of any criminal offense other than a minor traffic violation?

 

 

YES

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 (8a)), 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.

NO

NO

C. 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.

10. 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 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.

LEAVE BLANK

11.

HIGH SCHOOL GRADUATE

 

YES

NO

 

NUMBER OF YRS COMPLETED

0 1 2 3 4

GED

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

BUSINESS, TRADE, CORRESPONDENCE

FROM

TO

TIME

 

SUBJECTS

COURSE

 

COMPLETED

 

SCHOOL: NAME AND ADDRESS

 

MO

 

YR

MO

 

YR

FULL

 

PART

 

 

LENGTH

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. TECHNICAL/PROFESSIONAL LICENSE

NUMBER

STATE ISSUED

DATE ISSUED

MO YR

EXPIRATION DATE

MO YR

CMS 100 (Rev. 03/12) Printed on Recycled Paper

FOR CMS USE ONLY

EXAM DATE

TEST CENTER

MONTH DAY YEAR

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

 

 

HOURS

MAJOR

 

MINOR

DATES ATTENDED

LEVEL AND DATE OF

COLLEGES/UNIVERSITIES ATTENDED

 

EARNED

(DO NOT

 

(DO NOT

FROM

TO

 

DEGREE EARNED

 

 

 

 

SEM

 

QTR

ABBREVIATE)

 

ABBREVIATE)

MO/YR

MO/YR

 

LEVEL

MO

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Undergraduate:

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Graduate:

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIST UNDERGRADUATE AND

 

 

INDICATE THE ACTUAL NUMBER OF

DO NOT INCLUDE COURSES

 

 

GRADUATE HOURS SEPARATELY

 

SEMESTER OR QUARTER HOURS EARNED

MORE THAN ONCE

 

 

 

 

FIELDS OF STUDY

 

UNDERGRADUATE

 

GRADUATE

FIELDS OF STUDY

 

UNDERGRADUATE

GRADUATE

LIST ACTUAL

 

# OF

# OF

 

# OF

# OF

LIST ACTUAL

 

# OF

# OF

# OF

 

# OF

CREDIT HOURS

 

SEM HRS

QTR HRS

SEM HRS

QTR HRS

CREDIT HOURS

 

SEM HRS

QTR HRS

SEM HRS

 

QTR HRS

Accounting

 

 

 

 

 

 

 

Humanities

 

 

 

 

 

 

 

 

 

Actuarial Science

 

 

 

 

 

 

 

Human Services

 

 

 

 

 

 

 

 

 

Afro-American Studies

 

 

 

 

 

 

 

Hydrology

 

 

 

 

 

 

 

 

 

Agriculture

 

 

 

 

 

 

 

Industrial Arts

 

 

 

 

 

 

 

 

 

Agronomy

 

 

 

 

 

 

 

Industrial Hygiene

 

 

 

 

 

 

 

 

 

Animal Science

 

 

 

 

 

 

 

Insurance

 

 

 

 

 

 

 

 

 

 

Architecture

 

 

 

 

 

 

 

Journalism

 

 

 

 

 

 

 

 

 

Art

 

 

 

 

 

 

 

Law (specify)

 

 

 

 

 

 

 

 

 

Atmospheric Science

 

 

 

 

 

 

 

Law Enforcement

 

 

 

 

 

 

 

 

 

Audiovisual Instruction

 

 

 

 

 

 

 

Library Science

 

 

 

 

 

 

 

 

 

Bacteriology

 

 

 

 

 

 

 

Limnology

 

 

 

 

 

 

 

 

 

Biochemistry

 

 

 

 

 

 

 

Mgmt Info Systems

 

 

 

 

 

 

 

 

 

Biology

 

 

 

 

 

 

 

Marketing

 

 

 

 

 

 

 

 

 

Biostatistics

 

 

 

 

 

 

 

Mathematics

 

 

 

 

 

 

 

 

 

Botany

 

 

 

 

 

 

 

Medical Records

 

 

 

 

 

 

 

 

 

Business Admin/Mgmt

 

 

 

 

 

 

 

Medical Technology

 

 

 

 

 

 

 

 

 

Cell/Molecular Biology

 

 

 

 

 

 

 

Medicine

 

 

 

 

 

 

 

 

 

 

Chemistry

 

 

 

 

 

 

 

Microbiology

 

 

 

 

 

 

 

 

 

Computer Science

 

 

 

 

 

 

 

Nursing (specify)

 

 

 

 

 

 

 

 

 

Conservation

 

 

 

 

 

 

 

Park Management

 

 

 

 

 

 

 

 

 

Criminal Justice Admin

 

 

 

 

 

 

 

Pastoral Counseling

 

 

 

 

 

 

 

 

 

Criminology

 

 

 

 

 

 

 

Pharmacy

 

 

 

 

 

 

 

 

 

 

Demography

 

 

 

 

 

 

 

Physics

 

 

 

 

 

 

 

 

 

 

Dietetics, Nutrition

 

 

 

 

 

 

 

Political Science/Govt

 

 

 

 

 

 

 

 

 

Divinity/Theology

 

 

 

 

 

 

 

Programming

 

 

 

 

 

 

 

 

 

Early Childhood Development

 

 

 

 

 

 

 

Psychology

 

 

 

 

 

 

 

 

 

Economics

 

 

 

 

 

 

 

Public Administration

 

 

 

 

 

 

 

 

 

Education (specify)

 

 

 

 

 

 

 

Radio-Television

 

 

 

 

 

 

 

 

 

Engineering (specify)

 

 

 

 

 

 

 

Recreation

 

 

 

 

 

 

 

 

 

Engineering Technology

 

 

 

 

 

 

 

Rehab Counseling/Admin

 

 

 

 

 

 

 

 

 

Environmental Science

 

 

 

 

 

 

 

Risk Assessment

 

 

 

 

 

 

 

 

 

English

 

 

 

 

 

 

 

Secretarial Science

 

 

 

 

 

 

 

 

 

Entomology

 

 

 

 

 

 

 

Social Work

 

 

 

 

 

 

 

 

 

Environmental Health

 

 

 

 

 

 

 

Sociology

 

 

 

 

 

 

 

 

 

 

Epidemiology

 

 

 

 

 

 

 

Soil Science

 

 

 

 

 

 

 

 

 

Finance

 

 

 

 

 

 

 

Speech and Drama

 

 

 

 

 

 

 

 

 

Fire Science

 

 

 

 

 

 

 

Statistics

 

 

 

 

 

 

 

 

 

 

Fish Management

 

 

 

 

 

 

 

Therapy (specify)

 

 

 

 

 

 

 

 

 

Food Service Mgmt

 

 

 

 

 

 

 

Toxicology

 

 

 

 

 

 

 

 

 

Foreign Language (specify)

 

 

 

 

 

 

 

Urban Studies

 

 

 

 

 

 

 

 

 

Forensic Science

 

 

 

 

 

 

 

Wildlife Management

 

 

 

 

 

 

 

 

 

Forestry

 

 

 

 

 

 

 

Zoology

 

 

 

 

 

 

 

 

 

 

Geography

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

 

 

 

Geology

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Genetics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Guidance and Counseling

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health/Public Health

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

History

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Economics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach separate sheet of paper for additional coursework if necessary.

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. Unsigned or incomplete applications will be returned. 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. Place additional sheets/resumes inside 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

 

 

 

 

 

 

 

 

 

POSITION TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

AVERAGE # OF HOURS WORKED PER WEEK

 

CURRENT OR LAST SALARY

 

 

 

 

 

FULL-TIME

OR

 

PART- TIME

 

WEEKLY OR MONTHLY OR ANNUALLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

STATE

 

DATES OF EMPLOYMENT

 

 

 

TOTAL

 

 

 

 

 

 

MONTH

 

YEAR

 

TO

MONTH

 

YEAR

 

YEARS

MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISORY RESPONSIBILITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUAL/TRADES

 

CLERICAL

 

 

 

 

TECHNICAL/PARA-

 

 

PROFESSIONAL

 

 

ADMINISTRATIVE

LIST THE NUMBER OF EMPLOYEES YOU

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISED IN THE APPROPRIATE BOX(ES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE DUTIES AND RESPONSIBILITIES FOR EACH POSITION TITLE SEPARATELY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REASON FOR LEAVING:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

 

 

 

 

 

 

 

 

 

 

 

POSITION TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

AVERAGE # OF HOURS WORKED PER WEEK

 

CURRENT OR LAST SALARY

 

 

 

 

 

FULL-TIME

OR

 

PART- TIME

 

WEEKLY OR MONTHLY OR ANNUALLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

STATE

 

DATES OF EMPLOYMENT

 

 

 

TOTAL

 

 

 

 

 

 

MONTH

 

YEAR

 

TO

MONTH

 

YEAR

 

YEARS

MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISORY RESPONSIBILITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUAL/TRADES

 

CLERICAL

 

 

 

 

TECHNICAL/PARA-

 

 

PROFESSIONAL

 

 

ADMINISTRATIVE

LIST THE NUMBER OF EMPLOYEES YOU

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISED IN THE APPROPRIATE BOX(ES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE DUTIES AND RESPONSIBILITIES FOR EACH POSITION TITLE SEPARATELY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REASON FOR LEAVING:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

 

 

 

 

 

 

 

 

 

 

 

POSITION TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

AVERAGE # OF HOURS WORKED PER WEEK

 

CURRENT OR LAST SALARY

 

 

 

 

 

FULL-TIME

OR

 

PART- TIME

 

WEEKLY OR MONTHLY OR ANNUALLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

STATE

 

DATES OF EMPLOYMENT

 

 

 

TOTAL

 

 

 

 

 

 

MONTH

 

YEAR

 

TO

MONTH

 

YEAR

 

YEARS

MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISORY RESPONSIBILITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUAL/TRADES

 

CLERICAL

 

 

 

 

TECHNICAL/PARA-

 

 

PROFESSIONAL

 

 

ADMINISTRATIVE

LIST THE NUMBER OF EMPLOYEES YOU

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISED IN THE APPROPRIATE BOX(ES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE DUTIES AND RESPONSIBILITIES FOR EACH POSITION TITLE SEPARATELY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REASON FOR LEAVING:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

 

 

 

 

 

 

 

 

 

 

 

POSITION TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

AVERAGE # OF HOURS WORKED PER WEEK

 

CURRENT OR LAST SALARY

 

 

 

 

 

FULL-TIME

OR

 

PART- TIME

 

WEEKLY OR MONTHLY OR ANNUALLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

STATE

 

DATES OF EMPLOYMENT

 

 

 

TOTAL

 

 

 

 

 

 

MONTH

 

YEAR

 

TO

MONTH

 

YEAR

 

YEARS

MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISORY RESPONSIBILITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUAL/TRADES

 

CLERICAL

 

 

 

 

TECHNICAL/PARA-

 

 

PROFESSIONAL

 

 

ADMINISTRATIVE

LIST THE NUMBER OF EMPLOYEES YOU

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISED IN THE APPROPRIATE BOX(ES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE DUTIES AND RESPONSIBILITIES FOR EACH POSITION TITLE SEPARATELY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REASON FOR LEAVING:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

 

 

 

 

 

 

 

 

 

 

 

POSITION TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

AVERAGE # OF HOURS WORKED PER WEEK

 

CURRENT OR LAST SALARY

 

 

 

 

 

FULL-TIME

OR

 

PART- TIME

 

WEEKLY OR MONTHLY OR ANNUALLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

$

 

 

 

$

CITY

 

 

STATE

 

DATES OF EMPLOYMENT

 

 

 

TOTAL

 

 

 

 

 

 

MONTH

 

YEAR

 

TO

MONTH

 

YEAR

 

YEARS

MONTHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISORY RESPONSIBILITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUAL/TRADES

 

CLERICAL

 

 

 

 

TECHNICAL/PARA-

 

 

PROFESSIONAL

 

 

ADMINISTRATIVE

LIST THE NUMBER OF EMPLOYEES YOU

 

 

 

 

 

 

 

 

 

 

PROFESSIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPERVISED IN THE APPROPRIATE BOX(ES)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIBE DUTIES AND RESPONSIBILITIES FOR EACH POSITION TITLE SEPARATELY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REASON FOR LEAVING:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

•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).

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: Central Management Services, Examining and Counseling, Room 500, Stratton Office Building, 401 South Spring Street, Springfield, Illinois 62706. Applications for a closed exam will be maintained until an agency requests that the test be administered or for a maximum of one year.

17.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 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.

18.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.

DATE

WRITTEN SIGNATURE REQUIRED

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. Circle ONE letter and, if applicable, check the appropriate box.

FEMALE

MALE

 

A

G

White not of Hispanic Origin. A person having origins in any of the original peoples

 

 

of Europe, North Africa or the Middle East.

B

H

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”.

C

J

American Indian orAlaska Native. Aperson having origins in any of the original

 

 

peoples of North and South America, including Central America, and who maintains

 

 

tribal affiliation or community attachment.

D

K

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.

E

L

Hispanic or Latino. Aperson of Cuban, Mexican, Puerto Rican, South or Central

 

 

American, or other Spanish Culture or origin, regardless of race.

P

Q

Native Hawaiian or Other Pacific Islander. Aperson having origins in any of the

 

 

original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

DISABILITY

Yes

No

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 the central and northern portions of the City of Chicago shown crosshatched. A more detailed map is available on our website at http://www.cms.illinois.gov under Employment, 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 III

Laborer (Maintenance)

Security Officer

Cook I

Licensed Practical Nurse I and II

Stores Clerk

Heavy Construction Equip Operator

Office Aide

Storekeeper I

Highway Maintainer

Office Assistant

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 is 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.

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 Managment 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.

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