Pre-Employment Form "*" indicates required fields Champaign Park District Criminal BackgroundThe Champaign Park District complies with the State of Illinois statue (70 ILCS 1205/8-23) and requires a criminal background check on job applicants and volunteers. No park district shall knowingly employ a person who has been convicted (guilty) of one or more of several crimes of a sexual nature and/or illegal drug possession, or a Class X felony. Any other conviction(s) shall not automatically disqualify the applicant from consideration, but rather, the conviction(s) will be considered in relationship to the specific job. For a complete list of offenses, please see the human resources manager.Legal Name:* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Birth Date* MM slash DD slash YYYY Alias names you have used: Date* MM slash DD slash YYYY Gender:*MaleFemaleRace/Ethnicity:*CaucasianAfrican-AmericanAsian/Pacific IslanderHispanicNative AmericanOtherSocial Security Number:* State of Illinois Driver's Abstract RequestTo operate any Champaign Park District vehicle employees must be a minimum of 18 years of age (you must be 21 years of age to transport participants), have a valid State of Illinois driver’s license and a clean driving record. If you will be driving a Champaign Park District vehicle we will request an abstract of your driving record from the Illinois Secretary of State Department of Motor Vehicles.Do you meet the requirements above and need an abstract run?* Yes No Name (as stated on State of Illinois Driver’s License):* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Driver’s license number: Classification/endorsements: Pending CPD PositionHave you ever worked for the Champaign Park District before?* Yes No Job Title:* Supervisor:* Department:* Complete the next steps to electronically sign the document.*To the best of my knowledge all statements I have given are accurate.Check the following boxes: I authorize the Champaign Park District to obtain an abstract of my driving license from the Illinois Secretary of State Department of Motor Vehicles. I agree to a criminal background check with the Illinois State police. Full Name* First Middle Last Email*
