Check one or both
Complete this application completely and accurately. All statements made in your application will be subject to verification. Note those questions that do not apply to you by writing "N.A." for "not applicable".
List full names and their relationship to you
Requested by County EEO / Affirmative Action Committee for Monitoring Programs.
Name, Relationship, Complete Address, Occupation
Name, Date of Birth, Place of Birth, Lives with, Town or Residence, Phone #
Name of School, Address of School, Number of Years, Dates Attended, Graduate, Grade Average
From, To, Address of Residence, City, State
You are not required to disclose expunged juvenile records (705 ILCS 405/5-923)
Employer's Name, Employer's Address, Supervisor's Name, Type of Business, Phone #, Dates, Title, Left. Please place a * by the name of any employer you do not wish us to contact.
Name of Firm, Address of Firm, Phone #, Amount, Date Closed, Comments
Amount, Owed to: Name, Address, Length of Payments, Comments
Name, Address, Home Phone, Work Phone, Occupation, Years Known
Name, Address, Phone, Relationship
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I, hereby state that I wish to apply for employment at the Peoria County Sheriff's Office. I understand that as part of the application process I am to provide the following documents to the Peoria County Sheriff's Office. These documents can be uploaded as part of this application or submitted in person at the time of testing.
If submitting multiple please combine.
The undersigned, for and in consideration of being allowed to participate in the pre-employment examination process for criminal justice agency employment by the Peoria County Sheriff's Office, hereby releases and discharges the County of Peoria, a body politic and corporate, its officers, employees, and agents, of and from any and all claims, demands, causes of action and liabilities to me, my heirs and my assigns, which may result for any and all losses and damages arising wholly or partially as a result of the examinations, and/or any pre-employment background investigations conducted by and for the Peoria County Sheriff's Office.
The undersigned authorizes the release of medical, military, educational, credit, criminal history, and personal information from all sources to the County of Peoria for use in any pre-employment background examination.
This field is not part of the form submission.
* indicates a required field