Summer Tech-Trainee
PERSONAL
Name / Social Security Number
Address / County
City / State / Zip Code
Phone Number / 2nd Phone Number
Date of Birth / Location Preference(please circle one):
Email Address / District 1District 2District 3Central Office
District 4District 5District 6Central Office-
District 7District 8District 9 Chicago/JRTC
College Major
The Illinois Department of Transportation has a policy against relatives working in superior or subordinate relationships. Do you have a relative employed by the Illinois Department of Transportation?
Yes No
Name:
Title:
Relationship:
Work Location:
Have you ever been employed by the Illinois Department of Transportation? / Yes No
If yes, when?
Have you ever been fired from a job? Yes No If you answer “yes” to this question, please provide a detailed
explanation.
QUESTIONS
This is the beginning of the questionnaire. The following questions will be used to determine employment selection. Some of the following questions may have more than one part. Please answer completely. Attach additional sheets of paper if necessary, but please limit each answer to half a page.
1. / Please describe any relevant work experience regarding office duties, and/or construction or materials inspection.
2. / Please describe the skills that you have acquired from prior work/school experiences that will make you successful
in this position.
3. / Please list the computer software programs that you are familiar with and describe your level of experience with
each program.
4. / How many years of education and/or training do you have that would help you perform the duties of the job? describe the nature of this education and training.
Please describe the nature of this education and training.
5. / Please give an example of a school/work project in which you worked as part of a team. What was your role and
what was the end result?
6. / Please describe a time when you had to be very careful in communicating delicate information. What was the possible risk involved and how did you go about securing and delivering the information?
possible risk involved and how did you go about securing and delivering the information?
7. / Please provide an example of a time when you were able to successfully communicate with another person
even when that individual may not have personally liked you (or vice versa).
8. / Describe the system you use for keeping track of multiple projects. Explain how you track your progress to
meet deadlines and how you stay focused?
9. / Please describe a time when you succeeded in overcoming a major obstacle at work or school. How did this make you feel?
you feel?
10. / Please provide examples of work/school situations where you have gone beyond specified expectations.
AFFIRMATIVE ACTION DATA
The State of Illinois is an Equal Opportunity Employer. Each state agency is required to maintain demographic statistics for Equal Employment Opportunity/Affirmative Action purposes. To assist us in this matter we are seeking voluntary information from you. Providing this information is strictly voluntary on your part. Should you decide to offer the information, please check the appropriate box below.
Female / Male
A / G / White, not of Hispanic origin. A person having origins in any of the original people of Europe, North Africa or the Middle East.
B / H / Black, not of Hispanic origin. A person having origins in any of the black racial groups of Africa.
C / J / Native American. A person having origins in any of the peoples of North American and who maintain cultural identification through tribal affiliation of community.
D / K / Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. This area includes, for example, China, Japan, Korea, and the Philippine Islands.
E / L / Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
P / Q / Native Hawaiian or other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Please indicate whether you have any of the following conditions by checking the appropriate boxes below.
0. / No Impairment / 3. / Orthopedic Impairment / 6. / Nervous System Disorder
1. / Blindness/Visual Impairment / 4. / Cardiovascular Disorder / 7. / Respiratory Impairment
2. / Deafness/Hearing Impairment / 5. / Mental or Emotional Disorder / 8. / Loss of Limbs
9. / Other (Specify)
Does your disability require a job coach? Yes No
CONDITIONS
1. / I understand that employment may be contingent upon satisfactory results from a urine drug screen.
2. / I voluntarily authorize IDOT to verify information related to my education and employment and release from liability all personal or entities supplying or collecting such information.
3. / I understand and agree that the information I have provided on this application is accurate to the best of my knowledge. Any misrepresentation or deliberate omission of any fact in my application, resume or any other materials submitted will be justification for the refusal of employment or, if employed, termination from IDOT employment.
4. / I understand that if selected, IDOT would be appointing me to a temporary position for a period not to exceed 6 months. This temporary appointment does not entitle me to any future permanent or temporary appointment with IDOT.
Applicant’sSignature / Date
Printed 10/3/2018Page 1 of 5PM 2420 (Rev. 04/10/14)
Please return application by 4:30 on the posting deadline.Applications are to be returned to the Illinois Department of Transportation at the following locations:
District 1Illinois Department of Transportation
Attn: Charles Klemz
201 W Center Court
Schaumburg, IL 60196
Fax number 847/705-4489 / District 6
Illinois Department of Transportation
Attn: Marilyn Viehweg
126 East Ash
Springfield, IL61704
Fax number 217/557-1089
District 2
Illinois Department of Transportation
Attn: Charles Layer
819 Depot Ave
Dixon, IL61021
Fax number: 815/284-5908 / District 7
Department of Transportation
Attn: Grant White
400 West Wabash
Effingham, IL62401
Fax number 217/342-8384.
District 3
Illinois Department of Transportation
Attn: Dean Devert
700 East Norris Dr
Ottawa, IL61350
Fax number 815/433-7073 / District 8
Illinois Department of Transportation
Attn: Ross Breckenridge
1102 Eastport Plaza Dr
Collinsville, IL62234
Fax number 618/346-3386
District 4
Illinois Department of Transportation
Attn: Martin Clinch
401 Main Street
Peoria, IL 61602
Fax number 309/671-4882 / District 9
Illinois Department of Transportation
Attn: Michael Bigler
PO Box 100
Carbondale, IL62903
Fax number 618/351-5296
District 5
Illinois Department of Transportation
Attn: William Boyer
13473 IL Hwy 133
PO Box 610
Paris, IL61944
Fax number 217/463-8169 / Central Office
Illinois Department of Transportation
Harry Hanley Building
2300 South Dirksen Parkway, Room 113
Springfield, IL 62764
Fax Number 217/557-3134
Printed 10/3/2018Page 1 of 5PM 2420 (Rev. 04/10/14)
**ONLY COMPLETE IF YOU ARE APPLYING FOR DISTRICT 1**
/ Temporary Technical Employment SupplementNon-Engineering
ILLINOIS DEPARTMENT OF TRANSPORTATION
DISTRICT ONE
201 WEST CENTER COURT
SCHAUMBURG, ILLINOIS 60196
ATTN: CHRISTINE MEAD
(847) 705-4058
This form must be supplied before your application will be considered:
Field assignments may involve providing assistance to Resident Engineers and supporting staff in the inspection and layout of highway/bridge construction projects. Typical tasks involve: inspecting earthwork, drainage, concrete paving, resurfacing bridges and related structures; and taking or recording field measurements. The counties included are Cook, Will, DuPage, Lake, Kane and McHenry. Candidates should posses a working knowledge of mathematics (particularly trigonometry), the ability to follow oral and written instructions and cooperative relations with all parties involved in the projects.
Assignment Preference, please check one:
Field Assignment Office Assignment
If selecting the field, it will be necessary for you to purchase ANSI Class 75, 6” or higher, steel toe safety shoes.
College Major / Estimated Graduation Date:
Availability Preference, please check one / Full-Time Part-Time
Do you have a valid driver’s license: / Yes No
Do you or your parents have automotive liability insurance? / Yes No
Name of insurance company
Do you have transportation to travel to and from the job? / Yes No
What date can you start? / Final work date?
Name / Signature / Date
School Address: / Home Address:
School Phone: / Home Phone:
Email Address:
Printed 10/3/2018PM 2420 (Rev. 04/10/14)