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3. LAKE COUNTY PARKS AND RECREATION DEPARTMENT
   8411 E. Lincoln Highway, Crown Point, IN 46307 | (219) 796-7275
5. APPLICATION FOR EMPLOYMENT
   We recommend utilizing the 'sign in to save progress' feature in upper right hand section of this form in order to ensure you do not lose any information.
7. Date*
   Date
9. Contact Information
11. First Name*
12. Last Name*
13. Middle Initial
15. Address*
16. City*
17. State*
18. Zip Code*
20. Primary Phone*
21. Phone Type

    1. Home
    2. Cell
    3. Work
22. Secondary Phone
23. Phone Type

    1. Home
    2. Cell
    3. Work
25. Email Address
29. Areas of Interest
31. Are you seeking:

    1. Full-time

    1. Part-Time

    1. Seasonal
32. How many hours per week?
34. Are there any restrictions on hours you can work?

    1. Yes

    1. No
35. Please Explain
37. Park Site
    -- Select One --Bellaboo'sBuckley HomesteadCedar Creek Family Golf CenterDeep River County ParkDeep River WaterparkGibson Woods Nature PreserveGrand Kankakee MarshLake EttaLemon LakeOak Ridge PrairieStoney RunThree RiversTurkey CreekAny/AllOtherMultiple
38. Position Applying For
40. Check all that apply

    1. Bellaboo's
    2. Buckley Homestead
    3. Cedar Creek Family Golf Center
    4. Deep River County Park
    5. Deep River Waterpark
    6. Gibson Woods Nature Preserve
    7. Grand Kankakee Marsh

    1. Lake Etta
    2. Lemon Lake
    3. Oak Ridge Prairie
    4. Stoney Run
    5. Three Rivers
    6. Turkey Creek
    7. Other
41. Other
43. If hired, what date would you be able to start?
    If hired, what date would you be able to start?
44. Are you 18 years of age or older?

    1. Yes
    2. No
45. Please state your age.
    Please list what age you will be on the date you would be able to start work.
49. Background Information
51. Education History
53. High School
    Name and Location
54. Years Completed

    1. 1
    2. 2
    3. 3
    4. 4
    5. More
55. Did You Graduate?

    1. Yes
    2. No
    3. Still in Progress
56. Type of Degree
58. Have you received a Work Ethic Certificate through your school's Work Ethic Program?

    1. Yes

    1. No

    1. I am enrolled in the work ethic program, but have not completed it yet.
60. College
    Name and Location
61. Years Completed

    1. 1
    2. 2
    3. 3
    4. 4
    5. More
62. Did You Graduate

    1. Yes
    2. No
    3. Still in Progress
63. Type of Degree
65. Other
    Name and Location
66. Years Completed

    1. 1
    2. 2
    3. 3
    4. 4
    5. More
67. Did You Graduate

    1. Yes
    2. No
    3. Still in Progress
    4. Not Applicable
68. Type of Degree or Certification
70. Will you be attending school in the fall?

    1. Yes

    1. No
71. What date will you be leaving?
    What date will you be leaving?
75. Employment History
    Please provide your two most recent job experiences.
77. Company Name
78. Telephone Number
80. Address
81. City
82. State
83. ZIP
85. Dates Employed
    Dates Employed Start Date

    —

    Dates Employed End Date
    If still employed with company, select today's date date for second date.
86. Starting Wage
87. Ending Wage
89. Position Held
90. Job Duties
92. Reason for Leaving
94. May we contact this employer?

    1. Yes

    1. No
96. Company Name
97. Telephone Number
99. Address
100. City
101. State
102. ZIP
104. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
     If still employed with company, select today's date date for second date.
105. Starting Wage
106. Ending Wage
108. Position Held
109. Job Duties
111. Reason for Leaving
113. May we contact this employer?

     1. Yes

     1. No
115. Have you been employed by the Lake County Parks in the past?

     1. Yes
     2. No
116. When?
     When? Start Date

     —

     When? End Date
117. Where?
119. Do you have a relative employed with the Lake County Parks?

     1. Yes
     2. No
120. Their name
121. Their relationship to you
122. Where do they work?
126. Additional Information
128. If hired, do you have reliable transportation?

     1. Yes

     1. No
129. Do you have a valid driver's license?

     1. Yes

     1. No
131. Are you currently certified with the American Red Cross?

     1. Yes

     1. No
132. Please provide expiration date.
     Please provide expiration date.
134. Are you currently CPR Certified?

     1. Yes

     1. No
135. Please provide expiration date.
     Please provide expiration date.
137. Are you currently First Aid Certified?

     1. Yes

     1. No
138. Please provide expiration date.
     Please provide expiration date.
140. Are you applying to be a bartender?

     1. Yes

     1. No
142. Do you have a valid bartenders license?

     1. Yes

     1. No
143. Please provide expiration date.
     Please provide expiration date.
145. Have you completed the Server's Training Program?

     1. Yes

     1. No
146. Please provide expiration date.
     Please provide expiration date.
148. Did someone recommend that you apply?

     1. Yes
     2. No
149. Please list their first and last name.
151. Resume Upload
     You have the option to upload a resume. This is not required and will not be counted against you if you do not submit a current resume.
152. Double check your responses before submitting!
156. Applicant's Certification and Agreement
158. I hereby authorize Lake County Parks and Recreation Department to conduct background and reference checks in connection with my application for employment. I release Lake County Parks and Recreation Department from any and all liability that may arise from said background and reference checks. *

     1. I Agree
160. I understand that any falsification, misrepresentation, incomplete information, or omission of any facts called for during the application and/or hiring process will be sufficient for non-hiring or dismissal. *

     1. I Agree
162. I understand and hereby acknowledge that if I am offered employment with Lake County Parks and Recreation Department and accept said employment it is considered at-will, is for no definite period of time, and may be terminated at anytime with our without cause. I further understand that this application for employment does not constitute a contract of employment. *

     1. I Agree
164. E-Signature
     Please type your legal first and last name.
165. Date
Leave This Blank:


167. 1. Receive an email copy of this form.
168. Email address

     This field is not part of the form submission.

169. Submit Submit and Print

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