Pre-Employment Form

Champaign Park District Criminal Background

The 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:*

Prefix First Middle Last Suffix

Birth Date*

Alias names you have used:

Date*

Gender:*

Race/Ethnicity:*

Social Security Number:*

State of Illinois Driver's Abstract Request

To 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):*

Prefix First Middle Last Suffix

Driver’s license number:

Classification/endorsements:

Pending CPD Position

Have 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*

Phone

This field is for validation purposes and should be left unchanged.

Pre-Employment Form