Employee Connections™ | Official Site

Select the Program to which you are applying?

Are you a resident of Lake County?

First Name

Last Name

Date of Birth

Social Security Number

View

E-mail Address

Address

Apartment / Suite

City

State

Zip Code

Select Telephone Type

Telephone

Select Alternate Telephone Type

Alternate Telephone

Are you under the age of 18?

Because you are under the age of 18, below give us your parent (or guardian), their relations to you, and their contact information, such as their full name, relationship, address, and telephone number. Fill out fields below 1 through 8.

Do you live in the State of Illinois?

I'm authorized to work in the US?

Describe your eyesight or vision

Have a valid driver's license?

Gender

Are you over the age of 18 and registered with the Selective Services?

If over age 18, provide Selective Service Number

If not registered with Selective Services, click here to register.

Marital Status

Ethnicity

Race

What is your Primary Language?

How did you hear about us?

Military Status

Optional

Are you currently in school when school is in session?

Do you have a diploma/GED?

Are you willing to go back to school?

Select the one item that describes your current in school activity:

How can you travel to training?

Highest Level of Education

Do you have more degrees, certificates, licenses, or credentials?

Title

Institution

Date Earned

Credential Type

Credential Source

Upload Picture of Credential(s)
Send Picture

Are you working with any of the service providers below?

Select one or more that apply to you:

What are your immediate employment goals?

When are you ready to work?

What is the heaviest load that you could lift in the workplace?

What is the longest amount of time that you could stand upright in the workplace?

Are you able to sit for long periods of time?

Some employers require you to be drug free for 30-120 days. In those cases, they will require you to complete a drug test. Will you be able to pass a drug test?

What do you see as your work-related skills/strengths? Include knowledge of operating machines and equipment, ability to type, tools owned, etc.?

What work environment do you prefer?

Some employers will complete a background check on new employees. Please check all of the following that apply to your situation:

Social Media account for contact purpose

Have you had a job? If yes, list at least one job (most current).

Employment

Employer Name

Start Date

End Date

Job Title

City

State

Zip Code

Hours Per Week

Reason for Leaving

Where do you see yourself in 1 year?

Where do you see yourself in 5 years?

What steps have you taken to get there?

APPLICATION ID:

Address
2504 Washington Street • Suite 602
Waukegan, Illinois 60085
Telephone
(847) 360-7177
E-mail Address
stephanie@myEmployeeConnections.com
Fax
(847) 406-3106

APPLICATION ID:

Address

Telephone

E-mail Address

Fax