Form PM 1080 Employment Application for Technical Positions - Illinois

Form PM1080 is a Illinois Department of Transportation form also known as the "Employment Application For Technical Positions". The latest edition of the form was released in June 1, 2017 and is available for digital filing.

Download a PDF version of the Form PM1080 down below or find it on Illinois Department of Transportation Forms website.

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Employment Application for
Technical Positions
PLEASE NOTE: IDOT WILL NEITHER ACCEPT NOR PROCESS UNSIGNED OR INCOMPLETE APPLICATIONS.
Submittal Options:
Mail or hand deliver the signed and completed form to: Bureau of Personnel Management, 2300 S. Dirksen Parkway,
Room 113, Springfield, IL 62764
Fax the signed and completed form to: (217) 557-3134
E-mail the signed and completed form to:
DOT.CO.BPM.EmploymentApplications@illinois.gov
The Illinois Department of Transportation is an Equal Opportunity Employer and is committed to the policy of equal employment
opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job-related experience and other
qualifications will be considered without discrimination on grounds of race, color, religion, sex, national origin, age, or disability. We
seek to match your career interests and abilities with the opportunities available. Therefore, please make your responses as complete
and accurate as possible.
Please type or print legibly in blue or black ink.
Position Applying For and District/Position Location
IPR#
Date of Birth
Name: Last, First, M.I.
Social Security Number
Street Address
County
City
State
Zip Code
Driver's License Number State
Month/Year Expires
Restrictions
A
B
C
D
L
M
A
B
X
N
Non CDL
CDL
ENDR
E-mail Address
Telephone (home)
Telephone (work)
Conditions:
1. I understand that employment may be contingent upon satisfactory results from a urine drug screen.
2. I understand I may be required to submit proof of previous employment, education, military service, or other statements in this
application. I authorize release of this and other information covering job related factors for purposes of verification and
determination of suitability for State employment.
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 will be justification for
refusal of employment or, if employed, termination from the Illinois Department of Transportation.
Applicant's Signature
Date
The Department of Transportation is requesting disclosure of information that is necessary to process this application. Disclosure of this
information is REQUIRED. Failure to provide any information will result in this application not being processed.
Building Illinois
Building Your Career
visit us at
www.idot.illinois.gov
Printed 06/05/19
Page 1 of 4
PM 1080 (Rev. 06/01/17)
Employment Application for
Technical Positions
PLEASE NOTE: IDOT WILL NEITHER ACCEPT NOR PROCESS UNSIGNED OR INCOMPLETE APPLICATIONS.
Submittal Options:
Mail or hand deliver the signed and completed form to: Bureau of Personnel Management, 2300 S. Dirksen Parkway,
Room 113, Springfield, IL 62764
Fax the signed and completed form to: (217) 557-3134
E-mail the signed and completed form to:
DOT.CO.BPM.EmploymentApplications@illinois.gov
The Illinois Department of Transportation is an Equal Opportunity Employer and is committed to the policy of equal employment
opportunity in recruitment, hiring, career advancement, and all other personnel practices. Your job-related experience and other
qualifications will be considered without discrimination on grounds of race, color, religion, sex, national origin, age, or disability. We
seek to match your career interests and abilities with the opportunities available. Therefore, please make your responses as complete
and accurate as possible.
Please type or print legibly in blue or black ink.
Position Applying For and District/Position Location
IPR#
Date of Birth
Name: Last, First, M.I.
Social Security Number
Street Address
County
City
State
Zip Code
Driver's License Number State
Month/Year Expires
Restrictions
A
B
C
D
L
M
A
B
X
N
Non CDL
CDL
ENDR
E-mail Address
Telephone (home)
Telephone (work)
Conditions:
1. I understand that employment may be contingent upon satisfactory results from a urine drug screen.
2. I understand I may be required to submit proof of previous employment, education, military service, or other statements in this
application. I authorize release of this and other information covering job related factors for purposes of verification and
determination of suitability for State employment.
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 will be justification for
refusal of employment or, if employed, termination from the Illinois Department of Transportation.
Applicant's Signature
Date
The Department of Transportation is requesting disclosure of information that is necessary to process this application. Disclosure of this
information is REQUIRED. Failure to provide any information will result in this application not being processed.
Building Illinois
Building Your Career
visit us at
www.idot.illinois.gov
Printed 06/05/19
Page 1 of 4
PM 1080 (Rev. 06/01/17)
Military Service: If you have ever served in the U.S. Military, please complete the following:
Branch of Service
Rank Attained
Dates of Active Duty
From:
To:
Special Training
Licenses:
Engineering Applicants:
If applying for a CE/EE I, II or III position, you must possess a four-year degree from an ABET accredited college in engineering or
be a Licensed Engineer Intern in the State of Illinois.
If applying for a CE/EE IV and above position, you must be a Licensed Professional Engineer in Illinois.
Professional Engineer License Number
Technical / Professional License
Number
State
Date Issued
Current?
Mo.
Yr.
No
Yes
Technical / Professional License
Number
State
Date Issued
Current?
No
Mo.
Yr.
Yes
Education: List all of your education accurately.
High School
OR
GED
College / University
Years Completed
Graduated?
Received GED Certificate?
Years Completed
Graduated?
0 1 2 3 4
Yes
No
Yes No
0
1
2
3
4
5
6
7
8
Yes
No
Name of Colleges /
Total No.
Dates Attended
Level of
Date Degree
Universities Attended
of Hours
Major
Minor
From
To
Degree Earned
Awarded
Undergraduate
Sem. (or) Qtr.
Mo.
Yr.
Mo.
Yr.
Mo.
Yr.
Graduate
Mo.
Yr.
Mo.
Yr.
Mo.
Yr.
for
College
or
High School
Approximate GPA
out of
List other special degrees, training, skills, specialized work experience or other factors that should be considered.
Printed 06/05/19
Page 2 of 4
PM 1080 (Rev. 06/01/17)
Work History: Complete this section beginning with your last or present employer and work backward. Applicants should list summer jobs
and/or part time positions.
Employer
Address
Monthly Salary
Payroll Title
Employment Dates
From:
To:
Start:
End:
Mo. Yr.
Mo. Yr.
Duties and Responsibilities
Hours Actually Worked Per Week
Reason for Leaving
Employer
Address
Monthly Salary
Payroll Title
Employment Dates
From:
To:
Start:
End:
Mo. Yr.
Mo. Yr.
Duties and Responsibilities
Hours Actually Worked Per Week
Reason for Leaving
Employer
Address
Monthly Salary
Payroll Title
Employment Dates
From:
To:
Start:
End:
Mo. Yr.
Mo. Yr.
Duties and Responsibilities
Hours Actually Worked Per Week
Reason for Leaving
Add Employer
Printed 06/05/19
Page 3 of 4
PM 1080 (Rev. 06/01/17)
Citizenship: I certify that I am:
a U.S. citizen
a non-citizen with permanent work authorization
a non-citizen with renewable work authorization
Statements: If you answer “Yes” to any of the following statements, you must provide a detailed explanation in the space provided
below. Failure to provide a detailed explanation to any "Yes" statements will result in denial of your application.
Yes
No
1.
Have you ever been employed by the Illinois Department of Transportation?
Yes
No
2.
Do you have any relatives employed by the Department?
Yes
No
3.
Have you ever been fired from a job?
Yes
No
4.
Are you currently in default on the repayment of any State educational loan?
State law provides that any employee who is in default on the repayment of any educational loan for a period of 6 months or more and in the amount
of $600.00 or more shall, as condition of employment, make a satisfactory loan repayment arrangement with the maker or guarantor of the loan.
Detailed explanation for "yes" answers above
Affirmative Action: All State agencies are 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. Should you decide to offer this information,
please check the one letter, and, if applicable, the appropriate number(s).
Female
Male
A
G
White not of Hispanic Origin. A person having origins in any of the peoples 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.
Native American. A person having origins in any of the original peoples of North America, and who maintain cultural
C
J
identification through tribal affiliation or community.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian sub-continent, or the
D
K
Pacific Islands. This area includes, for example: China, Japan, Korea, the Philippine Islands, and Samoa.
Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish Culture or origin,
E
L
regardless of race.
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa,
P
Q
or other Pacific Islands.
1. blindness / visual impairment
2. deafness / hearing impairment
3. orthopedic impairment
4. cardiovascular disease
5. mental disorder
6. nervous system disorder
7. respiratory related impairment
8. loss of limbs
9. other (specify)
Professional References: Please do not list relatives. College students may include faculty reference.
Name
E-Mail Address
Phone
For information about IDOTs collection and use of confidential information review the department's
Identity Protection
Policy.
Printed 06/05/19
Page 4 of 4
PM 1080 (Rev. 06/01/17)

Download Form PM 1080 Employment Application for Technical Positions - Illinois

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