Form PM 2414 2019 Application for Snow Removal Operator (Hourly Snowbirds) - Illinois

Form PM2414 or the "Application For Snow Removal Operator (hourly Snowbirds)" is a form issued by the Illinois Department of Transportation.

The form was last revised in July 30, 2018 and is available for digital filing. Download an up-to-date Form PM2414 in PDF-format down below or look it up on the Illinois Department of Transportation Forms website.

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2018/2019 Application For Snow
Removal Operator (Hourly Snowbirds)
PLEASE NOTE: IDOT WILL NEITHER ACCEPT NOR PROCESS UNSIGNED, INCOMPLETE, OR OUTDATED VERSIONS OF
APPLICATIONS
Counties Applying For
1.
2.
(first county preference)
(second county preference)
PERSONAL
Name
Social Security Number
Date of Birth
State
Address
County
City
Email
Zip Code
Phone Number
2nd Phone Number
CONDITIONS OF EMPLOYMENT
1) This position requires you to be available to work in emergency conditions any time including weekends, holiday
and nights, as well as to report to the maintenance facility no later than 45 minutes from being called.
Can you meet requirement?
Yes
No
2) This position requires a CDL Class A or B license with an N or X endorsement and non-restricted air brakes.
Can you meet requirement?
Yes
No
If you answer “yes” to this question, please complete the CDL information in the boxes below. You must provide a copy of your CDL
CLASS A or B license prior to scheduling a pre-employment physical. You may attach a copy of your license to this application. If you
answer “no” to this question, you must obtain a CDL Class A or B license and provide prior to scheduling a pre-employment physical.
CDL CLASS
CDL#
CDL Endorsement
CDL Expiration Date
Restrictions
A
B
3) 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
If you answer “yes” to this question, you must answer a, b & c below.
a) Name
b) Title / Work Location
c) Relationship
4) Have you ever been employed by the Illinois Department of Transportation?
Yes
No
5) Have you ever been fired or asked to leave/resign from a job?
Yes
No
If you answer “yes” to this question, you must provide a detailed explanation in the box below.
Printed 06/05/19
Page 1 of 4
PM 2414 (Rev. 07/30/18)
2018/2019 Application For Snow
Removal Operator (Hourly Snowbirds)
PLEASE NOTE: IDOT WILL NEITHER ACCEPT NOR PROCESS UNSIGNED, INCOMPLETE, OR OUTDATED VERSIONS OF
APPLICATIONS
Counties Applying For
1.
2.
(first county preference)
(second county preference)
PERSONAL
Name
Social Security Number
Date of Birth
State
Address
County
City
Email
Zip Code
Phone Number
2nd Phone Number
CONDITIONS OF EMPLOYMENT
1) This position requires you to be available to work in emergency conditions any time including weekends, holiday
and nights, as well as to report to the maintenance facility no later than 45 minutes from being called.
Can you meet requirement?
Yes
No
2) This position requires a CDL Class A or B license with an N or X endorsement and non-restricted air brakes.
Can you meet requirement?
Yes
No
If you answer “yes” to this question, please complete the CDL information in the boxes below. You must provide a copy of your CDL
CLASS A or B license prior to scheduling a pre-employment physical. You may attach a copy of your license to this application. If you
answer “no” to this question, you must obtain a CDL Class A or B license and provide prior to scheduling a pre-employment physical.
CDL CLASS
CDL#
CDL Endorsement
CDL Expiration Date
Restrictions
A
B
3) 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
If you answer “yes” to this question, you must answer a, b & c below.
a) Name
b) Title / Work Location
c) Relationship
4) Have you ever been employed by the Illinois Department of Transportation?
Yes
No
5) Have you ever been fired or asked to leave/resign from a job?
Yes
No
If you answer “yes” to this question, you must provide a detailed explanation in the box below.
Printed 06/05/19
Page 1 of 4
PM 2414 (Rev. 07/30/18)
INTERVIEW QUESTIONS
6) This position requires a CDL Class A or B license with an N or X endorsement. You must only check one box
below that best describes how many miles per year you drive a vehicle requiring a CDL license.
40,000 miles or more
30,000 to 39,999 miles
20,000 to 29,999 miles
10,000 to 19,999 miles
1,000 to 9,999 miles
0 to 999 miles
7) How many years of experience do you have plowing snow or maintaining public streets or highways in adverse
weather conditions? You must only check one box below that best describes your experience.
10 years or more experience
7 to 9 years’ experience
4 to 6 years’ experience
1 to 3 years’ experience
No experience
8) You must check all the boxes that describe the specific vehicles or equipment you have operated.
3 Ton Dump Trucks
Truck Mounted Snowplows
6 Ton Dump Trucks
Truck Mounted Salt Spreaders
Farm Tractors
End Loaders
Graders
Other
None of the Above
9) You must only check one box below that best describes your highest level of completed education.
Bachelor’s Degree
Vocational/Trade School
Associate Degree
Completion of 12th Grade
GED
8th Grade Through 11th Grade
Less than 8th Grade
10) You must check all the boxes that best describe all the pertinent certifications/training that you have completed.
HazMat Training at the Awareness Level & Above
OSHA (ex 40 hr OSHA Construction Worker Class)
Equipment Training: Snow Plow, Loader, Backhoe, Motor Grader, Fork Lift, Power Industrial Truck
Heavy Equipment
Mechanic Training or Certification
Power Equipment/Tool Training
Defensive Driving
Training or Certification Through a Union Hall
Safety Training or Certificate
Snow Removal
Traffic Control/Flagger Training
CPR/First Aid/First Responder
Military Training
Pesticide Applicator/License
Truck Driving School
Trailering
Former IDOT/City/County/State Training
Equipment Transport
Drainage
Radio/Communications Training
Tree Trimming/Removal
Welding
Traffic Incident Management (TIM) Training
Respirator Training
Pavement Repair
National Incident Management (NIMS) and/or Incident Command System (ICS)
Truck Service/Repair
None
11) List the steps you would take if you came upon an accident during your shift.
12) List the steps involved with properly entering and exiting the cab of any piece of equipment or truck.
Printed 06/05/19
Page 2 of 4
PM 2414 (Rev. 07/30/18)
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. Provide
this information is strictly voluntary on your part. Should you decide to offer the information, please check the appropriate box below.
Female
Male
White, not of Hispanic origin. A person having origins in any of the original people of Europe, North Africa or the Middle
A
G
East.
H Black, not of Hispanic origin. A person having origins in any of the black racial groups of Africa.
B
Native American. A person having origins in any of the peoples of North American and who maintain cultural identification
C
J
through tribal affiliation of community
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent. This
D
K
area includes, for example, China, Japan, Korea, Philippine Islands
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
Please indicate whether you have any of the following conditions by checking the appropriate boxes below.
No Impairment
Orthopedic Impairment
Nervous System Disorder
Blindness/Visual Impairment
Cardiovascular Disorder
Respiratory Impairment
Deafness/Hearing Impairment
Mental or Emotional Disorder
Loss of Limbs
Other
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.
By checking this box and typing my name in the field below I agree to the conditions listed above and verify that the
information on this application is accurate and complete.
Applicant's Name (or Signature)
Date
Position subject to physical examination and random drug and alcohol testing.
PLEASE NOTE: IDOT WILL NEITHER ACCEPT NOR PROCESS UNSIGNED, INCOMPLETE, OR OUTDATED
VERSIONS OF APPLICATIONS
Please return application by 4:30 on the posting deadline.
Printed 06/05/19
Page 3 of 4
PM 2414 (Rev. 07/30/18)
Applications are to be returned to the Illinois Department of Transportation at the following locations
District 2
District 6
(Counties: Boone, Carroll, Henry, Jo Daviess, Lee, Ogle, Rock
(Counties: Adams, Brown, Cass, Christian, Hancock, Logan,
Island, Stephenson, Whiteside, Winnebago)
Macoupin, Mason, Menard, Montgomery, Morgan, Pike, Sangamon,
Illinois Department of Transportation
Schuyler, Scott)
Attn: Personnel
Illinois Department of Transportation
819 Depot Ave
Attn: Personnel
Dixon, IL 61021
126 E Ash St
Fax number (815) 284-5908
Springfield, IL 62704
Email: DOT.D2WinterApplications@illinois.gov
Fax number (217) 557-1089
Email: DOT.D6WinterApplications@illinois.gov
District 3
District 7
(Counties: Bureau, Dekalb, Ford, Grundy, Iroquois, Kankakee,
(Counties: Clark, Clay, Coles, Crawford, Cumberland, Edwards,
Kendall, La Salle, Livingston)
Effingham, Fayette, Jasper, Lawrence, Macon, Moultrie, Richland,
Illinois Department of Transportation
Shelby, Wabash, Wayne)
Attn: Personnel
Department of Transportation
700 E Norris Dr
Attn: Personnel
Ottawa, IL 61350
400 W Wabash
Fax number (815) 433-7073
Effingham, IL 62401
Email: DOT.D3WinterApplications@illinois.gov
Fax number (217) 342-8384
Email: DOT.D7WinterApplications@illinois.gov
District 4
District 8
(Counties: Fulton, Henderson, Knox, Marshall, Mc Donough, Mercer,
(Counties: Bond, Calhoun, Clinton, Greene, Jersey, Madison,
Peoria, Putnam, Stark, Tazewell, Warren, Woodford)
Marion, Monroe, Randolph, St. Clair, Washington)
Illinois Department of Transportation
Illinois Department of Transportation
Attn: Personnel
Attn: Personnel
401 Main St
1102 Eastport Plaza Dr
Peoria, IL 61602
Collinsville, IL 62234
Fax number (309) 671-4882
Fax number (618) 346-3386
Email: DOT.D4WinterApplications@illinois.gov
Email: DOT.D8WinterApplications@illinois.gov
District 5
District 9
(Counties: Champaign, Dewitt, Douglas, Edgar, Mc Lean, Piatt,
(Counties: Alexander, Franklin, Gallatin, Hamilton, Hardin, Jackson,
Vermilion)
Jefferson, Johnson, Massac, Perry, Pope, Pulaski, Saline, Union,
Illinois Department of Transportation
White, Williamson)
Attn: Personnel
Illinois Department of Transportation
13473 IL Hwy 133
Attn: Personnel
PO Box 610
2801 W Murphysboro Rd
Paris, IL 61944
Carbondale, IL 62903
Fax number (217) 463-8169
Fax number (618) 351-5298
Email: DOT.D5WinterApplications@illinois.gov
Email: DOT.D9WinterApplications@illinois.gov
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 2414 (Rev. 07/30/18)

Download Form PM 2414 2019 Application for Snow Removal Operator (Hourly Snowbirds) - Illinois

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