Employment Application Employment Application "*" indicates required fields Step 1 of 9 11% Position(s) Applied For* Date of Application* YYYY dash MM dash DD Potential Start Date* YYYY dash MM dash DD Applicant's Name* First Middle Initial Last Present Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your present address also your permanent address?* Yes No Permanent Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile PhoneHome PhoneWork PhoneEmail* Are you 18 years or older?* Yes No Where did you learn about this job opportunity?* Are you lawfully entitled to be employed in the United States?* Yes No Have you ever been convicted of, or plead guilty or no lo contendere to, a misdemeanor or felony?* Yes No If yes, please list the date, place and nature of the offense.Are there any misdemeanor or felony charges presently pending against you?* Yes No If yes, please list date of arrest, place and nature of the offense. Type of Employment* Full Time Part Time Have you ever applied to this library before?* Yes No For what position? When? MM slash DD slash YYYY Are you employed now?* Yes No May we contact your present employer? Yes No Current Employer Contact Name Current Employer Contact Title Current Employer Contact Phone Education InformationHigh School: Name High School: Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State High School: Number of Years AttendedHigh School: Did you graduate? Yes No College: Name College: Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State College: Number of Years AttendedCollege: Did you graduate? Yes No College: Subject / Major Specialized Training: Name Specialized Training: Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Specialized Training: Number of Years AttendedSpecialized Training: Did you graduate? Yes No Specialized Training: Subject / Major Please provide any additional information such as special skills, training, management experience, equipment operation or qualifications you feel will be helpful to us in considering your application. ReferencesThree individuals not related to you, whom you have known for at least one year.Reference 1: Name* First Last Reference 1: Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 1: Phone*Reference 1: Relationship* Reference 1: Years Acquainted*Reference 2: Name* First Last Reference 2: Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 2: Phone*Reference 2: Relationship* Reference 2: Years Acquainted* Reference 3: Name* First Last Reference 3: Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reference 3: Phone*Reference 3: Relationship* Reference 3: Years Acquainted* Emergency Contact's Name* First Last Emergency Contact's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact's Phone* Employment InformationPlease give a complete and accurate record of full-time and part-time employment for the past ten years. Starting with the most recent first.Employer 1: Start Date MM slash DD slash YYYY Employer 1: End Date MM slash DD slash YYYY Employer 1: Company Name Employer 1: Contact Name First Last Employer 1: Address Street Address Address Line 2 City State ZIP Code Employer 1: PhoneEmployer 1: Starting SalaryEmployer 1: Ending SalaryEmployer 1: Last Position Held/ResponsibilitesEmployer 1: Reason for LeavingEmployer 2: Start Date MM slash DD slash YYYY Employer 2: End Date MM slash DD slash YYYY Employer 2: Company Name Employer 2: Contact Name First Last Employer 2: Address Street Address Address Line 2 City State ZIP Code Employer 2: PhoneEmployer 2: Starting SalaryEmployer 2: Ending SalaryEmployer 2: Last Position Held/ResponsibilitesEmployer 2: Reason for leavingEmployer 3: Start Date MM slash DD slash YYYY Employer 3: End Date MM slash DD slash YYYY Employer 3: Company Name Employer 3: Contact Name First Last Employer 3: Address Street Address Address Line 2 City State ZIP Code Employer 3: PhoneEmployer 3: Starting SalaryEmployer 3: Ending SalaryEmployer 3: Last Position Held/ResponsibilitesEmployer 3: Reason for leavingEmployer 4: Start Date MM slash DD slash YYYY Employer 4: End Date MM slash DD slash YYYY Employer 4: Company Name Employer 4: Contact Name First Last Employer 4: Address Street Address Address Line 2 City State ZIP Code Employer 4: PhoneEmployer 4: Starting SalaryEmployer 4: Ending SalaryEmployer 4: Last Position Held/ResponsibilitesEmployer 4: Reason for leavingEmployer 5: Start Date MM slash DD slash YYYY Employer 5: End Date MM slash DD slash YYYY Employer 5: Company Name Employer 5: Contact Name First Last Employer 5: Address Street Address Address Line 2 City State ZIP Code Employer 5: PhoneEmployer 5: Starting SalaryEmployer 5: Ending SalaryEmployer 5: Last Position Held/ResponsibilitesEmployer 5: Reason for leavingMay we contact the employers listed?* Yes No If not, which one(s)? Employer 1 Employer 2 Employer 3 Employer 4 Employer 5 Select All Scheduling Availability*If there are any days or times you would not be able to work due to family commitments, school, or other activities, please list them here. Please read the following statement carefully before agreeing to indicate your understanding.*I understand that, prior to being offered employment, I may be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Library prior to the test so that a reasonable accommodation can be made. The Library reserves the right to require medical documentation regarding the need for accommodation. I certify that the facts contained in this application are true, accurate, and complete to the best of my knowledge and understand that falsified or misleading statements or omitted material facts on this application may result in my disqualification from consideration for employment or termination from employment if I have been hired. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice. I authorize investigation of all statements contained in this application for any employment-related purpose. I authorize the listed references, all employers, except those specifically excepted*, and any other third party to whom a request for information is made, to provide you with any and all applicable information they may have. I hereby release these references, current and former employers, and third parties, from all liability for any information they may give to you. I agreeEmployers Specifically ExceptedI do not release the following references and / or employers to provide any information. Document Submissions Drop files here or Select files Max. file size: 64 MB. Please attach any relevant documents, including cover letters, resumes, references, letters of recommendation, etc.PhoneThis field is for validation purposes and should be left unchanged.
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