Employment Application

Position(s) Applied For*
Date of Application*
Date Format: YYYY dash MM dash DD
Potential Start Date*
Date Format: YYYY dash MM dash DD
Applicant's Name*
First Middle Initial Last
Present Address*
Street Address Address Line 2 City State ZIP Code
Is your present address also your permanent address?*
- Yes
- No
Permanent Address
Street Address Address Line 2 City State ZIP Code
Mobile Phone
Home Phone
Work Phone
Email*
Are you 18 years or older?*
- Yes
- No
Are you lawfully entitled to be employed in the United States?*
- Yes
- No
Have you ever been convicted of a crime except a minor traffic violation?*
- Yes
- No
Please state citation, date, and place where offense occurred

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Salary Desired
Type of Employment*
- Full Time
- Part Time
Have you ever applied to this library before?*
- Yes
- No
For what position?
When?
Date Format: 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

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Education Information
High School: Name
High School: Location
City State
High School: Number of Years Attended
High School: Did you graduate?
- Yes
- No
College: Name
College: Location
City State
College: Number of Years Attended
College: Did you graduate?
- Yes
- No
College: Subject / Major
Specialized Training: Name
Specialized Training: Location
City State
Specialized Training: Number of Years Attended
Specialized 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.

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References
Three 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 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 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 State ZIP Code
Reference 3: Phone*
Reference 3: Relationship*
Reference 3: Years Acquainted*

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Emergency Contact's Name*
First Last
Emergency Contact's Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact's Phone*

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Employment Information
Please 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
Date Format: MM slash DD slash YYYY
Employer 1: End Date
Date Format: 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: Phone
Employer 1: Starting Salary
Employer 1: Ending Salary
Employer 1: Last Position Held/Responsibilites
Employer 1: Reason for Leaving
Employer 2: Start Date
Date Format: MM slash DD slash YYYY
Employer 2: End Date
Date Format: 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: Phone
Employer 2: Starting Salary
Employer 2: Ending Salary
Employer 2: Last Position Held/Responsibilites
Employer 2: Reason for leaving
Employer 3: Start Date
Date Format: MM slash DD slash YYYY
Employer 3: End Date
Date Format: 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: Phone
Employer 3: Starting Salary
Employer 3: Ending Salary
Employer 3: Last Position Held/Responsibilites
Employer 3: Reason for leaving
Employer 4: Start Date
Date Format: MM slash DD slash YYYY
Employer 4: End Date
Date Format: 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: Phone
Employer 4: Starting Salary
Employer 4: Ending Salary
Employer 4: Last Position Held/Responsibilites
Employer 4: Reason for leaving
Employer 5: Start Date
Date Format: MM slash DD slash YYYY
Employer 5: End Date
Date Format: 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: Phone
Employer 5: Starting Salary
Employer 5: Ending Salary
Employer 5: Last Position Held/Responsibilites
Employer 5: Reason for leaving
May we contact the employers listed?*
- Yes
- No
If not, which one(s)?
- Select All
- Employer 1
- Employer 2
- Employer 3
- Employer 4
- Employer 5

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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 Company prior to the test so that a reasonable accommodation can be made. The Company 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, if employed, falsified 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 release the listed references and all employers, except those specifically excepted,* to provide you with any and all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to you.
I agree
Employers Specifically Excepted
I do not release the following references and / or employers to provide any information.

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Document Submissions
Drop files here or
Please attach any relevant documents, including cover letters, resumes, references, letters of recommendation, etc.
Comments
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Step 1 of 9

Education Information

References

Employment Information

Hours the Applicant Cannot Work During the Week

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Step 1 of 9

Education Information

References

Employment Information

Hours the Applicant Cannot Work During the Week

Comments are closed.