Edith Belle Libby Memorial Library Employment Application

Employment Application

Applicant Information

Full Name:

___________________________

__________________________

_____

Date:

_________________

 

Last

First

M.I.

 

 

 

Address:

_____________________________________________________________________

__________________

 

Street Address

Apartment/Unit #

 

 

________________________________________________________

_____________

_________________

 

City

State

ZIP Code

 

Phone:

____________________________________

Email

___________________________________________

 

Date Available:

_____________

Social Security No.:

__________________

Desired Salary:

$________________

 

Position Applied for:

_______________________________________________________________________________________

 

Are you a citizen of the United States?

YES

 

NO

 

If no, are you authorized to work in the U.S.?

YES

NO

 

Have you ever worked for this company?

YES

NO

If yes, when?

_____________________________________

 

Have you ever been convicted of a felony?

YES

NO

 

 

If yes, explain:

_________________________________________________________________________________________

_________________________________________________________________________________________

Education

High School:

__________________________

Address:

__________________________________________________

 

From:

_________

To:

_________

Did you graduate?

YES

NO

Diploma::

__________________________

 

College:

________________________________

Address:

________________________________________________

 

From:

_________

To:

_________

Did you graduate?

YES

NO

Degree:

__________________________

 

Other:

______________________________

Address:

________________________________________________

 

From:

_________

To:

_________

Did you graduate?

YES

NO

Degree:

__________________________

References

Please list three professional references.

Full Name:

______________________________________________________________

Relationship:

_________________

Company:

______________________________________________________________

Phone:

_________________

Address:

__________________________________________________________________________________________________

 

 

 

 

Full Name:

______________________________________________________________

Relationship:

_________________

Company:

______________________________________________________________

Phone:

_________________

Address:

________________________________________________________________________________________________

 

 

 

 

Full Name:

______________________________________________________________

Relationship:

_________________

Company:

______________________________________________________________

Phone:

_________________

Address:

_________________________________________________________________________________________________

Previous Employment

Company:

_____________________________________________________________

Phone:

_________________

Address:

_____________________________________________________________

Supervisor:

_________________

 

Job Title:

__________________________

Starting Salary:

$______________

Ending Salary:

$_______________

 

Responsibilities:

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

From:

_____________

To:

_____________

Reason for Leaving:

_______________________________________________

_______________________________________________

 

May we contact your previous supervisor for a reference?

YES

NO

 

 

Company:

_____________________________________________________________

Phone:

_________________

Address:

_____________________________________________________________

Supervisor:

_________________

 

Job Title:

 

Starting Salary:

$

Ending Salary:

$

 

Responsibilities:

 

 

From:

_____________

To:

_____________

Reason for Leaving:

_______________________________________________

_______________________________________________

 

May we contact your previous supervisor for a reference?

YES

NO

 

 

Company:

_____________________________________________________________

Phone:

_________________

Address:

_____________________________________________________________

Supervisor:

_________________

 

Job Title:

 

Starting Salary:

$

Ending Salary:

$

 

Responsibilities:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

From:

_____________

To:

_____________

Reason for Leaving:

_______________________________________________

_______________________________________________

 

May we contact your previous supervisor for a reference?

YES

NO

 

Military Service

Branch:

_______________________________________________

From:

___________

To:

__________

 

Rank at Discharge:

_____________________________

Type of Discharge:

_______________________________

 

If other than honorable, explain:

___________________________________________________________________________

___________________________________________________________________________

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:

___________________________________________________________

Date:

______________________

 

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