APPLICATION FOR EMPLOYMENT

THIS APPLICATION MUST BE SIGNED AND DATED ON PAGE 3 BY APPLICANT AND LIBRARY STAFF MEMBER IN ORDER TO BE A VALID APPLICATION

YOUR OBJECTIVE

Job Position You Are Applying For: Today’s Date:

(Must Specify Open Position)

Date available for work Employment interests

Full-time Part-time

Will you work evenings/weekends if necessary?

Yes No

PERSONAL

Name: last first middle

Address: number street city state zip code

Telephone number E-mail Are you 18 years of age or older?

Yes No

EDUCATION

Highest elementary or high school grade completed (circle) 1 2 3 4 5 6 7 8 9 10 11 12

Did you graduate or receive a GED?

School name Dates attended

Major Subjects

Graduated

Date degree

granted or

expected

Diploma

or

Degree

From To

Mo.

Yr.

Mo.

Yr.

Vocational/technical school Yes

No

College Yes

No

Graduate school Yes

No

Other special schooling

MILITARY

Military Service

Yes No

U.S. Military Branch Highest rank achieved Date entered Date of separation or discharge Civilian related experience and training

REFERENCES (List three work references who are qualified to describe your work abilities) Name Email Address Telephone number Company

1)

2)

3)

AN EQUAL OPPORTUNITY EMPLOYER –

Applicant is not required to give any information on this form that is prohibited by federal, state, or local law EMPLOYMENT HISTORY (Also list any period of unemployment that exceeds 90 days) 1) Company name of last or current employer Title and primary job tasks Address Phone number

Date hired Salary Per

Date left Salary Per

Supervisor’s name

May we contact your supervisor for a reference before a job offer is made? Yes No

Reason for leaving

2) Company name of previous employer Title and primary job tasks Address Phone number

Date hired Salary Per

Date left Salary Per

Supervisor’s name Reason for leaving

3) Company name of previous employer Title and primary job tasks Address Phone number

Date hired Salary Per

Date left Salary Per

Supervisor’s name Reason for leaving

OFFICE EQUIPMENT SKILLS (Check skills and equipment operated)

Personal Computer

Macintosh

Internet

Windows 2010

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Outlook

Page layout software

Graphic Design

Other

FOREIGN LANGUAGES

FLUENT GOOD FAIR

SPEAK

READ

WRITE

OTHER INFORMATION

Have you previously applied for a job with the library?

Yes No

Have you previously been employed by the library?

Yes No

Have you been convicted under any criminal law as an adult?

Yes No

Note: a criminal conviction does not automatically disqualify you. If yes, explain:

Have you been convicted under any misdemeanor law as an adult?

Yes No

Note: a misdemeanor conviction does not automatically disqualify you. If you are hired, can you provide proof that you are eligible to work in the United States? Yes No Please use this space for any additional remarks you may have regarding your qualifications. Applicant: READ BEFORE SIGNING AND SUBMITTING THIS APPLICATION Proof of citizenship or immigration status will be required upon employment. To ensure that employees and volunteers of Fayetteville Public Library are well-qualified and to further ensure that Fayetteville Public Library maintains a safe and productive work environment free of any form of violence, harassment or misconduct—it is the policy of Fayetteville Public Library to screen applicants, whether for employment or volunteer work, and to verify applicant references, credentials, or both. I agree and understand that Fayetteville Public Library may investigate my background and employment history to ascertain any and all information pertaining to my record, whether same is of record or not. I release employers and persons named herein from all liability for any damages on account of their furnishing such information. I agree to furnish any additional information and/or submit to oral, written or physical examination as may be required to complete the employment file.

It is agreed and understood that this application for employment does not obligate the library to employ me. Further, I understand and agree that, if employed, my employment is at will only and for no term of definite duration. I also understand and agree that either I or the Fayetteville Public Library may terminate the employment relationship at any time. This certifies that this application was completed by me, the undersigned, and that all entries and information on it are true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts called for in this application, in any supplement thereto, or in any library records, will be sufficient grounds for not employing me, or will be cause for immediate dismissal without notice at any time during my employment.

We appreciate your interest in our library as a place of employment. Your qualifications will be given careful consideration. It is our continuing policy to provide each individual equal opportunity in all aspects of employment regardless of sex, color, age, religion, national origin or an otherwise qualified individual with a physical or mental impairment that limits a major life activity. Signature of applicant Date

Signature of staff person accepting this application Date

VOLUNTARY SELF-IDENTIFICATION

(CONFIDENTIAL - FOR STATISTICAL USE ONLY)

This page is completely voluntary and you do not have to fill it out. Your job application will not be favored or disfavored because you did or did not complete this page. The Fayetteville Public Library is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, or any other classification protected by federal, state or local law. Due to the Library’s receipt of Federal Grant Money, it is required to ask you to voluntarily provide the information below. If you choose to provide it, the information will be recorded for Equal Employment Opportunity Program purposes. This form will be removed from the job application by Human Resource staff for the purpose of recording the information for statistical analysis.

The rest of your application will then be forwarded to the hiring supervisor(s) for consideration. Neither the hiring supervisor nor any hiring decision makers will see this form. Referral source (please check one):

__Advertisement __Internal Job Posting __Friend __Relative __Walk-in __Employment agency Recruiting Job Fair __Other Gender: Female Male

White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. Asian or Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent or the Pacific Islands. This area includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, Samoa, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

NOTE: If you are a veteran, and an offer of employment is made to you, after the offer has been made and you have accepted, please notify the Human Resources Division of your veteran status at your New Employee Meeting when you are placed on payroll. This is strictly for EEOP program purposes. Thank you.

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