Bedford County Federated Library System

APPLICATION FOR EMPLOYMENT

Date: ____________________________

This library is an equal opportunity employer. Federal and State Laws prohibit discrimination in employment practices based on race, color, religion, sex, age, handicap, disability, or national origin. No question on this application is asked for the purpose of limiting or excluding any applicant’s consideration for employment because of his or her race, color, religion, sex, age, national origin, or the presence of a non-job-related medical condition or handicap.

 

The acceptance of this application does not indicate there are positions open

and does not obligate the Bedford County Federated Library System in any way.

 

Name:______________________________________________________________________________

(Last) (First) (Middle)

Present Address:_____________________________ ____________________________ ______ ___________

(Street) (Apt.#) (City) (State) (Zip Code)

How long have you lived at this address?__________________ Telephone Number:____________________

Position Desired:_______________________________________ Salary Desired:_______________________

Full or Part-time:_________________________ Would you have reliable transportation?_______________

Please indicate below the days and hours you would be available for work.

Monday _______ Tuesday ________ Thursday _______ Saturday _____

Wednesday _______

Friday _______

Would you accept temporary employment?_______________________

Special Skills: Keyboarding _________ Filing _________ Filing using Dewey Decimal System ___________

Knowledge of Microsoft Office ____________ Driving Large Vehicles________________

Other skills or qualifications which are related to the position for which you are applying: _________________

_________________________________________________________________________________________

Have you been convicted of a felony? ___________ If yes, describe in full:_____________________________

__________________________________________________________________________________________

Do you have current (less than one year old) Criminal Record Check, Child Abuse History Clearance and FBI fingerprint reports? __________________ If not, would you be willing to obtain them at your own expense? ___________

Date available for employment: ________________________________________________________________

****FILL IN THE FOLLOWING INFORMATION OR ATTACH A RESUME****

PERSONAL REFERENCES

(DO NOT INCLUDE RELATIVES OR FORMER EMPLOYERS)

____________________________________________________________________________________________________________

(Name) (Address) (Telephone Number)

____________________________________________________________________________________________________________

(Name) (Address) (Telephone Number)

____________________________________________________________________________________________________________

(Name) (Address) (Telephone Number)

EDUCATION

____________________________________________________________________________________________________________

(Name of High School) (Address) (Diploma or GED)

____________________________________________________________________________________________________________

(Post Secondary Education) (Address) (Degree or Certification)

____________________________________________________________________________________________________________

(If you did not graduate, why did you leave? Please explain)

FORMER EMPLOYERS

(LIST BELOW YOUR LAST FOUR EMPLOYERS, STARTING WITH THE MOST RECENT)

DATE

Month/Year

NAME, ADDRESS and PHONE NUMBER OF EMPLOYER

SALARY

POSITION & DUTIES

REASON for

LEAVING

From:

To:

 

Phone:

From:

To:

 

Phone:

     
From:

To:

 

Phone:

     
From:

To:

 

Phone:

     

May we contact the employers listed above? _____________ If not, indicate which one(s) you do not wish us to contact: __________

____________________________________________________________________________________________________________

I hereby certify that the answers in this application are true and correct to the best of my knowledge and authorize the library to investigate these statements without liability arising there from. I understand any false statements or omission of facts, wherever discovered, will be sufficient cause for discharge, if employed.

__________________________ ________________________________________________

(Date) (Signature)

 

Fill out after hiring: Social Security Number: _______________________________________________

Emergency Contact Name: ___________________________________________________ Phone: ___________________________

Relationship: Address: