Vigo County Public Library

APPLICATION FOR EMPLOYMENT

(Applications accepted for current openings only)

An Equal Opportunity Employer

The Vigo County Public Library provides equal employment opportunities to all applicants for employment without regard to race, color, creed, religious belief, sex, national origin, age, physical or mental disability, ancestry, or veteran status. Vigo County Public Library complies with all applicable federal, state and local laws governing nondiscrimination in employment in every library location. The Equal Employment Opportunity Policy applies to all terms and other conditions of employment, including, but not limited to, recruitment, selection, training, hiring, termination, transfer, leaves of absence, compensation, or any other personnel action.

Position Desired: / r Full time r Part time r Either / Today’s Date:
Referral Source / r Walk In r Advertisement r Library Employee
r Relative r Employment Agency r Other
Name:
Last Name / First Name / Middle Name
Address:
Street / City / State / Zip Code
Telephone: / ( ) / Social Security Number:
If you are under 18, can you furnish a work permit? r Yes r No
Have you ever filed an application here before? r Yes r No / If yes, give dates:
Have you ever been employed here before? r Yes r No / If yes, give dates:
Are you employed now? r Yes r No / May we contact your present employer? r Yes r No
Are you legally eligible to work in the United States? r Yes r No (Proof of U.S. Citizenship or immigration status will be required upon employment)
Date you will be available to work:
Days of the week you are available to work:
(VCPL is open Mon-Sun) / r Mon r Tues r Wed r Thurs r Fri r Sat r Sun
Time of day you are available to work:
(VCPL is open to public 9am to 9pm)
Have you ever been arrested for or convicted of a crime that has not been expunged by a court? r Yes r No
(Conviction will not necessarily disqualify applicant from employment) / If yes, please explain:
Are you a veteran of the U.S. Military Service? r Yes r No / If yes, branch and dates of service:
EDUCATION
High School
(Circle highest grade completed) / 1 2 3 4 / Location / Major/Minor / Degree
College or Vocational
(Circle highest grade completed) / 1 2 3 4 / Location / Major/Minor / Degree
Graduate School
(Circle highest grade completed) / 1 2 3 4 / Location / Major/Minor / Degree
Other Training or
Continuing Education / Location / Major/Minor / Degree
Computer and Software applications coursework
EMPLOYMENT EXPERIENCE
List all employment starting with your present or most recent employer. Account for all periods, including unemployment and service in the Armed Forces. Also include relevant volunteer work. Use additional sheet if necessary.
Employer: / Phone: / ( ) / Dates Employed / Work Performed
Address: / From / To
Job Title / Hourly Rate/Salary
Supervisor: / Starting / Final
Reason for Leaving:
Employer: / Phone: / ( ) / Dates Employed / Work Performed
Address: / From / To
Job Title / Hourly Rate/Salary
Supervisor: / Starting / Final
Reason for Leaving:
Employer: / Phone: / ( ) / Dates Employed / Work Performed
Address: / From / To
Job Title / Hourly Rate/Salary
Supervisor: / Starting / Final
Reason for Leaving:
Employer: / Phone: / ( ) / Dates Employed / Work Performed
Address: / From / To
Job Title / Hourly Rate/Salary
Supervisor: / Starting / Final
Reason for Leaving:
Special Skills (Computer etc. ) or Qualifications
Professional, business, or civic activities (you may exclude those which indicate race, religion, sex, national origin, age or disability) :

I understand that any false or misleading information given in my application or interview(s) will be sufficient grounds for immediate discharge. I authorize the investigation of all statements contained in the application as may be necessary in arriving at an employment decision including the contacting of my prior employers, and any references given. I understand that this application is not and is not intended to be a contract of employment.

Signature / Date