Application for Employment

Personal Data
Date Submitted : 
  
Last Name, First Name, Middle Initial:  
 
Mailing Address:  
 
City:  
  
County:  
  
State:  
  
ZIP: 
  
Home Phone:  
  
Alternate phone:  
  
Email:  
 
Are you legally eligible for employment in the United States? (Proof of U.S. citizenship or immigration status will be required upon employment.) yes no
Have you ever been convicted of a felony within the last seven years?
(Such conviction may be relevant if job related, but does not necessarily disqualify you from employment.) 		yes no
Position applying for:  
   full-time
part-time
Date available to start work:  
Do you have schedule limitations:  
 yes no
If yes, list times unavailable:
Have your ever been employed by Boyd County Public Library:  
 yes no
If yes...
Branch or Department: 
  
Employed: 
 from to
Does the Boyd County Public Library now employ any of your relatives:   yes no       If yes...
Name: 
Department: 
Relationship: 
Education and Employment Data
Education
High School Attended (Name and Location): 
 Diploma Received  yes no GED  yes no
List all schools attended; technical/vocational school, college, business, military, etc.
Name & city, state of School
Did you graduate
Principal field of study
No. of years completed
Degree/certificate
yes no
yes no
yes no

yes no
Employment History
(List current or most recent job first)
1
Employer :
Dates
Work Performed
Address :
From to
Job Title:
Hourly Rate/Salary
Starting Final
Supervisor:
May we contact him/her?
yes no
Supervisor's phone number
 
Reason for leaving:   
2
Employer :
Dates
Work Performed
Address :
From to
Job Title:
Hourly Rate/Salary
Starting Final
Supervisor:
May we contact him/her?
yes no
Supervisor's phone number
 
Reason for leaving:   
3
Employer :
Dates
Work Performed
Address :
From to
Job Title:
Hourly Rate/Salary
Starting Final
Supervisor:
May we contact him/her?
yes no
Supervisor's phone number
 
Reason for leaving:   
4
Employer :
Dates
Work Performed
Address :
From to
Job Title:
Hourly Rate/Salary
Starting Final
Supervisor:
May we contact him/her?
yes no
Supervisor's phone number
 
Reason for leaving:   
Affiliations
List Professional Memberships & Affiliations:
List Professional & Trade Licenses Held:
Skills
Profficient with Information Management Tools (such as Windows applications and Microsoft Office):
 yes no
List any integrated library systems used:
Check all skills that apply:
 copier Ten Key Switchboard            Fax Laminator
List Additional Skills and Proficiencies:
Why would you like to work at Boyd County Public Library?
What skills and training qualify you for this position?
What portions of your work experience qualify you for this job?
Professional References
1
Name:
Address:
Email:
Phone:
Relationship:
2
Name:
Address:
Email:
Phone:
Relationship:
3
Name:
Address:
Email:
Phone:
Relationship:
 

By clicking the SEND button:

I certify that answers given herein are true and complete to the best of my knowledge and that failure to provide the information requested in a truthful, accurate, and complete manner may result in disqualification, revocation of conditional employment, or termination.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that successfully passing a criminal background review, reference check, and if applicable, a credit check, may be required as a condition for employment. Also, I am aware that I must provide proof of U.S. citizenship, proof of permanent residence, or authorization to work if I accept the position.

I understand that this application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should resubmit a new application for any open positions.

I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means employment may be terminated either by the organization or the employee, and that such termination can be made with or without notice or cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

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