Employment Application - Permanent Part-Time - West Bloomfield Township Public Library

Step 1 of 8

12%

Personal Information

Name(Required)

First Middle Last

Other Name

First Middle Last

Email Address(Required)

Enter Email Confirm Email

Telephone(Required)

Address(Required)

Street Address City State Zip Code

Age(Required)

Are you 18 years of age or older?

Yes

Eligibility(Required)

Are you legally eligible for employment in the U.S.?

Yes

The West Bloomfield Township Public Library conforms to the Immigration Reform and Control Act of 1986, which requires you to furnish documentation showing your identity and legal authorization to work in the United States once you have been offered employment.

If related to anyone in our employ, state name, department and relationship to you.

Have you ever been convicted of, or plead guilty or no lo contendere to, a misdemeanor or felony?(Required)

(A criminal record will not necessarily prohibit you from being employed.)

Yes

Please list date, place and nature of offense.(Required)

Are there any misdemeanor or felony charges presently pending against you?(Required)

(Pending charges will not necessarily prohibit you from being employed.)

Yes

Please list date of arrest, place and nature of offense.(Required)

Can you perform the essential duties of the job in which you wish to be employed, with or without accommodation?(Required)

Yes

Employment Desired

Position You're Applying For(Required)

Circulation Clerk

Library Aide

Pay/Salary Desired(Required)

Will you accept part-time work?(Required)

Yes

Have you ever been an employee of the West Bloomfield Township Public Library?(Required)

Yes

Have you ever been an employee of another library?(Required)

Yes

Please list library name, title, and reason for leaving.(Required)

Education

Schools(Required)

Please list your education including high school, college, and vocational training.

School Name and Location

Years Completed

Subjects Studied

Degrees Earned

G.P.A.

Do you have any special training, skills, qualifications, licenses, certifications, or other experiences that relate to the position applied for?

Military Service

Have you served in the U.S. Military?(Required)

Yes

Service History(Required)

Branch of Service

Rank

Dates

Discharge Type

Emergency Contact

In case of emergency, notify:

Name(Required)

First Last

Address(Required)

Street Address City State Zip Code

Telephone(Required)

Medical Examinations: In accordance with the applicable legal requirements, the West Bloomfield Township Public Library may require job applicants to undergo a medical examination after an offer of employment has been made and prior to the commencement of employment duties, and may condition the offer of employment on the results of such examination.

Employment History

Have you ever been discharged or requested to resign any job?(Required)

Yes

Please explain circumstance, list the employer, and provide date.

Are you presently employed?(Required)

Yes

Former Employers(Required)

Please give an accurate, complete, full-time and part-time employment record for the past ten years. Start with the present or most recent employer.

Employer

Address

Phone

Dates

Job Title

Reason for Leaving

Please indicate if you would prefer that we not contact any of the listed employers including your current employer, and briefly explain your reason.

Do you have any commitment to another employer that might affect your availability to be scheduled?(Required)

Yes

References

Please list 3 persons not related to you, whom you have known for over a year and can speak to your employment performance.(Required)

Name

Address

Phone

Business/Library

Years Known

Relationship

Please list 3 persons not related to you, whom you have known for over a year and can speak to your employment performance.(Required)

Name

Address

Phone

Business/Library

Years Known

Relationship

Please list 3 persons not related to you, whom you have known for over a year and can speak to your employment performance.(Required)

Name

Address

Phone

Business/Library

Years Known

Relationship

Submit

Attach Resume(Required)

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 25 MB.

Terms and Conditions(Required)

I certify that the answers and information given by me in this application are true, correct and complete without qualification. I understand that the library has the right to refuse to hire or immediately discharge me at anytime if it discovers that I have provided incomplete, untrue, or misleading answers or information in this application or on any other documents or forms submitted at any time during my employment.

I hereby authorize the library to verify the answers and information given by me in this application and to make any investigation of my background deemed necessary. I authorize former employers, law enforcement organizations, educational institutions and any other third party contacted by the library to release to the library any information they have regarding me without providing written notice to me.

I authorize the library to use any information in its possession concerning me for any purpose it deems appropriate, including disclosure of information to any third party, future employer or prospective future employer without notification to me of such disclosure, and I release the library from any liability in connection with such use of disclosure.

If the library hires me, I understand and agree that I will be bound by the rules, regulations, policies, procedures, and other terms and conditions of employment of the library, as they are changed from time-to-time, with or without notice to me.

I agree to the terms and conditions.

Signature

Please type your name in the box.

Date

MM slash DD slash YYYY

How Do I?

Employment Application – Permanent Part-Time

Employment Application – Permanent PT

Personal Information

Employment Desired

Education

Military Service

Emergency Contact

Employment History

References

Submit