Application for Employment

The Sequoyah Regional Library is an equal opportunity employer. All employment decisions, both during the hiring process and throughout the employment relationship, are based on merit alone, without regard to race, color, religion, sex, pregnancy, parenthood status, national origin, citizenship, age, marital status, disability, sexual orientation, or other prohibited ciriteria.

Please answer each of the following questions completely. If the question is not applicable to you, please indicate that by writing "Not Applicable" or "N/A." This application must be dated and signed in all places where indicated. The company cannot consider this application unless every question is answered and it contains every required signature.

* Date:

* Full legal name

* Current mailing address:

* Day phone number:

* Evening phone number:

* Are you at least 18 years old?

Yes

* Are you legally eligible to work in the United States?

Yes

* What position are you applying for?

* Do you wish to work

Full Time

Part Time

How did you become aware of this job opening?

* When are you available to start work?

If you have had any formal education beyond high school, please describe, including names of schools attended and degrees received.

Please provide any additional information about your education that you believe makes you especially qualified for this position.

If you have previously been employed by the Library, please state the beginning and ending dates of employment and the name of your last supervisor.

If you have previously applied for a position at the Library, please state the date of your application and the position applied for.

If you are currently employed, please provide the following information about your current employer:

Employer's name and address

Beginning and ending dates of employment

Last salary or wages

Name of immediate supervisor

Reason for leaving

Please list in chronological order the dates of employment, name and phone numbers of your former employers.

Please describe any additional information about your work history, skills or interests that you believe makes you especially qualified for this position.

If you have been convicted of a felony crime within the last 10 years, please describe each conviction, including the date and place of conviction. (Do not include convictions that have been expunged).

If you currently hold a valid driver's license, in what state?

If your driver's license has been suspended or revoked within the last 10 years, please describe each suspension or revocation, including the date and the state involved.

* Do you currently use illegal drugs?

Yes

* Please give the names, addresses, and telephone numbers of three persons not related to you who know you and your work habits and abilities:

CERTIFICATIONS

I certify that the statements contained in my Application for Employment and in any résumé or similar document submitted in connection with my application for employment are true, correct and complete. I further certify that any transcript, certificate, reference letter or other document submitted in connection with my Application for Employment is genuine and has not been altered in any way. I understand that submitting false or incomplete information is grounds for termination.

I understand that, if offered employment and I accept, I may be required to undergo a medical examination at the Company’s expense, including a criminal background check and a test for current illegal drug use. Any offer of employment will be conditioned on my furnishing satisfactory evidence of my eligibility to work in the United States.

I understand that any employment that may be offered to me will be “at-will” employment only, meaning that I will not have a contract of employment and that the employment relationship can be terminated without cause at any time either by the Company or by me. I acknowledge that, as of the date of this application, I have not received any offers or promises of employment from the Company.

I acknowledge that this application for employment will remain active for a limited time. I will need to re-apply each time a position becomes available that I wish to apply for. I have been specific on this application as to which position I am applying for.

* I HAVE READ AND UNDERSTAND THE ABOVE CERTIFICATIONS:

Yes

AUTHORIZATION AND RELEASE

In connection with my application for employment, I authorize the release of information about my education, work experience, and fitness for employment by (a) schools I have attended; (b) my current and former employers; (c) employees and former employees of such employers; and, (d) my references. I release all persons and organizations from liability for furnishing information pursuant to this authorization.

* I AGREE TO THE ABOVE AUTHORIZATIONS

YES

* Indicates Response Required


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