Personal Information
calendar calendar
Eligibility Based on Age (compliance with U.S. and Connecticut law) *
Citizenship Status
Do you have the legal right to live and accept employment in the United States?
If YES, do you have a social security number?
Have you ever applied for employment with this Library in the past?
Have you ever been convicted of a felony in the past 10 years? *
Note: In answering this question you are not required to disclose the existence of any arrest, criminal charge or conviction, the record of which has been erased pursuant to section 46b-146, 54-76o or 54-142a of the Connecticut statutes. These statutes involve records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a truthful offended, a criminal charge that has been dismissed or nolled, a criminal charge for which a person has been found not guilty or a conviction for which the person received an absolute pardon. You should also be aware that when a criminal record has been erased pursuant to the three statutes listed above, the person is deemed to have never been arrested within the meaning of the statutes and may so swear under oath.
Employment Desired
Type of employment *
Are you willing to work overtime when required by your supervisor?
 Name and LocationYears CompletedDid you Graduate?Degree or Diploma
High School
College, University, Technical School
Other Schools or Special Courses
Work Experience and Professional References
A. Please give complete and accurate information regarding your most recent full-time and part-time employment. Start with your present or most recent job
 Employer's NameAddressPosition HeldTelephoneEmployment Dates (give month & year)Reason for Leaving
REFERENCE CHECKS – We may want to contact the references you listed on the previous page. Do you object? If so, identify the Employer by number and tell us why you do not want us to make contact
Employer No 1
Employer No 2
Employer No 3

By signing this application, I declare that the information provided by me is complete and accurate to the best of my knowledge. I understand that any omission or misrepresentation on this application will constitute sufficient cause for rejection of this application or withdrawal of an offer of employment, or may result in my discharge from employment if I am already employed at the time the omission or misrepresentation is discovered.
I authorize the Library to contact and obtain information about me from previous employers and references I have listed. To assist in the processing of this application, I waive all rights and claims I may otherwise have against the Library or its employees, agents and representatives, if any, for obtaining and using information to evaluate my application, as well as against all other persons, corporations or organizations who provide information for this purpose.
This application is not an employment agreement. If I accept an offer of employment, I recognize that it is employment-at-will and may be terminated at any time, with or without cause or prior notice, unless otherwise provided by law or contract.


Applicants will be considered without discrimination based on race, creed, color, sex, age, marital status, national origin, handicap, veteran status or any other status protected by applicable law.