Personal Information
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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?
Employment Desired
Type of employment *
Are you willing to work overtime when required by your supervisor?
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 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.