APPLICATION FOR EMPLOYMENT

Personal Information

Date +

Mr

Ms

Last Name *

First Name *

Middle Initial

Street Address *

City *

State *

Zip *

Home phone

Work Phone

Email

Eligibility Based on Age (compliance with U.S. and Connecticut law) *

Age 14-18

Over 18 years of age

Citizenship Status

United States

Other (complete next two questions)

Visa Status

Do you have the legal right to live and accept employment in the United States?

Yes

No

If YES, do you have a social security number?

Yes

No

Have you ever applied for employment with this Library in the past?

Yes

No

If yes, enter month and year:

Results of Application

Employment Desired

The job openings that the Library is currently trying to fill may be found by going to our website Please indicate what position you are applying for.

Type of employment *

Temporary

Regular

Part-time

Full-time

Days and Hours desired

Are you willing to work overtime when required by your supervisor?

Yes

No

When can you start work? +

Please list any special training, skills or licenses which you possess and which should be considered when reviewing your application

Education

	Name and Location	Years Completed	Did you Graduate?	Degree or Diploma
High School	Name and Location	Years Completed	Did you Graduate?	Degree or Diploma
College, University, Technical School	Name and Location	Years Completed	Did you Graduate?	Degree or Diploma
Other Schools or Special Courses	Name and Location	Years Completed	Did you Graduate?	Degree or Diploma

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 Name	Address	Position Held	Telephone	Employment Dates (give month & year)	Reason for Leaving
1	Employer's Name	Address	Position Held	Telephone	Employment Dates (give month & year)	Reason for Leaving
2	Employer's Name	Address	Position Held	Telephone	Employment Dates (give month & year)	Reason for Leaving
3	Employer's Name	Address	Position Held	Telephone	Employment Dates (give month & year)	Reason for Leaving

B. (Optional) Please provide the name, address and telephone number of two professional references

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

	Reason
Employer No 1	Reason
Employer No 2	Reason
Employer No 3	Reason

ADDITIONAL INFORMATION – Please provide any additional information you would like us to consider, including membership in professional or civic organizations, special accomplishments, awards, etc

ACKNOWLEDGEMENT

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.

I UNDERSTAND AND FULLY ACCEPT THE TERMS AND CONDITIONS SPELLED OUT ABOVE.

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.