Apply | Centerville Public Library

Type of Employment Desired*

(check which boxes apply)

Full-time
Part-time
Seasonal
Temporary

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone Number*

Email*

Position applied for

Referral source*

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Current Employee
Internet
Community Posting
Employment Agency
School
Other

Name the source of the referral (if applicable)

Employment Availability*

Days
Evenings
Saturday

Please list the hours, days, or shifts you cannot work*

Hourly pay rate desired*

Earliest date available for work*

Have you filed an application here before?*

Yes
No

If yes, what date?

Have you been employed here before?*

Yes
No

If yes, when did your employment end?

Are you legally eligible for employment in the United States?*

(Proof of U.S. Citizenship or immigration status will be required upon employment)

Yes
No

Have you ever been convicted of any crime(s) or misdemeanor(s)?*

Yes
No

If yes, please describe the nature of the incident(s). Please be consice and give dates.

Employment History

Please list all positions held for the past 10 years. Start with the most recent.

Employer

Position

Name and Title of Employer or Supervisor

Telephone of Employer or Supervisor

Date Employed From

Date Employed To

Hourly Rate - Starting

Hourly Rate - Final

Reason for Leaving

Summarize the nature of the work performed and Job Responsibilites. Be Concise.

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Please list any technical skills or abilities that might aid you in the position you are applying for:*

Please list all volunteer, community, and/or school activities that you are currently or have been involved with:*

Educational Background

Please list educational attainment, starting with High School or Equivalent.

Name

Location

Focus of Study

Did you graduate?

Yes
No

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References

List three business/work references who are not related to the applicant and are not former supervisors.

Name

First Last

Years known

Phone

Email

Relationship

Best method of contact

Phone
Email

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Is there any additional information you believe might be important for us to know while we consider your application for employment?

Certification and Consent*

I certify that all information I have provided in order to apply for and secure work with Centerville –Center Township Public Library is true, complete, and correct. I understand and agree that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause for the disqualification of this application and/or termination from Centerville –Center Township Public Library if I have been employed. Furthermore, I understand that just as I am free to resign at any time, Centerville –Center Township Public Library reserves the right to terminate my employment at any time, with or without reason or cause and without prior notice. I understand that no representative of Centerville –Center Township Public Library has the authority to make assurances to the contrary.

I expressly authorize, without reservation, Centerville –Center Township Public Library, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educationalinstitutions to verify the accuracy of all information provided by me in this application, resume, or job interview including, but not limited to, my performance, character, reputation, and previous employment record.

I hereby release from liability Centerville –Center Township Public Library, its representative, employees, or agents for seeking, gathering, and using such information in the employment process and all other persons, organizations, and corporation for furnishing such information about me.

I authorize Centerville –Center Township Public Library to make any pre-employment investigation of my personal history, driving record, financial, criminal history and sexual offender registries through any investigative or credit agencies or bureaus of their choice.

I hereby release Centerville –Center Township Public Library and its representatives and all other persons, agencies, and bureaus from any liability or damages for having requested for furnished such information.

Centerville –Center Township Public Library is an equal Opportunity Employer and does not discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicantfrom consideration for employment on a basis prohibited by local, state, or federal law.

I understand that this applicationremains current for only 90 days. At the conclusion of that time, if I have not heard from Centerville –Center Township Public Libraryand still wish to be considered for employment, it will be necessary to reapply and complete a new application.

I agree

Signature*

Please type your full name.

Date Signed*

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About

Careers: Apply

Employment Application

Personal Information

Employment History

Educational Background

References