Application For Employment – Rampart Library District

Rampart Library District: An Equal Opportunity Employer
We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, genetic information or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

Employment Application Form

Today's Date (YYYY-MM-DD)

Job Applied for

Are you seeking Full-time, Part-time, or Temporary Employment?

When could you start work?

Full Name

Telephone number

Present Street Address

City, State Zip

Are you 18 years of age or older? (required)

Yes

If hired, can you furnish proof you are eligible to work in the U.S.?(required)

Yes

Have you ever applied here before? (Answer as "Yes" or "No", if yes provide date)

Were you ever employed here? (Answer as "Yes" or "No", if yes provide date)

If employed, do you expect to be engaged in any additional business or employment outside of our job? If yes, give details.

Do you have a valid driver’s license? (required)

Yes

Have you had your driver’s license suspended or revoked in the last 3 years (Answer as "Yes" or "No")? If yes, give details:

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, genetic information or other protected status.)

List name and address of school. High School or GED:

List name and address of school. Provide number of years attended and if degree or certificate completed. College or University:

List name and address of school. Provide number of years attended and if certificate completed. Vocational or Technical:

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

Provide Name of Employer/Address, Job Title (Duties), Supervisor(s) Telephone, Dates of Employment (From – To date in MO/YR format), List Starting Pay and Final Pay, Provide reason for leaving:

Have you worked or attended school under any other names (Answer as "Yes" or "No")? If yes, give names:

Are you presently employed (Answer as "Yes" or "No")? If yes, whom do you suggest we contact?

Have you ever been fired from a job or asked to resign (Answer as "Yes" or "No")? If yes, please explain:

Give three references, not relatives or former employers. Provide Name, Address, and Phone of references:

PLEASE READ EACH STATEMENT CAREFULLY BEFORE CHOOSING "Agree"…… I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE. I have read, understand, and by choosing "Agree" in the text box I consent to these statements.(required)

Agree