APPLICANT INFORMATION

*Date

*Last Name *First Name M.I.

*Street Address Apartment/Unit #

*City *State *ZIP

*Phone Alternate Phone

*E-mail address

Date Available

*Position Advertised

Type of position: Shelving    Clerical    Library Assistant    Technology    Professional    Other

*Library Location

*Are you available for full-time employment? Yes No

If no, what hours can you work?
Mornings    Afternoons    Nights    Saturdays    Sundays

*Are you available to meet year-round schedule requirements? Yes    No

If no, please explain.

*Do you have relatives employed at the Athens Regional Library System? Yes    No

If yes, please list their names:

*Are you legally eligible for employment in the United States? Yes    No

*Do you have the ability to perform the essential functions of this position without accommodation? Yes    No

If no, what accommodation is needed?

*Have you ever been discharged from employment because your work conduct was not satisfactory? Yes    No

If yes, please explain.

*Have you ever been convicted of, or plead guilty to, a crime in the past 10 years which has not been annulled, expunged, or sealed by court? Yes    No

If yes, please explain.

EDUCATION

*High School

*Address

*Did you graduate? Yes No

*Degree

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College

Address

Did you graduate? Yes No

Degree

---

Graduate School

Address

Did you graduate? Yes No

Degree

---

Other

Address

Did you graduate? Yes No

Degree

PREVIOUS EMPLOYMENT

Please list your last 3 employers, starting with the most recent.

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From To

Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

---

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From To

Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

---

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From To

Reason for Leaving

May we contact your previous supervisor for a reference? Yes No

SKILLS, QUALIFICATIONS

*Please list any specialized skills or courses which relate to the position for which you are applying. Examples include professional training courses and foreign languages in which you are proficient.

*Describe your computer skills and experience. Please include specific software applications in which you are proficient.

*Please describe in detail how your education, training and experience qualify you for this position.

REFERENCES

Give the names of three references, e.g., supervisors or teachers, who know most about your work experience and/or qualifications. References may include supervisors listed under "Previous Employment." DO NOT list relatives or friends.

*Full Name

*Relationship

*Company

*Phone

Address

---

*Full Name

*Relationship

*Company

*Phone

Address

---

*Full Name

*Relationship

*Company

*Phone

Address

DISCLAIMER AND SIGNATURE

It is agreed that any misrepresentation by me in this application will be sufficient cause for the rejection of this application and/or separation from the library's service if I have been employed. I agree to conform to the rules and regulations of the Library.

By completing this application, I authorize Athens Regional Library System and its representatives to contact all present and former employers regarding my work history. Employers who provide information to the Library shall not be liable in any way for such release. I understand that this release gives the Library the right, without liability, to investigate my background as it relates to my employment.

The Athens Regional Library System is an Equal Opportunity Employer. The Athens Regional Library System does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law. The Athens Regional Library System is a drug-free workplace and requires a pre-employment drug test. Electronic employment eligibility verification will be required.

If offered employment, I understand I will be required to provide documentation to verify employment eligibility to work in the United States.

This application will remain on file for 1 year. I understand that at the conclusion of this time, if I still wish to be considered for employment, it will be necessary to fill out a new employment application.

I have read the statements above and fully understand and agree. If applying online, I understand that if and when I am invited to an interview I will be asked to provide a signature for this application form.

This application will not be accepted unless this box is checked.
* I agree.

*Date