WEST BLOOMFIELD TOWNSHIP PUBLIC LIBRARY
APPLICATION FOR EMPLOYMENT
INTERN, MONITOR, ASSISTANT, SUBSTITUTE, TEMPORARY STAFF
(An equal opportunity employer)

Date of Application:
Date available to begin work:

PERSONAL INFORMATION
Last Name:
First Name:
Middle Name:
Home Telephone:
Other Last Name:
Other First Name:
Other Middle Name:
Other Telephone:

Mobile Work Other
Street Address:

City:
State:
Zip:
Email Address:

Are you 18 years or older?
Yes No
Are you legally eligible for employment in the U.S.?
Yes No

The West Bloomfield Township Public Library conforms to the Immigration Reform and Control Act of 1986, which requires you to furnish documentation showing your identity and legal authorization to work in the United States once you have been offered employment.
If related to anyone in our employ, state name, department and relationship to you:


Have you ever been convicted of, or plead guilty or no lo contendere to, a misdemeanor or felony?
Yes No
If yes, please list date, place and nature of offense:

Are there any misdemeanor or felony charges presently pending against you?
Yes No
If yes, please list date of arrest, place and nature of offense:

(A criminal record or pending charges will not necessarily prohibit you from being employed.)

Can you perform the essential duties of the job in which you wish to be employed, with or without accommodation?
Yes No

EMPLOYMENT DESIRED
Position applied for:
Pay/salary desired:
$
Will you accept part-time work?
Yes No
Have you ever been an employee of the West Bloomfield Township Public Library?
Yes No
Have you ever been an employee of another library?
Yes No
If yes, library name/classification and reason for leaving:

EDUCATION
Education School Name and Location No. of Years
Completed 		Subjects
Studied 		Degrees
Earned 		G.P.A.
High School
College / University
Vocational, Trade, Graduate School

GENERAL
Do you have any special training, skills, qualifications, licenses, certifications or other experiences that relate to the position(s) applied for?
U.S. Military Service:
Branch of Service:
From:
To:
Rank or Rating:
Type of Discharge:
Explain reason for discharge (optional):

EMERGENCY CONTACT
In case of emergency, notify:
Name:
Address:
Phone:

Medical Examinations: In accordance with the applicable legal requirements, the West Bloomfield Township Public Library may require job applicants to undergo a medical examination after an offer of employment has been made and prior to the commencement of employment duties, and may condition the offer of employment on the results of such examination.

EMPLOYMENT INFORMATION
Have you ever been discharged or requested to resign any job?
Yes No
If yes, please explain circumstance, list the employer, and provide date:
Are you presently employed?
Yes No

FORMER EMPLOYERS
Please give an accurate, complete, full-time and part-time employment record for the past ten years. Start with the present or most recent employer.

Company Name:
Telephone:
Company Address:
Employed From:
Employed To:
City:
State:
Zip:
Reason for Leaving:
List Job Title / Responsibilities:



Please indicate if you would prefer that we not contact any of the listed employers including your current employer, and briefly explain your reason:
Do you have any commitment to another employer that might affect your availability to be scheduled?
Yes No
If yes, please explain:

REFERENCES
Please give the name of 3 persons not related to you, whom you have known for over a year and can speak to your employment performance.

Name Address Telephone Business /
Library 		Years
Known 		Relationship

FILE UPLOADS
Please attach your Resume and Cover Letters if applicable for the job you are applying to:

Cover Letter: (10Mb Limit: .pdf, .doc, .docx, .txt)


Resume: (10Mb Limit: .pdf, .doc, .docx, .txt)

SIGNATURE
(Please read carefully and acknowledge the statements below by checking the boxes before signing)

I certify that the answers and information given by me in this application are true, correct and complete without qualification. I understand that the Library has the right to refuse to hire or immediately discharge me at any time if it discovers that I have provided incomplete, untrue, or misleading answers or information in this application or on any other documents or forms submitted at any time during my employment.
I hereby authorize the Library to verify the answers and information given by me in this application and to make any investigation of my background deemed necessary. I authorize former employers, law enforcement organizations, educational institutions and any other third party contacted by the Library to release to the Library any information they have regarding me without providing written notice to me.
I authorize the Library to use any information in its possession concerning me for any purpose it deems appropriate, including disclosure of information to any third party, future employer or prospective future employer without notification to me of such disclosure, and I release the Library from any liability in connection with such use of disclosure.
If the Library hires me, I understand and agree that I will be bound by the rules, regulations, policies, procedures, and other terms and conditions of employment of the Library, as they are changed from time-to-time, with or without notice to me.
If the Library hires me, I understand and agree that I have the right to terminate my employment at any time and for any reason, with or without notice. I further understand that the Library can terminate the employment relationship at any time, with or without cause, with or without notice. This employment relationship exists regardless of any other written statements or policies or any other Library document or any verbal statement to the contrary. No one except the Library Director can enter into any kind of employment relationship or agreement that is contrary to the above. To be enforceable, any employment relationship or agreement, which is contrary to the above, must be in writing and personally signed by the Library Director and myself.
Signature (Please type your name in the box)
Date