BiblioTemps Application for Employment

Competencies: Please check all that apply

What type of position are you seeking?

Part-time Full-time Limited duration

Education

Additional Training or Skills (Certificates or Degrees, etc.)

Which library automation systems have you worked with?

Employment History

(List employers in order giving the most recent first. You may include any verifiable work performed on a volunteer basis.)

Employer (Name & Address)

May we contact this employer?

Yes No

Employer (Name & Address)

May we contact this employer?

Yes No

Employer (Name & Address)

May we contact this employer?

Yes No

Employer (Name & Address)

May we contact this employer?

Yes No

You may answer no to the following question if:

You have a sealed record on file with the commissioner of probation
You have prior arrests, court appearances and adjudications in cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.

Have you been convicted of a misdemeanor within the past five years (other than a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace)?

Additional Information

Use the space below to elaborate on any of the above fields, or for other information you would like to include with this application:

Signatures

*You must indicate that you have read and understood the terms of the following statements by typing your initials in the space provided:

* Statement #1:

The information I provided in the Application for Employment is true and complete. I authorize BiblioTemps® to investigate my past employment, education and activities and to verify all data I provided on this application or in interviews. I authorize all individuals, schools, or firms I listed to provide information requested about me, with the exception of my current employer if so noted.

I have read and understood these terms. My initials: Please type your initials.Exceeded maximum number of characters.Minimum number of characters not met.

* Statement #2:

I understand that I may be discharged or not be hired if I have provided false information or omitted facts.

I have read and understood these terms. My initials: Please type your initials.Exceeded maximum number of characters.Minimum number of characters not met.

* Statement #3:

I understand that in order to be employed by BiblioTemps®, I will be required to provide evidence of my identity and authorization for employment in the United States. I understand that employment may be contingent upon the performance of a criminal background check and /or drug test.

I have read and understood these terms. My initials: Please type your initials.Exceeded maximum number of characters.Minimum number of characters not met.

* Sign and date the application

Your full name below consitututes your signature.
I accept all terms and conditions of this application.

Signed: Please type in your name.Exceeded maximum number of characters.

Today’s Date

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

First name
Last name
Street
City/Town
State
Zip Code	A value is required.Please enter your five digit zip code.
Contact phone(s)	A value is required. Please enter full telephone number with area code, i.e. 555-666-7777
* E-mail address	Please enter a valid email address.A value is required.
Competencies: Please check all that apply
Administration	Information Technology
Adult Services	Instruction
Archives	Reference
Cataloging	Systems Librarian
Children's Services	Technical Services
Circulation	YA
Other (List)
Languages (List)
When could you begin to work?
What type of position are you seeking?
Part-time Full-time Limited duration
Education
School (Name & Location)
Major/Minor
Degree
Number of years attended

School (Name & Location)
Major/Minor
Degree
Number of years attended

School (Name & Location)
Major/Minor
Degree
Number of years attended

Additional Training or Skills (Certificates or Degrees, etc.)

Which library automation systems have you worked with?

Employment History (List employers in order giving the most recent first. You may include any verifiable work performed on a volunteer basis.)
Employer (Name & Address)

Dates of Employment
Position Title
Salary
Supervisor’s Name and Title
Phone Number
Reason for Leaving
May we contact this employer?	Yes No

Employer (Name & Address)

Dates of Employment
Position Title
Salary
Supervisor’s Name and Title
Phone Number
Reason for Leaving
May we contact this employer?	Yes No

Employer (Name & Address)

Dates of Employment
Position Title
Salary
Supervisor’s Name and Title
Phone Number
Reason for Leaving
May we contact this employer?	Yes No

Employer (Name & Address)

Dates of Employment
Position Title
Salary
Supervisor’s Name and Title
Phone Number
Reason for Leaving
May we contact this employer?	Yes No

Are you under age 18?	Yes No
You may answer no to the following question if: You have a sealed record on file with the commissioner of probation You have prior arrests, court appearances and adjudications in cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.
Have you been convicted of a felony?	Yes No
If yes, please explain
Have you been convicted of a misdemeanor within the past five years (other than a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace)?
	Yes No
If yes, please explain
Additional Information Use the space below to elaborate on any of the above fields, or for other information you would like to include with this application:

Signatures
*You must indicate that you have read and understood the terms of the following statements by typing your initials in the space provided:
* Statement #1: The information I provided in the Application for Employment is true and complete. I authorize BiblioTemps® to investigate my past employment, education and activities and to verify all data I provided on this application or in interviews. I authorize all individuals, schools, or firms I listed to provide information requested about me, with the exception of my current employer if so noted. I have read and understood these terms. My initials: Please type your initials.Exceeded maximum number of characters.Minimum number of characters not met.

* Statement #2: I understand that I may be discharged or not be hired if I have provided false information or omitted facts. I have read and understood these terms. My initials: Please type your initials.Exceeded maximum number of characters.Minimum number of characters not met.
* Statement #3: I understand that in order to be employed by BiblioTemps®, I will be required to provide evidence of my identity and authorization for employment in the United States. I understand that employment may be contingent upon the performance of a criminal background check and /or drug test. I have read and understood these terms. My initials: Please type your initials.Exceeded maximum number of characters.Minimum number of characters not met.

* Sign and date the application Your full name below consitututes your signature. I accept all terms and conditions of this application. Signed: Please type in your name.Exceeded maximum number of characters. Today’s Date It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.