First name |
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Last name |
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Street |
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City/Town |
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State |
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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. |
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Administration |
Information Technology |
Adult Services |
Instruction |
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Reference |
Cataloging |
Systems Librarian |
Children's Services |
Technical Services |
Circulation |
YA |
Other (List) |
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Languages (List) |
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When could you begin
to work? |
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What type of position are you seeking? |
Part-time
Full-time
Limited duration |
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School (Name & Location) |
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Major/Minor |
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Degree |
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Number of years attended
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School (Name & Location) |
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Major/Minor |
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Degree |
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Number of years attended |
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School (Name & Location) |
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Major/Minor |
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Degree |
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Number of years attended |
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Additional Training or Skills (Certificates or Degrees, etc.) |
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Which library automation systems have you worked with? |
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(List employers in order giving the most recent first. You may include any verifiable work performed on a volunteer basis.)
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Employer (Name & Address) |
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Dates of Employment |
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Position Title |
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Salary |
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Supervisor’s Name and Title |
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Phone Number |
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Reason for Leaving |
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May we contact this employer? |
Yes
No |
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Employer (Name & Address) |
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Dates of Employment |
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Position Title |
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Salary |
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Supervisor’s Name and Title |
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Phone Number |
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Reason for Leaving |
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May we contact this employer? |
Yes
No |
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Employer (Name & Address) |
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Dates of Employment |
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Position Title |
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Salary |
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Supervisor’s Name and Title |
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Phone Number |
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Reason for Leaving |
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May we contact this employer? |
Yes
No |
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Employer (Name & Address) |
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Dates of Employment |
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Position Title |
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Salary |
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Supervisor’s Name and Title |
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Phone Number |
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Reason for Leaving |
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May we contact this employer? |
Yes
No |
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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.
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Have you been convicted
of a felony? |
Yes
No
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If yes, please explain |
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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)? |
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Yes
No
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If yes, please explain |
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Use the space below to elaborate on any of the above fields, or for other information you would like to include with this application: |
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*You must indicate that you have read and understood the terms of the following statements by typing your initials in the space provided:
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* 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.
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* 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.
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* 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. |
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| * 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.
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