Central Massachusetts Regional Library System

8 Flagg Road

Shrewsbury, MA  01545

Telephone: (508) 757-4110

Fax: (508) 757-4370

Email: BiblioTemps@cmrls.org

http://www.BiblioTemps.com

 

 

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

 

Note: If you need more space to complete any of these questions, please use the Additional Information field at the end of this form.

Name:

Address:

 

City:     State:    Zip Code:

 

Contact Phone (s)

 

E-mail address:

 

Competencies (check all that apply):

Administration   Adult Services 
Cataloging   Children's Services   Circulation  

Information Technology   Instruction  

Reference   Systems Librarian   Technical Services  YA

 

Other (list)

 

Languages (list)

 

 

 

When could you begin work: 

 

What type of position are you seeking? 

Full-Time   Part-Time   Limited Duration

 

Would you work overtime if asked?  Yes    No

 

EDUCATION  

School (Name and Location): 

 

Major/Minor:   Degree:  

 

Number of years attended: 

School (Name and Location): 

 

Major/Minor:   Degree:  

 

Number of years attended: 

School (Name and 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:

Employer (Name & Address):

Dates of Employment:   
Position Title:    Salary:  

Supervisor's Name and Title:

Phone Number:

Reason for Leaving:

Employer (Name & Address):

Dates of Employment:   
Position Title:    Salary:  

Supervisor's Name and Title:

Phone Number:

Reason for Leaving:

Employer (Name & Address):

Dates of Employment:   
Position Title:    Salary:  

Supervisor's Name and Title:

Phone Number:

Reason for Leaving:

Employer (Name & Address):

Dates of Employment:   
Position Title:    Salary:  

Supervisor's Name and Title:

Phone Number:

Reason for Leaving:

 

Are you under the age of 18? 

Yes   No

 

An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions.  An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' to an inquiry herein relative to prior arrests or criminal court appearances.  In addition, any applicant for employment may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances and adjudications in all 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
 

* Responses to the following statements are required. Please read the following carefully then choose the appropriate box below.

_______________________________________________________________________________

 

* Statement #1:

I hereby declare that the information provided by me in this Application for Employment is true, correct and complete to the best of my knowledge.  I authorize BiblioTemps to investigate my past and present employment, education and activities and verify all data provided by me on this application, on related papers and in interviews.  I authorize all individuals, schools and/or firms named herein (except my current employer, if so noted) to provide any information requested about me.  I release from all liability any persons, companies, corporations or educational institutions supplying such information.  I release BiblioTemps from any and all liability resulting from the verification of such information.

 

I agree     

Yes                   No   

If no, please explain

 

* Statement #2:

I understand that any false statement or omission of fact on this application or on any supporting documents shall be grounds for non-hire or discharge, regardless of when discovered by BiblioTemps or otherwise.

 

I agree

Yes                       No

If no, please explain

 

* Statement #3:

I understand that, if I am extended an offer by BiblioTemps, I will be required to provide evidence of my identity and authorization for employment in the United States prior to the commencement of my employment.  I understand further that employment may be contingent upon the performance of a criminal background check and/or drug test.

 

I agree

Yes                       No

If no, please explain

 

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.

 

* Acceptance of terms:

  I accept the terms listed above. (choosing this box is equivalent to your signature.  An original signature will be necessary at time of employment.)

I do not accept the terms listed above.

 

Date: