COAL CITY PUBLIC LIBRARY DISTRICT APPLICATION FOR EMPLOYMENT

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1 IN OFFICE USE ONLY DATE RCVD: COAL CITY PUBLIC LIBRARY DISTRICT APPLICATION FOR EMPLOYMENT WE CONSIDER APPLICANTS FOR ALL POSITIONS WITHOUT REGARD RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A N-JOB-RELATED MEDICAL CONDITION OR HANDICAP, OR ANY OTHER LEGALLY PROTECTED STATUS. LAST NAME FIRST NAME MIDDLE NAME STREET CITY STATE ZIP CODE FOR WHAT POSITION ARE YOU APPLYING? ARE YOU CURRENTLY EMPLOYED? IF SO, MAY WE CONTACT YOUR CURRENT EMPLOYER? ARE YOU PREVENTED LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS? PROOF OF CITIZENSHIP OR IMMIGRATION STATUS WILL BE REQUIRED UPON EMPLOYMENT.

2 ON WHAT DATE WOULD YOU BE AVAILABLE BEGIN WORK? ARE YOU AVAILABLE WORK: PLEASE CHECK ALL THAT APPLY FULL TIME PART TIME EVENINGS WEEKENDS IF INTERESTED IN PART TIME EMPLOYMENT, HOW MANY HOURS PER WEEK WOULD YOU PREFER WORK? 8-10 HRS HRS HRS. 25 OR MORE WHAT RATE OF PAY DO YOU EXPECT PER HOUR? HAVE YOU EVER HAD ANY JOB-RELATED TRAINING IN THE U.S. MILITARY? IF, PLEASE DESCRIBE:

3 EDUCATION ELEMENTARY HIGH UNDERGRADUATE COLLEGE/ UNIVERSITY GRADUATE/ PROFESSIONAL SCHOOL NAME LOCATION YEARS COMPLETED (PLEASE CIRCLE) DIPLOMA/ DEGREE DESCRIBE COURSE OF STUDY DESCRIBE ANY SPECIALIZED TRAINING, APPRENTICESHIP, SKILLS & EXTRA-CURRICULAR ACTIVITIES. DESCRIBE ANY HORS YOU HAVE RECIEVED. STATE ANY INFORMATION YOU FEEL MAY BE HELPFUL US IN CONSIDERING YOUR APPLICATION. SPECIAL SKILLS & QUALIFICATIONS SUMMARIZE SPECIAL JOB-RELATED SKILLS AND QUALIFICATIONS ACQUIRED EMPLOYMENT OR OTHER EXPERIENCE.

4 EMPLOYMENT EXPERIENCE WITH YOUR PRESENT OR LAST JOB. INCLUDE ANY JOB-RELATED MILITARY SERVICE ASIGNMENTS AND VOLUNTEER ACTIVITIES. YOU MAY EXCLUDE ORGANIZATIONS WHICH INDICATE RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, HANDICAP OR OTHER PROTECTED STATUS. EMPLOYER EMPLOYER

5 EMPLOYER EMPLOYER

6 REFERENCES PLEASE LIST THREE REFERENCES WHO ARE T RELATED YOU AND ARE T PREVIOUS EMPLOYERS. NAME PHONE NUMBER(S) NAME PHONE NUMBER(S) NAME PHONE NUMBER(S) APPLICANT S STATEMENT I CERTIFY THAT ANSWERS GIVEN HERIN ARE TRUE AND COMPLETE THE BEST OF MY KWLEDGE. I AUTHORIZE INVESTIGATION OF ALL STATEMENT CONTAINED IN THIS APPLICATION FOR EMPLOYMENT AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. THIS APPLICATION FOR EMPLOYMENT SHALL BE CONSIDERED ACTIVE FOR A PERIOD OF TIME T EXCEED 45 DAYS. ANY APPLICANT WISHING BE CONSIDERED FOR EMPLOYMENT BEYOND THIS TIME PERIOD SHOULD INQUIRE AS WHETHER OR T APPLICATIONS ARE BEING ACCEPTED AT THAT TIME. I HEREBY UNDERSTAND AND ACKWLEDGE THAT UNLESS OTHERWISE DEFINED BY LAW, ANY EMPLOYMENT RELATIONSHIPS WITH THIS ORGANIZATION IS OF AN AT WILL NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. IT IS FURTHER UNDERSOD THAT THIS AT WILL EMPLOYMENT RELATIONSHIP MAY T BE CHANGED BY ANY WRITTEN DOCUMENT OR BY CONDUCT UNLESS SUCH CHANGE IS SPRECIFICALLY ACKWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION. IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW(S) MAY RESULT IN DISCHARGE. I UNDERSTAND, ALSO, THAT I AM REQUIRED ABIDE BY ALL RULES AND REGULATIONS OF THE EMPLOYER. SIGNATURE OF APPLICANT DATE

7 FOR PERSONNEL DEPARTMENT USE ONLY ARRANGE INTERVIEW? REMARKS EMPLOYED? DATE OF EMPLOYMENT DEPARTMENT BY: NAME AND TITLE DATE TES