Fort Vancouver Regional Library District Serving Southwest and South Central Washington State 1007 East Mill Plain Blvd. Vancouver, WA 98663 (360) 906-4953 jobs@fvrl.org APPLICATION FOR EMPLOYMENT We are an equal opportunity employer, dedicated to a policy of employment nondiscrimination on the basis of race, religion, national origin, citizenship status, color, sex, sexual orientation, marital status, workers compensation status, age, physical or mental disability, veteran status or any other status protected under applicable local, state or federal nondiscrimination laws. It is our intention that all applicants be given equal opportunity and that selection decisions are based on job- related factors. Any person needing reasonable accommodation in the application process should contact the Human Resources Department. EMPLOYMENT DESIRED Position you are applying for Schedule availability: Full time Part time Substitute (On call) Date you can start: PERSONAL INFORMATION Last name First name Middle name Street City State Zip Home phone Cell phone Email address How did you hear about the position? (please be specific): Have you been employed by Fort Vancouver Regional Library District before? Yes If so, when: If hired, can you provide proof that you are authorized to work in the United States? (Passport, permanent resident card or alien registration receipt card and a social security card) Yes No Have you been convicted of any crime or been released from prison following a criminal conviction within the last seven years? (A conviction in itself does not bar employment.) Yes No If yes, please explain: No LOCATION DESIRED Indicate the library locations at which you are willing to accept employment: Battle Ground Cascade Park La Center Goldendale Ridgefield Stevenson/North Bonneville The Mall Library Connection Three Creeks Vancouver Washougal White Salmon Valley Woodland District Headquarters in Vancouver Fort Vancouver Regional Library District Application for Employment 1-2015 1
HOURS Some positions require evening and weekend work hours. Working hours vary in each library. Schedules may include assignments between 5:00 am and 10:00 pm, seven days a week. Indicate the hours and days you are AVAILABLE for work between 5:00 am and 10:00 pm each day: Sunday Monday Tuesday Wednesday Thursday Friday Saturday SKILLS LANGUAGE Please indicate any languages that you speak besides English and your level of proficiency with each. Spanish Basic Intermediate Advanced Japanese Basic Intermediate Advanced Russian Basic Intermediate Advanced Chinese Basic Intermediate Advanced French Basic Intermediate Advanced Vietnamese Basic Intermediate Advanced German Basic Intermediate Advanced American Sign Language Basic Intermediate Advanced Other: Basic Intermediate Advanced TECHNOLOGY Please indicate any area in which you possess skills and your level of proficiency with each. Microsoft Office: Word (or other word processing platform)... Basic Intermediate Advanced Microsoft Office: Excel (or other spreadsheet platform)... Basic Intermediate Advanced Microsoft Office: Publisher (or other desktop publishing platform)... Basic Intermediate Advanced ereaders, tablets, smartphones... Basic Intermediate Advanced Social media... Basic Intermediate Advanced Mobile applications... Basic Intermediate Advanced Copiers and scanners... Basic Intermediate Advanced Please summarize special skills, qualifications, and professional licenses or memberships relevant to the position applied for: 2 Fort Vancouver Regional Library District Application for Employment 1-2015
EDUCATION School name School type (i.e. High School) Years completed Did you graduate? Yes No Degree(s) received School name School type (i.e. High School) Years completed Did you graduate? Yes No Degree(s) received School name School type (i.e. High School) Years completed Did you graduate? Yes No Degree(s) received Do you have an M.L.S. from an accredited school? Yes No Do you hold a Washington State Librarian Certificate? Yes No EMPLOYMENT List your most recent job first. Include all jobs, military service and periods of unemployment lasting more than one month. Please use an additional sheet if needed. May we contact your current employer? Yes No CURRENT EMPLOYER Employed from/to (mm/yyyy) Employer name Employer address/location Employer phone Employer website (if applicable) Position/title Final rate of pay Supervisor name Fort Vancouver Regional Library District Application for Employment 1-2015 3
PREVIOUS EMPLOYER 1 Employed from/to (mm/yyyy) Employer name Employer address/location Employer phone Employer website (if applicable) Position/title Final rate of pay Supervisor name PREVIOUS EMPLOYER 2 Employed from/to (mm/yyyy) Employer name Employer address/location Employer phone Employer website (if applicable) Position/title Final rate of pay Supervisor name PREVIOUS EMPLOYER 3 Employed from/to (mm/yyyy) Employer name Employer address/location Employer phone Employer website (if applicable) Position/title Final rate of pay Supervisor name 4 Fort Vancouver Regional Library District Application for Employment 1-2015
PROFESSIONAL REFERENCES Academic or mentor references, as well as business references, are appropriate here. For business references, list only previous co- workers and supervisors. Do not list the agency you were employed by. (Provide any other names under which your references may be listed.) PROFESSIONAL REFERENCE 1 Name Years known Relationship Employed by Title/Occupation Phone Email PROFESSIONAL REFERENCE 2 Name Years known Relationship Employed by Title/Occupation Phone Email PROFESSIONAL REFERENCE 3 Name Years known Relationship Employed by Title/Occupation Phone Email Please review and sign your name below: If I am employed by the library, I will comply with all work related requirements set forth by the library. I acknowledge that I am physically able to perform the essential job duties of the position for which I am applying. I authorize investigation of all information provided during the application process and the references listed above, to give the library any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise. I release from all liability or responsibility this company, its agents and all persons, companies or corporations providing information to the library about me. I hereby acknowledge that I have read and understand the above statements. I certify that all answers to questions in this application and all additional information I may have submitted are true and complete to the best of my knowledge. I understand that giving false information, misrepresenting facts, and material omissions may be grounds for denial of employment or discharge, if hired. Applicant s signature Date (If submitting electronically, signature will be obtained at time of interview) Fort Vancouver Regional Library District Application for Employment 1-2015 5
To all applicants: Fort Vancouver Regional Library District is an Equal Opportunity/Affirmative Action employer, and complies with all applicable federal and state regulations. We are requesting that you provide us with the information indicated below. This information is kept for statistical reporting and Federal Equal Employment requirements. It is treated in a highly confidential manner. Your responses are strictly voluntary. However, we urge and appreciate your cooperation, as it will help our organization in its statistical reporting to state and federal agencies. Position you are applying for: Position: Department: First Name: Last Name: Email: Gender: Male Female I choose not to declare Ethnic/Racial category: (Select the ONE which best identifies you) White (not Hispanic) Black (not Hispanic) American Indian Hispanic: Mexican/Mexican- American Latin/Latin- American Other Spanish/Spanish- American Asian or Pacific Islander: Chinese/Chinese- American Japanese/Japanese- American Filipino/Pilipino Pakistani/East Indian Other Asian Native Hawaiian or other Pacific Islander I choose not to declare Military veteran: (Select all that apply) Not a veteran Recently separated veteran Vietnam Era veteran War/campaign/expedition veteran Armed Forces service medal veteran I choose not to declare 6 Fort Vancouver Regional Library District Application for Employment 1-2015