Job Application

Candidates must complete all questions on this application.
Incomplete applications may not be accepted.

SECTION 1

Name:
Last:
First: Middle Initial:

Address:
Street: Apt. Number:
City: State: Zip:

Phone Number: Alternate Number:

Email:

Position applied for:
(Complete separate application for each position applied.)

Date of birth if under age 18:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
(Proof of citizenship or immigration status will be required upon employment)
Yes No
Comments:

How did you learn of this opening?

How long would you plan to stay in this position?

If hired, what date could you begin work?

Were you previously employed by Monroe County Public Library (MCPL)?  Yes  No
Volunteered? Yes No
If yes, dates and department:

List any relatives or members of the immediate household currently working for MCPL:

A driver's license and/or proof of auto insurance may be required for specific positions due to job related responsibilities. Do you have a current valid driver's license?
Yes No

Have you ever been convicted of, or are you currently charged with, any crime or has your driver's license ever been suspended? (A charge or conviction will not necessarily disqualify an applicant from employment)
Yes No
If yes, please explain:


We may contact previous employers listed on the application and/or resume, or provided as a reference, unless you indicate those you do not want us to contact.
DO NOT Contact:
REASON:

Have you ever been discharged or resigned as a result of or while under investigation for violation of any employer rules or policies?
Yes No
If yes, reason:

STOP! Applicants for a non-hourly position (pay grade 11 or higher), please proceed to SECTION 6. Be sure to submit your Resume and Cover Letter.

Hourly position applicants, continue here:



SECTION 2
RECORD OF EDUCATION

Name of Institution (beginning with high school) Number of Years Attended Did you graduate? (Yes or No) Degree Minor/Major
Yes
No
Yes
No
Yes
No


SECTION 3
SCHEDULE OF AVAILABILITY
(please check off the boxes that represent times you are available to work or choose "All" if your are available at all times listed)



All
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00
9:00-10:00 9:00-10:00 9:00-10:00 9:00-10:00 9:00-10:00 9:00-10:00 9:00-10:00
10:00-11:00 10:00-11:00 10:00-11:00 10:00-11:00 10:00-11:00 10:00-11:00 10:00-11:00
11:00-12:00 11:00-12:00 11:00-12:00 11:00-12:00 11:00-12:00 11:00-12:00 11:00-12:00
12:00-1:00 12:00-1:00 12:00-1:00 12:00-1:00 12:00-1:00 12:00-1:00 12:00-1:00
1:00-2:00 1:00-2:00 1:00-2:00 1:00-2:00 1:00-2:00 1:00-2:00 1:00-2:00
2:00-3:00 2:00-3:00 2:00-3:00 2:00-3:00 2:00-3:00 2:00-3:00 2:00-3:00
3:00-4:00 3:00-4:00 3:00-4:00 3:00-4:00 3:00-4:00 3:00-4:00 3:00-4:00
4:00-5:00 4:00-5:00 4:00-5:00 4:00-5:00 4:00-5:00 4:00-5:00 4:00-5:00
5:00-6:00 5:00-6:00 5:00-6:00 5:00-6:00 5:00-6:00 5:00-6:00 5:00-6:00
6:00-7:00 6:00-7:00 6:00-7:00 6:00-7:00 6:00-7:00 6:00-7:00 6:00-7:00
7:00-8:00 7:00-8:00 7:00-8:00 7:00-8:00 7:00-8:00 7:00-8:00 7:00-8:00
8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00 8:00-9:00


Certain job positions require employees to be available beyond the times specified above. If the position you applied for requires this, what times would you be available to work prior to 8:00 am Monday-Sunday:
After 9:00 pm Monday-Sunday:

SECTION 4

Work Experience: Begin with your most recent job. List each job separately. Please include related volunteer work.



  DATES EMPLOYERS DUTIES
1. Month and Year:
From
To 		Name of Current or Last Employer
 Your Title
Duties Performed
Address
Hours per week
 City, State, Zip Code
Salary Immediate Supervisor
Phone No. Reason for Leaving
2. Month and Year:
From
To 		Name of Former Employer
 Your Title
Duties Performed
Address
Hours per week
 City, State, Zip Code
Salary Immediate Supervisor
Phone No. Reason for Leaving
3. Month and Year:
From
To 		Name of Former Employer
 Your Title
Duties Performed
Address
Hours per week
 City, State, Zip Code
Salary Immediate Supervisor
Phone No. Reason for Leaving
4. Month and Year:
From
To 		Name of Former Employer
 Your Title
Duties Performed
Address
Hours per week
 City, State, Zip Code
Salary Immediate Supervisor
Phone No. Reason for Leaving
5. Month and Year:
From
To 		Name of Former Employer
 Your Title
Duties Performed
Address
Hours per week
 City, State, Zip Code
Salary Immediate Supervisor
Phone No. Reason for Leaving
6. Month and Year:
From
To 		Name of Former Employer
 Your Title
Duties Performed
Address
Hours per week
 City, State, Zip Code
Salary Immediate Supervisor
Phone No. Reason for Leaving


SECTION 5

List your special qualifications, skills or accomplishments which you feel would apply to this specific position.


SECTION 6

MCPL conducts candidate background checks relevant to position responsibilities upon acceptance of an offer and as a contingency of employment.

I, (please type your name), I certify that I have made true, correct and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application. I understand that any omission, false answered statements made by me on this application, or any supplement to it will be sufficient cause for failure to employ or for my discharge should I become employed with the Monroe County Public Library.

SECTION 7

Attachments: Optional for hourly positions. Required for salaried positions.)

Are you submitting a resume or other attachment?
Yes
No

If Yes, please email you MS Word document to jobopenings@mcpl.info

Please complete the following Voluntary Equal Employment Opportunity Information Request form.

Voluntary Equal Employment Opportunity
Informational Survey Request
The following information is for statistical purposes only.
It will be kept strictly confidential and will not be used for employment purposes.

- TO BE COMPLETED BY APPLICANT FOR EMPLOYMENT -
FORM WILL BE FILED SEPARATELY FROM APPLICATION

The Library is an equal opportunity employer and does not discriminate on the basis of race, color, religiion, sex, age, nation origin, disability, veteran status, sexual orientation, or any classification protected by federal, state, or local law. This survey is for statistical purposes related only to our recording requirements for the Equal Employment Opportunity Commission and other governmental and legal record keeping obligations.

All surveys will be kept in a confidential file separate from applications for employment. Submission of this information is completely voluntary; it will not be used in considering your application. Inclusion of exclusion of any date will not affect any employment decisions. Thank you for your cooperation.

ZIP Code:

Position Title Applied For:

Sex: Male Female Date of Birth: (mm/dd/yyyy) Age: 

Referral Source:
MCPL Website MCPL employee Newspaper IU  IvyTech
WorkOne Friend Other

With which racial/ethnic group do you identify?
White (non-Hispanic) Black (non-Hispanic) Hispanic
Asian or Pacific Islander American Indian or Alaska Native