Employment Application

Employment Application

Plainfield-Guilford Township Public Library

1120 Stafford Rd.

Plainfield, IN 46168

317-839-6602

www.plainfieldlibrary.net

DATE OF APPLICATION*

MonthDayYear
Please note: Fields marked with a red asterisk are required fields that must be filled in. Use "N/A" as appropriate.
The Library is an equal opportunity employer.

Applicants are considered for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, sex, age, disability or any other legally protected class.
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you have resided at your present address less than three years, list other addresses at which you have resided during the past three years.
Address
Contact Number*

Area CodePhone Number
E-mail*
WHAT POSITION ARE YOU APPLYING FOR?*

Bookkeeper (Part-time, 25 hrs/week)
HOURLY RATE/SALARY REQUIRED *
ARE YOU AVAILABLE TO WORK FULL TIME?*

YesNo
ARE YOU AVAILABLE TO WORK PART TIME?*

YesNo

What hours and days of the week are you available to work? *

	Starting Time	Ending Time
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY

WILL YOU WORK OVERTIME IF NEEDED?*

YesNo
AFTER REVIEWING THE JOB DESCRIPTION(S) THAT CORRESPOND(S) TO THE POSITION(S) FOR WHICH YOU APPLIED, ARE YOU ABLE TO PERFORM ALL JOB FUNCTIONS?*

YesNo
ON WHAT DATE WOULD YOU BE ABLE TO START WORK?*

MonthDayYear
HAVE YOU EVER BEEN EMPLOYED BY THE LIBRARY BEFORE?*

YesNo
IF YES, GIVE DATE AND REASON FOR LEAVING
DO YOU HAVE ANY RELATIVES CURRENTLY EMPLOYED BY THE LIBRARY OR WHO CURRENTLY SERVE ON THE LIBRARY BOARD OF TRUSTEES?*
(NOTE: Nepotism clauses in library policy and library board by-laws prohibit the employment of relatives of current library board members. Library policy also places some restrictions on the employment of relatives of current library staff members.)
Please disclose the name of your relative*
ARE YOU ELIGIBLE TO WORK IN THE U.S.?*

YesNo
HAVE YOU EVER BEEN CONVICTED OF OR PLEAD GUILTY TO A CRIME THAT HAS NOT BEEN EXPUNGED BY A COURT?*

YesNo
IF YES, PLEASE EXPLAIN
CONVICTION WILL NOT NECESSARILY DISQUALIFY APPLICANT FROM EMPLOYMENT
HAVE YOU EVER BEEN DISCHARGED FROM OR ASKED TO RESIGN FROM ANY POSITION?*

YesNo
IF YES, PLEASE EXPLAIN
EDUCATION

	Name	City/State	Years completed	Graduate?	Degree granted
High School
College or University
Business, Trade, or Technical

MILITARY SERVICE
DID YOU SERVE IN THE UNITED STATES ARMED FORCES?*

YesNo
IF YES, WHAT BRANCH OF SERVICE?
ARE YOU IN THE ARMED FORCES RESERVE?*

YesNo
IF YES, WHAT BRANCH OF THE RESERVE?
IF YES, WHAT IS YOUR STATUS?

ActiveInactive
SPECIAL SKILLS AND QUALIFICATIONS
SUMMARIZE SPECIAL JOB-RELATED SKILLS AND QUALIFICATIONS ACQUIRED FROM EDUCATION, EMPLOYMENT, VOLUNTEER WORK, OR MILITARY SERVICE. INCLUDE FOREIGN LANGUAGE FLUENCY*
LIST SPECIFIC OFFICE MACHINES, SOFTWARE, TOOLS, MACHINERY, OR OTHER EQUIPMENT THAT YOU ARE TRAINED ON AND CAN OPERATE THAT WILL BE HELPFUL IN PERFORMING THE RESPONSIBILITIES OF THE POSITION FOR WHICH YOU ARE APPLYING.*
PERSONAL REFERENCES

List the name, address, and telephone number of three references who are not related to you and are not previous employers.
EMPLOYMENT RECORD

Starting with your present or most recent job, list employment experience for up to your last seven jobs. Job-related military service assignments and volunteer activities may be listed. Please note: all fields require an answer; use “N/A” as appropriate.
MAY WE CONTACT THE EMPLOYERS LISTED ABOVE?*

YesNo
If no, list which one(s) you do not wish us to contact and state the reason why you prefer that we do not contact the employer(s).
PROVIDE ANY INFORMATION THAT YOU BELIEVE WOULD BE HELPFUL IN CONSIDERING YOUR APPLICATION.
Please attach Resume*

Upload a File

Cancelof
APPLICANT’S STATEMENT

(Please indicate that you have read and understand each paragraph of this statement by checking the boxes.)
Date*

MonthDayYear
SIGNATURE OF APPLICANT*
Should be Empty:

The Library is an equal opportunity employer.

EDUCATION

MILITARY SERVICE

SPECIAL SKILLS AND QUALIFICATIONS

PERSONAL REFERENCES

EMPLOYMENT RECORD

APPLICANT’S STATEMENT