ACL Application for Employment

Application for Employment

You must complete this form to be considered an applicant. Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered.
We do not discriminate on the basis of race, color, religion, national origin, gender, age, sexual orientation, veteran status, disability or any other legally protected status. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

The Ada Community Library is an Equal Opportunity Employer

EDUCATION

	Name of School	Location (City, State)	Course of Study/Major	Diploma/ Degree	Graduated? Y/N (If No, # of years completed)
High School
College
Graduate School
Other (Business, Vocational, Military)

SPECIAL TRAINING, SKILLS, EXPERIENCE

You may exclude any information that may reveal race, color, religion, national origin, gender, age, sexual orientation, veteran status, disability or any other legally protected status.
Describe any specialized skills, training, or certifications that relate to the position you are applying for:

0/90
List professional and/or volunteer activities and offices you have held that relate to the position you are applying for:

0/100
List any computer software and/or office equipment you are proficient with (Please include any library software or databases you are highly familiar with and have used on a regular basis):

0/125
State any additional information you feel may be helpful to us in considering your application:

0/125

EMPLOYMENT HISTORY
MAY WE CONTACT YOUR PRESENT EMPLOYER?

YESNO
Please list below your most recent employment first. May include temporary jobs or internships. Be sure to list all relevant employment history:
Employer #1
Address (Street, City, State, Zip)
Supervisor Name
Phone
Position Held
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Hours Worked Per Week
Pay Rate Upon Leaving
Duties
Reason For Leaving
Employer #2
Address (Street, City, State, Zip)
Supervisor Name
Phone
Position Held
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Hours Worked Per Week
Pay Rate Upon Leaving
Duties
Reason For Leaving
Employer #3
Address (Street, City, State, Zip)
Supervisor Name
Phone
Position Held
Date From

MonthDayYear
Date
Date To

MonthDayYear
Date
Hours Worked Per Week
Pay Rate Upon Leaving
Duties
Reason For Leaving

PROFESSIONAL REFERENCES

Please provide references who are familiar with your work history and/or experience.

	Name	Organization	City, State	Relationship	Years Known	Phone
1
2
3

APPLICANT STATEMENT

PLEASE READ THE FOLLOWING BEFORE SIGNING THIS APPLICATION:
Are you capable of performing the essential functions of the job for which you applied, with or without reasonable accommodation? (Do not answer this question until you have read the job description carefully)

YESNO
We will give preference to qualified veterans in accordance with Idaho Code Title, 65, Chapter 5 or its successor.
1. Are you a veteran or family member who qualifies for and are claiming preference pursuant to Idaho Code 65-503 or its successor? (If YES, please complete the attached veteran’s preference sheet)

YESNO
2. Have you previously claimed such preference?

YESNO
I certify that all information contained in this application is true, accurate, and complete to best of my knowledge. I understand that any false or misleading statements as part of this application or interview process may result in a refusal to hire or if hired, may subject me to immediate dismissal.
I understand that the Ada Community Library may make a thorough investigation of my work and personal history as it applies to employment, now and in the future, and may verify all data given to the Library on this application, on any related papers, or in an interview. I authorize investigation of such data as may be necessary in arriving at an employment decision. I also hereby release all parties and persons connected with any such request from all claims, liabilities, or damages for any reason arising out of the furnishing of such information.
I understand and acknowledge that, if hired, my employment is for no definite period and that either the Employer, Ada Community Library, or I may terminate our relationship at will at any time, with or without notice or cause, and that this employment application does not constitute an employment contract.
This application for employment shall be considered active only for a period of 90 days.
I have read and understand all of the above.
Signature of Applicant:*

Clear
Date:

MonthDayYear
Date
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VETERAN’S PREFERENCE
Per Idaho Code, Title 65, Chapter 5, the Ada Community Library will afford a preference to employment of veterans. In the event of equal qualifications and experience between candidates for an available position, a veteran who qualifies will be preferred. If claiming veteran’s preference, please complete the information below and attach a copy of your DD-214 to this application.
(Reference Idaho Code, Title 65, Chapter 5, and 5 U.S.C. § 2108)
The term “active duty” means full-time duty in the Armed Forces, but NOT active duty for training.
Part 1. Preference Eligible Veterans:
I have a service-connected disability of 10% or more.I am the spouse of an eligible disabled veteran, who has a service-connected disability.I am the widow or widower of an eligible veteran and have remained unmarried.I do not meet any of the selections above, but I served on active duty in the armed forces of the United States for a period of more than one-hundred eighty (180) days and was honorably discharged
Part 2. Documentation & Signature:
By my signature, I certify that all statements on this form are true and complete to the best of my knowledge. I understand that should an investigation disclose inaccurate or misleading answers, my application may be rejected and my name removed from consideration for employment with the Ada Community Library.

I have attached a copy of my DD-214. Veteran’s preference will not be considered without this document.
Name (Please Print)
Signature

Clear
Date:

MonthDayYear
Date
Should be Empty:

Application for Employment

POSITION INFORMATION

PERSONAL INFORMATION

EDUCATION

SPECIAL TRAINING, SKILLS, EXPERIENCE

EMPLOYMENT HISTORY

PROFESSIONAL REFERENCES

APPLICANT STATEMENT

VETERAN’S PREFERENCE