Tangipahoa Parish Library Employment Application

Please complete each section EVEN IF you decide to attach a resume.

FULL NAME:*

FirstMiddleLast

DATE:*

Date

ADDRESS:*

Street Address

Apt/Suite

CityState

Zip Code

E-MAIL:*

example@example.com

PHONE:*

Area Code and Phone NumberFormat: (000) 000-0000.

POSITION(S) APPLIED FOR (select all that apply):*

I am interested in:*

FULL-TIMEPART-TIMESEASONAL

I am interested in working at (select all that apply):*

Are you legally eligible for employment in the country?*

YESNO*

*IF NO, PLEASE EXPLAIN:

Have you previously worked for Tangipahoa Parish Library?*

YES*NO

*If yes, list the date (s) of employment and position (s) held:

Are you related to anyone currently working for the Library or serving on the Library's Board?*

YES*NO

*If yes, please list their name (s) and relationship (s):

Have you ever pleaded "guilty" or "no contest" to or been convicted of a crime?*

YES*NO

*IF YES, PLEASE EXPLAIN:

Answering "yes" to the previous question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered. NOTE: You are not obligated to disclose convictions that have been expunged.

INSTITUTION:*

CITY / STATE:*

Type (select one):*

FROM:*

Date

TO:*

Date

Completed?*

YESNO

DIPLOMA, DEGREE, or CERTIFICATION:

CURRENT EMPLOYER:

Company / Individual

EMPLOYER E-MAIL:

example@example.com

EMPLOYER PHONE:

Area Code and Phone NumberFormat: (000) 000-0000.

EMPLOYER ADDRESS:

Street Address

Apt / Suite

CityState

Zip Code

JOB TITLE:

RESPONSIBILITIES:

FROM:

Date

TO:

Date

May we contact?

YESNO

REASON FOR LEAVING:

PREVIOUS EMPLOYER:

Company / Individual

PREVIOUS EMPLOYER E-MAIL:

example@example.com

PREVIOUS EMPLOYER PHONE:

Area Code and Phone NumberFormat: (000) 000-0000.

PREVIOUS EMPLOYER ADDRESS:

Street Address

Apt / Suite

CityState

Zip Code

JOB TITLE:

RESPONSIBILITIES:

FROM:

Date

TO:

Date

May we contact?

YESNO

REASON FOR LEAVING:

REFERENCE 1

FULL NAME:

RELATIONSHIP:

COMPANY:

TITLE:

E-MAIL:

example@example.com

PHONE:

Area Code and Phone NumberFormat: (000) 000-0000.

REFERENCE 2

FULL NAME:

RELATIONSHIP:

COMPANY:

TITLE:

E-MAIL:

example@example.com

PHONE:

Area Code and Phone NumberFormat: (000) 000-0000.

REFERENCE 3

FULL NAME:

RELATIONSHIP:

COMPANY:

TITLE:

E-MAIL:

example@example.com

PHONE:

Area Code and Phone NumberFormat: (000) 000-0000.

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?*

YESNO

I certify that all information I have provided in order to apply for and secure work with Tangipahoa Parish Library is true, complete and correct. Read each paragraph and check the box to confirm you understand and agree with the statement.*

I expressly authorize, without reservation, the Library, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in the application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the Library, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.I understand that the Library is an Equal Opportunity Employer, and does not unlawfully discriminate in employment, and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. I understand that I may request to fill out and Equal Opportunity Employment form to be used for research, reporting, statistical purposes and to monitor legal compliance. I understand that completion of an Equal Opportunity Employment form is voluntary and will not affect my opportunity for employment or terms or conditions of employment if hired.If I am hired, I understand that I am free to resign with or without cause and a minimum of two (2) weeks notice. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the Library is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to foregoing express language are valid unless they are in writing and signed by the Library Director.I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.The Library does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state or local law. The Library likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, genetic information, age, disability or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display or derogatory pictures or other graphic materials, and any other words or conduct that demeans, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. The Library takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the Library's service, whenever it is discovered.I certify that I have read, fully understand and accept all terms of the forgoing applicant statements.

SIGNATURE*

DATE*

Date

PRINT NAME*

Attach resume, if desired.

PDF preferred

Employment / Job Application

PERSONAL INFORMATION

EMPLOYMENT ELIGIBILITY

EDUCATION

EMPLOYMENT HISTORY

REFERENCES

REFERENCE 1

REFERENCE 2

REFERENCE 3

BACKGROUND CHECK CONSENT

DISCLAIMER