Greensburg Decatur County Public Library Director Application Form

Employment History Information
List in order, with present or most recent employer first. Account for all work history and the periods of unemployment. Continue on a separate sheet or upload additional entries if necessary. IF YOU WORKED UNDER A NAME OTHER THAN INDICATED ON FRONT OF APPLICATION, PLEASE INDICATE BELOW.
Company name and address:
Type of business:
Starting job title:
Ending job title:
Start Date

MonthDayYear
Separation Date

MonthDayYear
Company telephone number:

Area CodePhone Number
Supervisor name & job title:

First NameLast NameJob Title
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Company name and address:
Type of business:
Starting job title:
Ending job title:
Start Date

MonthDayYear
Separation Date

MonthDayYear
Company telephone number:

Area CodePhone Number
Supervisor name & job title:

First NameLast NameJob Title
Describe your duties:
Reason for leaving
NEXT EMPLOYER
Company name and address:
Type of business:
Starting job title:
Ending job title:
Start Date

MonthDayYear
Separation Date

MonthDayYear
Company telephone number:

Area CodePhone Number
Supervisor name & job title:

First NameLast NameJob Title
Describe your duties:
Reason for leaving
Additional Information
Professional References

Please list at least three professional references
Reference #1
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Relationship
Reference #2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Relationship
Reference #3
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Relationship

Upload Resume or additional information
Resume, additional references, and/or additional employment entries (please upload as a *.docx, *.xlsx, or *.pdf file)

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Read carefully before signing
I certify that the information given by me in this application is true and complete to the best of my knowledge. I understand and agree that any false information, misrepresentation, omission, or concealment of fact is sufficient grounds for my immediate termination by the Greensburg-Decatur County Contractual Public Library.

I understand and acknowledge that this is an application for employment, and that no employment contract is being offered. I acknowledge that if I am employed such employment is for an indefinite period of time and that the Greensburg-Decatur County Contractual Public Library can change wages, benefits, and conditions at any time.

I understand and agree that all information furnished in this application may be verified by the Greensburg-Decatur County Contractual Public Library. I authorize the Library to conduct a criminal background check. I release the listed references and all employers, except those specifically excepted*, to provide you with any and all applicable information they may have. I hereby release such individuals, organizations, and former/present employer(s) from all liability for any information they may give you.
Choose one:*

I ACCEPTI DO NOT accept
Date*

MonthDayYear
Signature*
*Employers specifically excepted:
Enter the message as it's shown*
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Greensburg-Decatur County Contractual Public Library	Phone: (812) 663-2826
1110 E. Main St.	Fax: (812) 663-5617
Greensburg, IN 47240	Website: http://www.greensburglibrary.org

Greensburg hours:	Westport hours:
Mon., Tues., and Thurs. 9:00 AM - 8:00 PM	Mon., Thurs. 10:00 AM - 7:00 PM
Wed. 9:00 AM - 6:00 PM	Tues., Wed. 10:00 AM - 5:00 PM
Fri. - 9:00 AM - 5:00 PM	Friday: Closed
Sat. - 9:00 AM - 1:00 PM	Sat. - 9:00 AM - 1:00 PM

APPLICATION FOR EMPLOYMENT

JOB INTEREST

EDUCATION INFORMATION

Employment History Information

Additional Information

Upload Resume or additional information

Read carefully before signing