Job Application

Complete all questions on this application. Candidates submitting incomplete applications may not be considered for opening.

Name:
Last:
First: Middle Initial:

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

Phone No: Email:

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

Date of birth if under age 18:

Are you legally eligible for employment in the U.S.? (Proof of U.S. 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:

Can you perform the essential functions of the position applied for, with or without reasonable accommodation?
Yes No
Comments:

Do you have a valid Driver's license and safe driving record, if required? (record and documentation will be required for some jobs)
Yes No N/A
Comments:

Have you ever been convicted of or pled guilty to a felony or misdemeanor?
Yes No
If yes, what were you convicted of or what did you plead guilty to and when did that occur?

The information in this section is subject to the Indiana Access to Public Records Act IC 5-14-3-4(4)(b)(8) and may be made available to the general public when requested.

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
Yes
No
Yes
No



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:

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


We may contact the employers listed above unless you indicate by number those you do not want us to contact.
DO NOT Contact REASON

Have you ever been discharged or resigned under charges from any employment?
Yes No
If yes, reason



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


Monroe County Public Library is an equal opportunity employer. Monroe County Public Library selects the best matched individual based on job related qualifications, regardless of race, creed, color, sex, national origin, age, handicap, or other protected groups under state, federal, or equal opportunity laws.

Background Check: (Please read carefully before submitting application.)

I, (please type your name), understand that
my check in this box authorizes Monroe County Public Library to conduct a background investigation and authorizes release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institution, personal/professional references, and other appropriate sources. I waive my right of access to any such information, and without limitation hereby release Monroe County Public Library and the reference source from any liability in connection with its release or use.

Furthermore, 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.