YPSILANTI DISTRICT LIBRARY

APPLICATION FOR EMPLOYMENT

 

To the Applicant: We appreciate your interest in the Ypsilanti District Library and assure you that we are interested in your qualifications.  A clear understanding of your background and work history will aid us in placing you in a position which, in our judgment, best meets your qualifications.

 

As an equal opportunity employer, we will consider qualified applicants for all positions without regard to race, color, handicap, sex, religion, national origin, age, marital or veteran status.  If you have a disability and need accommodation in order to participate in this process, please contact the

Library Director.

PERSONAL

 

Name_________________________________________________________Date of Application_______________

                (Last)                      (First)                                    (Middle)

 

Address__________________________________________________________Telephone Number_____________

             (Number)                         (Street)                         (City)         (zip)

 

Social Security No.______________________________________________

Are you a U.S. citizen or permanent resident alien? Yes____No____

Have you been previously employed here? Yes____No____

If yes, date(s)_____________________________Supervisor's Name(s)___________________________

Have you filed an application before? Yes____No____  If yes, date(s)____________________________

List any friends or relatives working here:___________________________________________________

____________________________________________________________________________________

 

EMPLOYMENT DESIRED

Position(s) applying for:_________________________________________________________________________

Kind of work sought: Full Time____ Part Time____Other______________________________________________

If part-time, please specify hours and days desired:____________________________________________________

____________________________________________________________________________________________

Salary Desired:_________________________________________Date available to work:_____________________

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

 

 

Name/Location

Years

Completed

Diploma/

Degree

Courses

of Study

Vocation/

Training

 

 

 

 

 

 

 

 

 

 

High

School

 

 

 

 

 

 

 

 

 

 

College

 

 

 

 

 

 

 

 

 

 

Graduate

 

 

 

 

 

 

 

 

 

 

 

Any other educational training:____________________________________________________________________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

 

Military Service Record

Have you had experience in the Armed Forces of the United States or in a State National Guard?  Yes____No____

If yes, what branch?________________Rank at discharge__________________Date of discharge______________

Are you in the reserves? Yes____No____          If yes, date obligation ends_________________________________

Special/technical training________________________________________________________________________

____________________________________________________________________________________________

 

RELEVANT EXPERIENCE

 

List any licenses, registrations, certifications and skills you possess (For example, CPA, Registered Engineer,Typing and Shorthand skills)_____________________________________________________

 

____________________________________________________________________________________

 

____________________________________________________________________________________

Have you had any other experience which would help you in this job? (For example, misc. employment,
hobbies, work for schools, community groups, clubs or associations, or military experience)___________

____________________________________________________________________________________

____________________________________________________________________________________

 

 

 

EMPLOYMENT EXPERIENCE  List current or most recent job first:

 

Employer and Address (Last or Present Employer)____________________________________________________

 

Job Title____________________________________Immediate Supervisor________________________________

 

Why did you leave?_____________________________________________________________________________

 

Describe your duties:___________________________________________________________________________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

From: Month____Year____                  Full Time____         Part Time____

 

To:       Month____Year____

 

Final Salary_______________________  Hours per week_________ No. of Employees you Supervised__________

 

 

Employer and Address (Next Previous Employer)____________________________________________________

 

Job Title____________________________________Immediate Supervisor________________________________

 

Why did you leave?_____________________________________________________________________________

 

Describe your duties:___________________________________________________________________________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

From: Month____Year____                  Full Time____         Part Time____

 

To:       Month____Year____

 

Final Salary_______________________  Hours per week_________ No. of Employees you Supervised__________

 

 

Employer and Address (Next Previous Employer)____________________________________________________

 

Job Title____________________________________Immediate Supervisor________________________________

 

Why did you leave?_____________________________________________________________________________

 

Describe your duties:___________________________________________________________________________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

From: Month____Year____                  Full Time____         Part Time____

 

To:       Month____Year____

 

Final Salary_______________________  Hours per week_________ No. of Employees you Supervised__________

 

 

 

Employer and Address (Last or Present Employer)____________________________________________________

 

Job Title____________________________________Immediate Supervisor________________________________

 

Why did you leave?_____________________________________________________________________________

 

Describe your duties:___________________________________________________________________________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

From: Month____Year____                  Full Time____         Part Time____

 

To:       Month____Year____

 

Final Salary_______________________  Hours per week_________ No. of Employees you Supervised__________

 

REFERENCES (Do not include relatives)

 

 

Name

Mailing Address

Phone Number

Relationship

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

Additional Information

 

Have you been convicted of a crime?  Yes____No____

 

If so, where, when and nature of offense_____________________________________________________________

 

____________________________________________________________________________________________

Do you have a valid driver's license?  Yes____No____ License No. ____________________State______________

List professional, trade, business or civic activities and offices held excluding groups the name or character of which indicate race, color, religion, sex, national origin, handicap, marital or veterans status_________________________

 

____________________________________________________________________________________________

 

State any additional information that you feel may be helpful to us in considering your application_______________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

____________________________________________________________________________________________

 

 

 

 

AUTHORIZATION AND UNDERSTANDING

Release of Prior Personnel Records

By signing this application, I agree that all of the information now or later given by me in support of my application for employment is true and complete.  I give you my permission to verify any of the information concerning my employment, education. credit or medical history with the appropriate individuals, organizations, or governmental agencies.  I give these individuals, organizations, or governmental agencies my permission to release any information that you need, including my previous disciplinary record, without requiring them to contact me or give me written notice before revealing the information to you.  By signing this application, I release you and them from any liability whatsoever arising out of any information request or disclosure.  I agree that any false information in support of mv application may subject me to discharge at anvtime during my employment.

At-Will Employment Status

I AGREE THAT EITHER PARTY MAY TERMINATE THE EMPLOYMENT RELATIONSHIP, WITH OR WITHOUT CAUSE.  AT ANY TIME.  FOR ANY REASON.  I agree that I shall be bound by the other rules, policies, regulations. and terms and conditions of employment of the Library as they are from time to time changed and that no additional obligations can be imposed by me on the Library except those which have been acknowledged, in writing by the Library Director or his/her designated representative.  I further agree that my employment is conditional upon satisfactory completion of documentation as required by the Immigration Reform and Control Act of 1986 and until such time as the results of my pre-employment physical (if such physical is required) are known.

ADA Accommodation Request

I understand that Michigan law requires employers to make accommodations to applicants and employees with handicaps where the accommodation does not impose an undue hardship on the employer.  I further understand employees and applicants with handicaps may request an accommodation of their handicap by notifying the Library in writing of the need for accommodation within 182 days of the date the individual knows or should know that an accommodation is needed.  Failure to properly notify the Library will preclude any claim that the Library failed to accommodate the individual.

Limitation on Time for Employment Complaints

I AGREE THAT ANY ACTION OR LAWSUIT AGAINST THE LIBRARY ARISING OUT OF MY EMPLOYMENT OR TERMINATION OF EMPLOYMENT, INCLUDING BUT NOT LIMITED TO CLAIMS ARISING UNDER STATE OR FEDERAL CIVIL RIGHTS STATUTES.  MUST BE BROUGHT WITHIN ONE YEAR OF THE EVENT GIVING RISE TO THE CLAIMS OR BE FOREVER BARRED.  I WAIVE ANY LIMITATION PERIOD TO THE CONTRARY.

 

_____________________________________________________                     ____________________________

                                                Signature                                                                                                               Date