Birmingham Public Library



BIRMINGHAM PUBLIC LIBRARY

EMPLOYMENT APPLICATION

Answer each question fully and accurately. Please print or type. Date

|Last Name First Name Middle Name |

|                  |

|Address Street City State Zip |

|                     |

|Telephone Cell Phone       |Social Security Number |

|Home      Email Address       |      |

| | |

|Position applied for:       |Salary Requirement:       |

| |

|Date available for employment       |

| |

|Are you seeking: Regular Full-time Part-time |

Have you ever worked at Birmingham Public Library? YES NO

Do you have any relatives working here? YES NO If so, who ________________

EDUCATION

Apprentice, business or vocational school:      

|Type of School |Name of School |Major Subject |Graduated |Last Year |

| | | | |Attended |

|High School |      |      |      |      |

|College |      |      |      |      |

|Graduate |      |      |      |      |

LIST ADDITIONAL SKILLS, KNOWLEDGE OR OTHER RELEVANT QUALIFICATIONS.

          

EMPLOYMENT EXPERIENCE (List U.S. Military Services, if any)

please complete this section even if you plan to attach a resume. List names and addresses of any former employees beginning with the most recent.

|Name and Address of Employer |Dates Employed |Duties Performed |

|      |MO/YR |      |

| |From       | |

|      |To       | |

| | | |

|      | | |

|Telephone: | | |

|      | | |

| |Hourly rate/salary: | |

| |Start:       | |

| |End       | |

|Job Title:       Status: Full-time Part-time Temporary |

| |

|Supervisor’s Name:       |

| |

|Reason for leaving:       |

|Name and Address of Employer |Dates Employed |Duties Performed |

| |MO/YR |      |

|      |From       | |

| |To       | |

|      | | |

| | | |

|      | | |

|Telephone: | | |

|      | | |

| |Hourly rate/salary: | |

| |Start:       | |

| |End       | |

|Job Title:       Status: Full-time Part-time Temporary |

| |

|Supervisor’s Name:       |

| |

|Reason for leaving:       |

|Name and Address of Employer |Dates Employed |Duties Performed |

| |MO/YR |      |

|      |From       | |

| |To       | |

|      | | |

| | | |

|      | | |

|Telephone: | | |

|      | | |

| |Hourly rate/salary: | |

| |Start:       | |

| |End       | |

|Job Title:       Status: Full-time Part-time Temporary |

| |

|Supervisor’s Name:       |

| |

|Reason for leaving:       |

Indicate by Number       which employers you do not wish us to contact.

As part of our employment process, an investigation may be made with respect to an applicant’s credit status, character, general reputation, personal characteristics and mode of living. Additional information as to the nature and scope of such report, if made, will be provided upon written request of the applicant.

_____________________________________________ _____________________________________

Signature of Applicant Date

EQUAL EMPLOYMENT OPPORTUNITY DATE

LIABILITY RELEASE

TO WHOM IT MAY CONCERN:

As an applicant for employment with Birmingham Public Library, I understand that a thorough background investigation may be conducted to qualify me for eligibility.

“I hereby authorize the custodian of any information related to my previous employment, driving record, education, residence, criminal convictions, credit standing, or character, to release said information to the person or agency identified herein, unless restricted by law. This authorization is made voluntarily, for the purpose of employment only. Upon receipt of this document, please release information directly related to the categories shown, and to which you have direct knowledge or documented evidence. I agree to hold harmless any individual or agency involved with the authorized release of legitimate information.” Thank you for your cooperation.

Authorized by:

______________________________________________

Full Name, print or type

______________________________________________

Current Address

______________________________________________

City, State, Zip Code

______________________________________________

Telephone Number

______________________________________________

Social Security Number

______________________________________________

Drivers License #, State of Issue

Birmingham Public Library

___________________________________ ____________________________________

Company/Agency Requesting Info Applicant Signature

___________________________________ ____________________________________

Authorizing Signature, Title Date

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