Application for Employment | Henry County Library

Personal Information

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Age (if under 18)

Employment Desired

What position are you applying for?

Salary Required

What date are you able to start?

I'm looking for...

Full-time Employment
Part-time Employment

I can work...

Days
Nights
Weekends

Education

Do you have a high school diploma?

Yes
No

Do you have a GED?

Yes
No

What is the highest year of schooling you have completed?

Name of High School Attended

Are you currently enrolled in school?

Yes
No

Have you attended a college, university, or trade school?

Yes
No

Name of College/University/Trade School

Do you have a degree?

Yes
No

Name of Degree

Do you have a postgraduate degree?

Yes
No

Name of Postgraduate Degree

Name of Postgraduate College or University

Highest Year of Post-secondary School Completed

Are you currently enrolled in college or postgraduate courses?

Yes
No

Employment History

Please list your 3 most recent places of employment, beginning with the most recent.

Most Recent Employer

Name of Employer

Phone

Supervisor's Name

State

City

Date Employed

Position(s) Held

Date Left

Reason for Leaving

Employer #2

Name of Employer

Phone

Supervisor's Name

State

City

Date Employed

Position(s) Held

Date Left

Reason for Leaving

Employer #3

Name of Employer

Phone

Supervisor's Name

State

City

Date Employed

Position(s) Held

Date Left

Reason for Leaving

Please describe any specialized education, training, or job skills, including computer experience.

Please list 3 references (not relatives or friends) who can speak about your qualifications and character.

Name

Phone

Name

Phone

Name

Phone

Upload Your Resume (if applicable)

Click or drag a file to this area to upload.

Upload Your Cover Letter (if applicable)

Click or drag a file to this area to upload.

How did you find out about this position?

Applicant's Statement

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Yes
No

Please describe the nature of the crime, when & where convicted, and disposition of the case.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary to arrive at an employment decision. I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge the employee at any time with or without cause. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge (please sign by printing your full legal name in the box below).

Digital Signature

Today's Date