Bath County Memorial Library

24 West Main Street

Owingsville, Kentucky 40360

606-674-2531

www.bathcountylibrary.com

Employment Application

Please answer all questions as completely as possible.  The use of this application does not create a contract between you and the Library, does not indicate that there are positions open, and does not in any way obligate you or the Library.  The Library does not discriminate in employment on the basis of race, color, sex, age, disability, religion, national origin, status as a disabled Veteran, or because an individual is a smoker or nonsmoker, as long as such individual complies with any workplace policy concerning smoking.

Date  _______/_______/_______

PLEASE PRINT IN INK OR TYPE

Name  _________________________________________________    Social Security #  ______/_______/_______

                         (Last)                                 (First)

Address  _______________________________________________________________________________________

                                              (Street)                                    (City)                                      (State)                    (Zip) Code

Phone  __________________________       ____________________________           _________________________

                               (Home)                                                                 (Work)                                                                        (Cell)

Position for which you are applying  _____________________________________      Full-time    Part-time

(Optional)  Your salary requirement      $ ______________   hourly rate               $ _________________  annual salary      

Availability  

            Days                        regularly                          sometimes                     never

                Evenings               regularly                          sometimes                     never

Weekends             regularly                          sometimes                     never

What date are you available to begin employment?   _____/_____/_____

Are you legally eligible for employment in the United States?      yes                  no

If you are less than 18 years of age, please give your date of birth      _____/_____/_____

Have you been convicted of a felony within the last 7 years?       yes    no

(Such conviction may be relevant if job related, but does not necessarily disqualify you from employment.)

If yes, state date, place, and nature of each conviction   __________________________________________ ________________________________________________________________________________________________

Have you ever been known by any other name(s) that the Library will need to know to verify any of the information contained on this application     yes        no   If yes, give name(s) and identify the related school, employer, etc.  __________________________________________________________________

________________________________________________________________________________________________

Does the Library now employ any of your relatives?       yes       no   If yes, please complete:

Name(s)  _______________________________     Dept.  ____________________     Relationship  ___________

Can you drive an automobile?     yes     no             Do you have a valid license?      yes    no

Do you have adequate transportation to travel both inside the library area and out?     yes    no

List your current or most recent employer first and indicate a continuous record of employment for the last five employers or from the time you left school.  If currently employed, may we contact your employer at this time for a reference?      yes            no

Circle highest grade completed   1  2  3 4  5  6  7  8          9  10 11  12          1  2  3  4                1  2  3  4

                                                                          Grade School                  High School             College          Graduate School

List all school attended:  high school, technical/vocational school, college, business, military, etc.  Use another sheet if necessary.

                        School                                            Did you               Certification or                             Major/Minor

                                                                            graduate?           degree received                       Subjects

SPECIALIZED TRAINING SKILLS

List all current licenses and/or areas of certification (if not listed above):   _________________________ ________________________________________________________________________________________________

List all equipment (office, trade, or laboratory) that you operate proficiently:   _____________________ ________________________________________________________________________________________________

List any other training, skills, aptitudes, and qualifications that you feel are relevant to the type of employment you are seeking at the Library:   _____________________________________________________ ________________________________________________________________________________________________

READ CAREFULLY BEFORE SIGNING

I certify that the information given by me in this application is true and complete.  I understand and agree that any false information, misrepresentation, or concealment of the fact is sufficient grounds for either my immediate discharge without recourse or refusal of employment by the Bath County Memorial Library.

                I agree that if I am employed by the Bath County Memorial Library my employment may be terminated at any time without liability except such wages as may have been earned at the date of my termination.  I further understand and acknowledge that this is an application for employment, that no employment contract is being offered and that if I am employed such employment is for an indefinite period of time and that the 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 Library.  I also understand that any employment is subject to a satisfactory check of references and a Police Department background check.  I hereby authorize all individuals and organizations named or referred to in this application and any law enforcement organization to give the Library all information relative to my employment, work habits, and character and hereby release such individuals, organizations, and the Library from any liability for any claim or damage that may result.

Signature   ____________________________________________________________  Date   ________________________

Please provide three references.  You may provide additional references if you like on a separate sheet of paper.