FHPL Employment Application Form

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Thank you for your interest in a position at Fairport Harbor Public Library. Your application will be kept active for 6 months and on file for 1 year.

Personal Information:

Name

Preferred Name

Phone Number

Address

Are you a US Citizen? (answer yes or no)

Have You Ever Been Convicted of a Crime (Felony or Misdemeanor)? (answer yes or no) If Yes, please explain.

If Selected for Employment Are You Willing to Submit to a Pre-Employment Drug Screening Test / Background Check? (answer yes or no)

Position:

Position You Are Applying For

Available Start Date:

Desired Pay

Type of Employment Desired:

Full Time

Part Time

Availability : (check all that apply)

Morning

Afternoon

Evening

Weekday

Saturday

Education:

School Name / Location / Years Attended / Degree Received / Major / Minor

References – other than employers listed below or family members

Reference 1:
Name / Company & Position / Relationship / Phone / Email

Reference 2:
Name / Company & Position / Relationship / Phone / Email

Reference 3:
Name / Company & Position / Relationship / Phone / Email

Employment History

Employer 1:
Name of Employer / Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Employer 2:
Name of Employer / Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Employer 3:
Name of Employer / Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Employer 4:
Name of Employer / Job Title / Dates Employed / Starting Pay Rate / Ending Pay Rate / Address / City, State, Zip / Supervisor Name / Supervisor Email

Other:

Please give additional information or describe any skills, certifications, or experience that may be pertinent to this position

Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Name

Date (DD/MM/YYYY)