Application For Employment with Cook Memorial Public Library District

Name

First Name:
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Middle Name:
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Last Name:
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Address

Street:
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City:
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State:
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Zip:
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Home Phone:
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Cell Phone:
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Email Address:
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Social Security #:
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Are you authorized to work in the United States on an unrestricted basis?
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Position Applying for:
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Hours:
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Wage or Salary Desired?
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When can you start?

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Are there any hours, shifts or days you cannot or will not work?
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How did you learn of this opening?
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Have you ever been convicted of a felony?
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If yes, explain:
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Please Note: You are not obligated to disclose sealed or expunged convictions pursuant to 20 ILCS 2630/12-13. Acknowledgement of prior conviction will not automatically result in rejection of applicant's jon application or disqualification from consideration for employment. The Library will consider, among other factors, nature of crime and conviction, nature of job responsibilities, and age of applicant at time of conviction and crime. However, applicant must answer truthfully and accurately.

Education

High School

Name of School:
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Location of School:
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Major:
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Diploma/Degree:
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College/University

Name of School:
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Location of School:
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Major:
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Diploma/Degree:
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Computer Skills:
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Language Skills

Spanish?
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ASL?
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Other?
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Personal References

Name:
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Address:
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Telephone Number:
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Occupation:
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Name:
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Phone:
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Occupation:
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Work History

May we contact your present employer?
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Most Recent Employer:
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Address:
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Phone:
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Date Started:
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Starting Salary:
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Date Left:
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Salary on Leaving:
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Position on Leaving:
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Name and Title of Supervisor:
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Description of Duties:
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Reasons for Leaving:
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Previous Employer:
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Address:
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Date Started:
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Starting Salary:
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Date Left:
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Salary on Leaving:
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Position on Leaving:
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Name and Title of Supervisor:
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Description of Duties:
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Reasons for Leaving:
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Previous Employer:
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Address:
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Telephone Number:
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Date Started:
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Starting Salary:
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Date Left:
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Salary on Leaving:
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Position on Leaving:
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Name and Title of Supervisor:
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Description of Duties:
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Reasons for Leaving:
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Applicant's Certification and Agreement

I certify that the facts set forth in this application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in dismissal. I authorize Cook Memorial Public Library District to make an investigation of any of the facts set forth in this application.

Electronic Signature(*)
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Cook Memorial Public Library District is an equal oppurtunity employer and shall be non-discriminatory in its employment practices with respect to race, color, religion, sex, national origin, veteran status, age or disability