Employment Application Name First Name Middle Last Name Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number Email Address If employed, can you provide proof of authorization to work in the U.S.? Yes No Position(s) applying for: Referred by Ad Friend Relative Agency Other… Enter other… High School Address Did you graduate high school? Yes No College/University Address Degrees or Diplomas Years Attended 1 2 3 4 Trade or Technical School Address Degrees or Diplomas Graduate School Address Degrees or Diplomas Years Attended 1 2 3 4 Special Skills Summarize any special skills or qualifications that you acquired through employment or other experience that are applicable to the job that you are applying for: Employment HistoryBegin with the most recent employer. Attach additional sheet if needed. Employer Dates of Employment Address Address Phone Number Manager's Name Ending Salary Title/Duties Reason for Leaving Employer Dates of Employment Address Address Phone Number Manager's Name Ending Salary Titles/Duties Reason for Leaving Employer Dates of Employment Address Address Phone Number Manager's Name Ending Salary Titles/Duties Reason for Leaving Have you been employed here before? Yes No May we contact your current employer? Yes No Signature of Applicant I certify that all of my answers given here are true and complete to the best of my knowledge, and that supplying false information herein shall result in immediate disqualification for consideration for employment or termination from employment, regardless of when such false information is discovered. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision; and I hereby agree to indemnify and hold harmless each and every current or prior employer in defending against any charge, complaint or suit filed with any Federal, State or local agency, or in any court of the State or Federal government for providing an accurate, factual history of employment information. I understand that neither this document nor any offer of employment from the employer constitutes an employment contract, unless a specific document to that effect is executed by the employer and employee in writing. Signature Date Download the Byron Public Library District Employment Application (PDF)