Employment Application Survey

1. Application for Employment for the Calcasieu Parish Public Library

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

Calcasieu Parish Public Library

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1. Information

Information First Name
Last Name
Middle Name
Address
City
State
Zipcode
Telephone Number (s)

Your application will be submitted to the Human Resources Division of the Calcasieu Parish Public Library. Please email your resume' to jobs@calcasieu.lib.la.us

2. Preferred Location(s).

Preferred Location(s). Administration

Carnegie

Central

Computing Services

DeQuincy

Epps

Fontenot

Genealogy

Hayes

Iowa

Maplewood

Moss Bluff

Starks

Sulphur

Warehouse

Westlake

3. Position (s) applied for:

Position (s) applied for: Branch Manager

Computer System Technician

Library Assistant

Library Associate

Library Associate/Library Assistant

Maintenance Technician

Page

Other (please specify)

4. Date of Application

	MM		DD		YYYY
Month/Date/Year	Date of Application Month/Date/Year Month	/	Day	/	Year

5. How Did you Learn About Us?

How Did you Learn About Us? Advertisement

Employment Agency

Friend

Inquiry

Relative

Other

Website

Other (please specify)

6. Email address:

Email address:

7. Social Security Number
Optional, but will be required prior to employment.

Social Security Number Optional, but will be required prior to employment.

8. Best Time to Contact
Time range is acceptable: Ex (9:00am to 11:00am or anytime)

Best Time to Contact Time range is acceptable: Ex (9:00am to 11:00am or anytime)

9. If you are under 18 years of age, can you provide required proof of your eligibility to work?

If you are under 18 years of age, can you provide required proof of your eligibility to work? YES

10. Have you ever filed an application with us before?

Have you ever filed an application with us before? YES

If YES, give date: (MM/DD/YYYY)

11. Have you ever been employed with us before?

Have you ever been employed with us before? YES

If YES, give date: (MM/DD/YYYY)

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12. Do any of your relatives work for Calcasieu Parish Public Library?

The Library recognizes the desire of employees to assist relatives in seeking careers. However, to comply with statutory requirements and/or avoid potential conflicts, problems, and compromises, individuals will not be hired or appointed to situations where they report to and/or are supervised, directly or indirectly, by a relative or domestic partner. Relatives or domestic partners of the Director or of the Board of Control shall not be employed by the Library.

Do any of your relatives work for Calcasieu Parish Public Library? The Library recognizes the desire of employees to assist relatives in seeking careers. However, to comply with statutory requirements and/or avoid potential conflicts, problems, and compromises, individuals will not be hired or appointed to situations where they report to and/or are supervised, directly or indirectly, by a relative or domestic partner. Relatives or domestic partners of the Director or of the Board of Control shall not be employed by the Library. YES

13. Are you currently employed?

Are you currently employed? YES

14. May we contact your present employer?

May we contact your present employer? YES

15. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
NOTE: Proof of citizenship or immigration status will be required upon employment.

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? NOTE: Proof of citizenship or immigration status will be required upon employment. YES

16. Date available for work

	MM		DD		YYYY
Date	Date available for work Date Month	/	Day	/	Year

17. What is your desired salary range?

What is your desired salary range?

18. Are you available to work

Are you available to work Part Time

Full Time

Temporary

19. Please indicate if appropriate

Please indicate if appropriate Mornings

Afternoons

Evenings

20. Please indicate dates available

Please indicate dates available From:
To:

21. Are you currently on "lay-off" status and subject to recall?

Are you currently on "lay-off" status and subject to recall? YES

22. Can you travel if a job requires it?

Can you travel if a job requires it? YES

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23. Have you been convicted of a felony within the last five years?
Note: A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

Have you been convicted of a felony within the last five years? Note: A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question. YES

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.

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24. Education

Education High School Attended
Diploma or GED

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25. College or University attended.

College or University attended.

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26. Type of Degree received and year received.

Type of Degree received and year received. Associate
Bachelor
Master
Certification
Other

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27. Describe any specialized training, apprenticeship and skills.

Describe any specialized training, apprenticeship and skills.

28. Describe any job-related training received in the United States Military.

Describe any job-related training received in the United States Military.

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29. List specialized skills and equipment operated.

	Typing	Software Programs	Office Equipment	Repairs & Maintenance Equipment	Other
Check all that apply and list below.	*List specialized skills and equipment operated. Check all that apply and list below. Typing	Check all that apply and list below. Software Programs	Check all that apply and list below. Office Equipment	Check all that apply and list below. Repairs & Maintenance Equipment	Check all that apply and list below. Other

Please enter specifics

30. List professional, trade, business or civic activities and offices held.
You may exclude membership which would reveal race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

31. EMPLOYMENT EXPERIENCE AND HISTORY
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

EMPLOYMENT EXPERIENCE AND HISTORY Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status. Company
Address
City/Town
State
Zipcode
Phone Number
Job Title
Supervisor's Name
Date of employment (starting and final)
Salary (starting and final)
Duties Performed
Reason for Leaving

32. EMPLOYMENT EXPERIENCE AND HISTORY
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

EMPLOYMENT EXPERIENCE AND HISTORY Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status. Company
Address
City/Town
State
Zipcode
Phone Number
Job Title
Supervisor's Name
Date of employment (starting and final)
Salary (starting and final)
Duties Performed
Reason for Leaving

33. EMPLOYMENT EXPERIENCE AND HISTORY
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

EMPLOYMENT EXPERIENCE AND HISTORY Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status. Company
Address
City/Town
State
Zipcode
Phone Number
Job Title
Supervisor's Name
Date of employment (starting and final)
Salary (starting and final)
Duties Performed
Reason for Leaving

34. EMPLOYMENT EXPERIENCE AND HISTORY
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status.

EMPLOYMENT EXPERIENCE AND HISTORY Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, ancestry, age, disability, marital or veteran status, or any other legally protected status. Company
Address
City/Town
State
Zipcode
Phone Number
Job Title
Supervisor's Name
Date of employment (starting and final)
Salary (starting and final)
Duties Performed
Reason for Leaving

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35. PERSONAL REFERENCES:

PERSONAL REFERENCES: Name:
Company:
Address:
City/Town:
State:
ZIP:
Phone Number:

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36. PERSONAL REFERENCES:

PERSONAL REFERENCES: Name:
Company:
Address:
City/Town:
State:
ZIP:
Phone Number:

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37. PERSONAL REFERENCES:

PERSONAL REFERENCES: Name:
Company:
Address:
City/Town:
State:
ZIP:
Phone Number:

38. NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.

NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given. YES

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39. I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby 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 Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authroized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

As a condition of my employment, I agree to submit to a criminal background check, driving record check, drug screen, and/or physical and to have the results reviewed by the Director of Human Resources. I understand that my employment with the Calcasieu Parish Public Library is contingent upon satisfactory results of these screenings.

Upon completing application, please type your name below.

Signature of Applicant to be secured at interview.

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby 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 Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authroized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. As a condition of my employment, I agree to submit to a criminal background check, driving record check, drug screen, and/or physical and to have the results reviewed by the Director of Human Resources. I understand that my employment with the Calcasieu Parish Public Library is contingent upon satisfactory results of these screenings. Upon completing application, please type your name below. Signature of Applicant to be secured at interview.

Your application will be submitted to the Human Resources Division of the Calcasieu Parish Public Library. Please email your resume' to jobs@calcasieu.lib.la.us

Employment ApplicationExit this survey

1. Application for Employment for the Calcasieu Parish Public Library

Calcasieu Parish Public Library

*1. Information

2. Preferred Location(s).

3. Position (s) applied for:

4. Date of Application

5. How Did you Learn About Us?

6. Email address:

7. Social Security NumberOptional, but will be required prior to employment.

8. Best Time to ContactTime range is acceptable: Ex (9:00am to 11:00am or anytime)

9. If you are under 18 years of age, can you provide required proof of your eligibility to work?

10. Have you ever filed an application with us before?

11. Have you ever been employed with us before?

13. Are you currently employed?

14. May we contact your present employer?

15. Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?NOTE: Proof of citizenship or immigration status will be required upon employment.

16. Date available for work

17. What is your desired salary range?

18. Are you available to work

19. Please indicate if appropriate

20. Please indicate dates available

21. Are you currently on "lay-off" status and subject to recall?

22. Can you travel if a job requires it?

*23. Have you been convicted of a felony within the last five years?Note: A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.

*24. Education

*25. College or University attended.

*26. Type of Degree received and year received.

*27. Describe any specialized training, apprenticeship and skills.