Job Application



NAME:                   _____________________________________________   DATE: __________________
              (last)                                      (first)                                        (middle)


ADDRESS: _______________________________________________________________________________

                    (number)     (street)                                              (city)     (state)                         (zip)

PHONE:                                     ___________________________   LIBRARY: ______________________


EMAIL ADDRESS:              __________________________________________________________________


The Highland County District Library is an Equal Opportunity Employer.
You will need a Social Security Number as a condition of being hired; both FBI & BCI background checks are completed.


Available to work:   ___ full time   ___ part time   ___ days   ___ evenings   ___ weekends

If hired, what date will you be available to start:   __________________________________________


Have you ever been employed by the Library before?   _____ yes   _____ no


Do you have any relatives employed by the Library?   _____ yes   _____ no
Includes Board members: Fred Yokum, Larry Nartker, Jeff Cloud, Steve Hunter, Kim Douglas, Terry Burden, and Randy Lennartz


If yes, please list names:   _________________________________________________________________


Are you legally eligible for employment in this country?    _____ yes   _____ no

Proof of eligibility to work in the USA is required upon employment.


Are you 18 years or older?   _____ yes   _____ no  
Hiring is subject to verification of minimum legal age

Are you drawing a pension from OPERS. 
_____ yes   _____ no  


Education/ Training

Name and Address

Last Year


Did you


Degree/Course of Study

High School


 9   10   11   12

5 Yes  5 No






 1   2   3   4 +

5 Yes  5 No





Employment Experience
Please list present or most recent employer first.


Name:                                                                                                   Phone:                                                        

Address:                                                                                                Position: ____________________________

Dates Employed   From: ____________   To: _____________    Supervisor: _______________________________


Reason for leaving:                                                                                                                                                   

Name:                                                                                                   Phone:                                                        


Address:                                                                                                Position: ____________________________

Dates Employed   From: ____________   To: _____________    Supervisor: _______________________________


Reason for leaving:                                                                                                                                                   

Name:                                                                                                   Phone:                                                        


Address:                                                                                                Position: ____________________________

Dates Employed   From: ____________   To: _____________    Supervisor: _______________________________


Reason for leaving:                                                                                                                                                   


Particular employer(s) you do not wish us to contact: ______________________________________________


Additional Achievements, Awards, and Qualifications
Please identify any additional academic achievements, extracurricular activities, or knowledge and skills relevant to the job in order to help us consider your application fully for employment (include a description of your technological ability):                                                                                                                                                   



Please provide the name, phone number, and email address of three additional professional references other than present/former employers:




I certify that the information contained on this application is correct to the best of my knowledge and understand that any misstatement, omission, falsification or misrepresentation of fact will disqualify me from consideration for employment or, once I am hired, is grounds for dismissal.  I understand and acknowledge that any employment relationship is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason.  I further understand that this application is not nor is it intended to be a contact of employment and does not obligate Highland County District Library in any way if they employ me.  I authorize the references and employers listed, except as noted, to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you.  I also understand and authorize that as a part of the employment procedure, investigations and inquires of the information provided be made concerning my character, general reputation, and personal characteristics.


READ CAREFULLY: I agree that any claim or lawsuit relating to any service with the Highland County District Library or any of its branches or subsidiaries must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit.  I waive any statute of limitations to the contrary.  I hereby acknowledge that I have read the above statement and understand.


By submitting this application to the Highland County District Library, I certify that the above information is correct.


Signature                                                                        Date