Online Employment Application Form

Today's Date

Position desired

Name *

First

Middle

Last

Are you known by any other name? If yes, please list other name(s).

Email

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Have you ever been convicted of a felony, misdemeanor involving any violent act, use or possession of a weapon or act of dishonesty for which the record has not been sealed or expunged? (Answering "yes" does not represent an automatic bar to employment.) *

Yes
No

Select the highest grade completed:

Are you able to perform essential functions of the job for which you are applying with or without reasonable accommodations?

Yes
No

High School Name, Address

High School Diploma/Degree, Grade Average, Specialization

College Name, Address

College Diploma/Degree, Grade Average, Specialization

Graduate School Name, Address

Graduate School Diploma/Degree, Grade Average, Specialization

Other Education Name, Address

Other Education Diploma/Degree, Grade Average, Specialization

Employment history

Employment history: Position and dates worked; Company name and address; supervisor name and phone number, reason for leaving

Employment history: Position and dates worked; Company name and address; supervisor name and phone number, reason for leaving (copy)

Employment history: Position and dates worked; Company name and address; supervisor name and phone number, reason for leaving (copy) (copy)

Employment history: Position and dates worked; Company name and address; supervisor name and phone number, reason for leaving (copy) (copy) (copy)

References

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Why are you interested in working for the James Prendergast Library?

Do you possess any special skills which you feel would recommend you over other candidates? (List computer, mechanical, second language, or other skills related to desired position)

Have you previously worked for Prendergast Library or another member of the Chautauqua Cattaraugus Library System? If yes, in what capacity and when?

Availability

Full-time
Part-time

List days and times of availability:

Upload your resume (if applicable)

Click or drag a file to this area to upload.

Upload your cover letter (if applicable)

Click or drag a file to this area to upload.

Additional Information

I certify that all statements given on this application are correct, and understand that falsification or misrepresentation in this or any other personnel record may result in my dismissal. I agree to provide proof of age upon notification of hire. I authorize my former employers and other individuals to give information concerning me, whether or not it is part of their written record, and I release them and their companies from any liability whatsoever. I understand that the above noted examination and reference inquiries will be kept confidential and will not be released to anyone without my written consent. Also, I understand that if I accept employment with James Prendergast Library, it will be employment at will. Accordingly, either I or the James Prendergast Library can terminate the relationship at will, with or without cause, at any time, so long as there is not violation of applicable federal or state law.

Today's date:

The New York State Human Rights Law prohibits discrimination in employment because of age, race, creed, color, national origin, sex, disability, marital status, or criminal record. Accordingly, nothing in this application form should be viewed as expressing, directly or indirectly, any limitation, specification, or discrimination as to age, race, creed, color, national origin, sexual orientation, military status, sex, disability, predisposition genetic characteristics, marital status, domestic violence victim status or criminal record in connection with employment.