Name

Social Security Number

Address

City

State

Zip

Phone Number (home)

(Business)

Education

Name and Location

of School

Course of Study

Number of

Years Completed

Did you Graduate?

High School

College

Trade, Business, Correspondence School

Training

Have you taken the following courses?

Typing

Words per minute

Bookkeeping

Number of Years

Computers

Programs

Office Machines you are able to operate

Special Qualifications or training

Experience working with our type of clients

Physical Record

Do you have any physical limitations that would keep you form performing any work for which you are being considered?

If Yes, please describe:______________________________________________________________________

__________________________________________________________________________________________

Former Employers

Please give accurate, complete full-time and part-time employment record.

Start with Present or most recent employer.

1) Company Name

                            Telephone

Address                                                                                            State                               Zip  

Name of your Supervisor

Your Job Title and brief work description:

Date of Employment From

To

Salary

Reason for Leaving

2) Company Name                                                                                       Telephone

                            Telehone

Address

              State                               Zip

Name of your Supervisor

Your Job Title and a brief work description:

Date of Employment From

To

Salary

Reason for Leaving

3) Company Name                                                                                      Telephone

Address

           State                                Zip

Name of your Supervisor

Your Job Title and a brief work description:

Date of Employment From

To

Salary

Reason for Leaving

 We may contact the employers listed above unless you indicate those you do not want us to contact.

Do not contact Employer Number (s)______________________________

Reason:

References

Give the names of two people who are not related to you and are not former employers.

Name

Years Acquainted

Address

Phone Number

Name

Years Acquainted

Address

Phone Number

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from any liability for any damage that may result from furnishing same to you.

Signature of Applicant _____________________________________ Date _________________________

Marion County Library is an equal opportunity employer;

does not discriminate on the basis of disability in its hiring or employment practices;

and is a drug-free workplace;

drug test required.

Marion County Library

101 East Court Street

Marion, South Carolina, 29571

843-423-8300

www.marioncountylibrary.org