Employment Application If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. All information provided will be kept confidential and the completed application becomes the property of the Dodge City Public Library system once submitted. Personal Information Name(required) Email(required) Phone Number(required) Choose one(required) Cell Home Street Address(required) City(required) State(required) Zip(required) Are you now employed or have you at any time in your work history been employed in any capacity for Dodge City Public Library?(required) Yes No If yes, please explain Have You Been Convicted of a Felony?(required) Yes No If yes, please explain Conviction of a crime is not an automatic bar to employment. The library will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position for which you are applying. Are you legally allowed to work in the United States?(required) Yes No Other If you chose "no" or "other, please explain Are you related to or reside with present employees or Library board members?(required) Yes No If yes, please give the name or the individual and the relationship Have you ever been employed under another name?(required) Yes No If yes, please provide the name(s) Language (which language or languages are you proficient in)(required) Position Position Applying For:(required) Employment Desired(required) Full-time Part-time Available Start Date(required) Desired Starting Wage(required) Availability(required) Morning Afternoon Evening Education High School Name(required) Location(required) Years Attended(required) Diploma or Equivalent(required) Diploma or Equivalent College #1 College Name Location Years Attended Degree Received Major College #2 College Name Location Years Attended Degree Received Major Work History Employment #1 Organization Name Position Held Start date and end date of position Supervisor Reason for leaving Employment #2 Organization name Position held Start date and end date of position Supervisor Reason for leaving Employment #3 Organization name Position held Start date and end date of position Supervisor Reason for leaving Have you ever been involuntarily terminated from employment?(required) Yes No If yes, please explain References (professional or educational) Reference #1 Name(required) Number(required) Relationship (required) Reference #2 Name(required) Number(required) Relationship (required) Reference #3 Name(required) Number(required) Relationship (required) Why are you interested in working with Dodge City Public Library?(required) What qualifications and experiences do you feel contribute to your candidacy?(required) What else would you like us to know about you?(required) My signature below authorizes the library to conduct a background investigation and authorizes the release of information in connection with my application for employment. This investigation may include such information as criminal or civil convictions, driving records, previous employers and educational institutions, personal and professional references, and other appropriate sources. I waive my right to access to any such information, and without and without limitation hereby release the Library and the reference source from any liability in connection with its release or use. This release includes the sources cited above and specific examples as follows: the local Sheriff, information from the Central Criminal Records Exchange of either data on all criminal convictions or certification no date on criminal convictions are maintained, information from Kansas or other State Department of Social Services Child Protective Services Unit and any Locality to which they may refer for release of information pertaining to any findings of child abuse or neglect investigations around me. Furthermore, I certify that I have made true, correct, and complete answers and statements on this application in the knowledge that they may be relied upon in considering my application, and I understand that any omission and/or false answered statement made by me on this application or any supplement to it will be sufficient ground for failure to employ or for my discharge would I become employed with the Dodge City Public Library. I further agree to observe all rules, regulation, and policies of the Library. Signature of Applicant(required) Please submit cover letter, resume, or other application materials to carissad@dcpl.info and aprilw@dcpl.info. Send Δ{{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. 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