Alexandria Library - Application for Employment

Application for Employment
Alexandria Library
Administrative Office
5005 Duke Street
Alexandria, VA 22304-2903

INSTRUCTIONS: Your completed application for employment will be retained in our active file for six months. You will be called ONLY when there is a job opening for which you are qualified. Thank you for your interest in the Alexandria Library. Incomplete applications will not be considered.

Date: 03-19-2010		* Required fields

Title (Mr., Mrs.)

First Name *	Middle Initial	Last Name *


Street Address *

City *	State *	Zip Code *

Home Phone *	Work Phone	Email

Position for which you are applying *

Date of Birth

Month: Day: Year:

Are you now or have you ever been employed by the City of Alexandria?
YES NO
If yes, please provide:
Job Title	Department

Dates of Work
FROM: Month Year TO: Month Year

Are you a U.S. citizen or are you otherwise legally eligible for employment in the U.S.?
(Anyone offered employment is required to provide proper identification and documentation of eligibility for employment in the U.S.)

YES NO

Have you ever been convicted (found guilty, sentenced, or fined) of a law violation since your 18th birthday?

YES NO

If yes, give date, place, charge, court and any fine or sentence imposed:

A conviction does not automatically mean that you cannot be employed. The nature of the offense and when it occurred will be considered. Give ALL of the facts.

EDUCATION
Select the highest grade completed in high school:
9 10 11 12
Select the number of years completed in college:
1 2 3 4
Please list the name and location of the following:
High School
College
Business School
Graduate and other
Indicate degrees, certificates, or semester credit hours obtained:

List any special skills you possess, languages (other than English) you speak, licenses or certificates you have, or machines or software you can operate.

REFERENCES
Please list two references
1	Name	Address	Telephone Number
1

2	Name	Address	Telephone Number
2

WORK HISTORY
Click on the checkbox if you would like to substitute your resumé for this section.
1	Position title

	FROM: Month Year TO: Month Year
	Employer Information
	Name	Telephone Number

	Address

	City	State	Zip Code

	Starting Salary	Final Salary

	Full Time: Part Time:	Hours/week

	Supervisor's Name	Telephone Number

	In your own words describe your work

	Reasons for leaving

	Number of persons whom you supervised


2	Position title

	FROM: Month Year TO: Month Year
	Employer Information
	Name	Telephone Number

	Address

	City	State	Zip Code

	Starting Salary	Final Salary

	Full Time: Part Time:	Hours/week

	Supervisor's Name	Telephone Number

	In your own words describe your work

	Reasons for leaving

	Number of persons whom you supervised


	You may paste your resumé below

I hereby certify that all information in this application and attachments is true. I authorize the Alexandria Library to obtain medical, education, and employment records and references related to my job application, and I understand that all information provided here is subject to verification. I agree, as a condition of continued employment, to authorize criminal records checks during the course of my employment, if requested. I acknowledge that any falsification on this application is grounds for disqualification and, if I am employed, for discipline, including dismissal.

I understand that I may be required to pass various job-related examinations in order to be considered for employment and that I may be asked to successfully complete a physical examination and drug test prior to my employment being official and complete. I also understand that, if employed by the Alexandria Library, I am required to serve a probationary period during which time my performance will be evaluated and I may be terminated if my conduct or performance is not fully satisfactory. I further understand that if employed by the Alexandria Library I am subject to termination for program revision or budgetary reasons and I may be dismissed for cause at any time during the course of my employment.

Date: 03-19-2010