KANSAS CITY PUBLIC LIBRARY 14 West 10th Street Kansas City, Missouri 64105 816/701-3651 Fax

: 816/701-3401 Job Line: 816/701-3421 Web site: http://www.kclibrary.org An Equal Opportunity Employer Committed to Cultural Diversity

APPLICATION FOR EMPLOYMENT
Please print in black or blue ink. If filled out on-line, use the tab key to move through the form. When finished, you can save a copy of this Word document to a disk.                  

Date:      

Last (print above)
     

First

Middle (     )       Phone: Home (     )       Phone: Business

Address (street, apt. #)
     

City, State, Zip Code
     

E-mail Address Do you have the legal right to work permanently in the United States? Yes No How were you referred to the Library? List any other names under which you have been employed.
                       

Is your age under 16? Yes No

Name of any relative(s) employed by the Library: Are you currently employed by KCPL? Have you ever been employed by KCPL?
     

Yes Yes

Name No No

Relationship

If yes, give the titles and dates of employment:

POSITION OBJECTIVE (write below) For what position(s) or type of work are you applying?
     

Are you interested in: (mark all that apply) Full-time Part-time Substitute Hours Available:
Morning Monday Tuesday Wednesday Thursday Friday Saturday Sunday Afternoon Evening

Minimum salary requirement:
     

Temporary Full-time Temporary Part-time

Tell briefly why you are interested in employment with the Kansas City Public Library:
     

EMPLOYMENT RECORD
List all employment starting with the latest employer first and activities including self-employment for the past 10 years if possible. Account for periods of unemployment. Use additional paper if necessary. LIST YOUR CURRENT OR MOST RECENT EMPLOYER FIRST.

1. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

2. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

3. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

4. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

5. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

May we contact your previous employer at this time for a reference and verification? Yes No After notification, may we contact your current employer for a reference and verification? Yes No If needed, may we call you at your current place of employment? Yes No

EDUCATION Check highest grade completed: 9 10 11 High School 12 1 2 3 4 College 5 6+

List all schools attended: high school and above, technical/vocational, college, business, military, etc. Did you Certification or School (write below) Credit Hours graduate? Degree Received Major Subject Name:       Yes                               No City State Name:
                       

Yes
           

City Name:
           

State
           

No Yes
           

City Name:
     

State
                 

No Yes
           

City

State

No
     

Please list the state and type of your current driver’s license. State: (some of our positions require that you hold a specific type). Special Skills and Qualifications Summarize special training, skills and proficiencies (i.e. typing, etc.):
     

Type:      

List all computer software in which you are proficient and describe your level of competency:
     

List any honors, scholarships, fellowships, publications and thesis topics:
     

List foreign languages read, written or spoken (and indicate fluency):
     

List any special courses or seminars taken within the last 5 years:
     

ACTIVITIES List any activities and other information you feel would be       of use in evaluation of your qualifications for the position you seek (e.g., professional assoc., positions in outside organizations). Do not list information revealing race, religion, color, national origin, sex, age or ancestry.

PROFESSIONAL REFERENCES. Please furnish the names and addresses of three people to whom you are not related and who can attest to your work performance.
           

Name
     

Occupation
     

E-mail Address
(     )            

Business Address
(     )            

Home Phone Name
     

Business Phone Occupation
     

E-mail Address
(     )            

Business Address
(     )            

Home Phone Name
     

Business Phone Occupation
     

E-mail Address
(     )      

Business Address
(     )      

Home Phone

Business Phone
Yes No     

Have you ever been convicted of a crime? (Exclude misdemeanors and Summary offenses) If yes, please provide details.      

PRE-EMPLOYMENT STATEMENT I certify that the information given by me in this application is true and complete. I understand and agree that any false information, misrepresentation, or concealment of fact is sufficient grounds for either my immediate discharge without recourse or refusal of employment by the Kansas City Public Library. In consideration of my employment, I agree to conform to the rules and regulations of the Kansas City Public Library, and my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Library or myself. I understand that no manager or representative of Kansas City Public Library, other than the Library Executive Director or Board, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

Applicant Signature

Date

Please supplement this record with a resume, references or any additional information that you feel will aid in our evaluation of your qualifications. We will keep your application on file for one year. If you want to apply for another position, just contact us. It’s not necessary to do another one except to make changes or if asked to do so. Thank you for your interest in the Kansas City Public Library.

Revised 4/28/08

EMPLOYMENT RECORD (pg. 2)

Name:

     

List all employment starting with the latest employer first and activities including self-employment for the past 10 years if possible. Account for periods of unemployment. Use additional paper if necessary. LIST YOUR CURRENT OR MOST RECENT EMPLOYER FIRST.

6. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

7. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

8. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

9. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

10. Name of Employer
     

Address
     

Phone
     

Employed (mo/yr) From:       To:       Job Title
     

Starting Salary
     

Ending Salary
     

Name of Supervisor
     

Dept.
     

Reason for Leaving; Please explain
     

Duties:
     

CONFIDENTIAL FILE

APPLICANT DATA RECORD
Applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap disability. As employers, we comply with government regulations and affirmative action responsibilities. To help us comply with government record keeping, and, in the event you are hired by the Library, to help us quickly add your name to our payroll, please fill out the Applicant Data Record. We appreciate your cooperation. This data is for periodic government reporting and payroll purposes and will be kept in a Confidential File separate from the application for employment.

REQUIREMENTS

Today’s Date:       Name:
                       

Last

First

Middle

Last 4 digits of Social Security Number

AFFIRMATIVE ACTION SURVEY This data is for analysis and affirmative action record keeping purposes only. Check one: Female Male Check one of the following: Race/Ethnic Group: White/Caucasian African American (not of Hispanic descent) Latin American/Hispanic Check if any of the following are applicable: Vietnam Era Veteran Veteran with Disability Individual with Disability

Native American Indian/Alaskan Native Asian/Pacific Islander Other

6/04

Thank you for applying at the KANSAS CITY PUBLIC LIBRARY 14 West 10th Street, Kansas City, MO 64105 Human Resources: 816-701-3651 Jobline: 816-701-3421 www.kclibrary.org Please read the following information. •
• • • •

Our Application for Employment form must be completely filled out, even if you are also submitting your current resume for a job opening.
Please be sure to carefully read the job description for the position to make sure you are interested in applying and understand the requirements. Note the closing date for the position for which you’re applying. Applications received after the closing date will not be considered. Your application will first be prescreened in the Human Resources Department. Selected applications will be referred to the hiring supervisor after the closing date has passed. The hiring supervisor will review that applications and selects the applicants he or she would like to interview. In most cases, the hiring supervisor schedules the interviews. If you are not selected for an interview, you will receive a letter from us.

Because the application review process can be lengthy and cannot begin until after the position’s closing date, a considerable amount of time may pass before you may be contacted by the Kansas City Public Library for an interview or regarding the position status. In the event you are not selected for this position, you may apply for other openings using the same application. Your application will be kept for one year. It is to your benefit to keep your application updated. We post our job openings on our web site www.kclibrary.org and on the telephone jobline (816-7013421). If you wish to be considered for a current opening, please contact Human Resources by phone at 816-701-3651 x2202 or by e-mail at jobs@kclibrary.org. Human Resources will pull your application for consideration. Most of our positions are year-round permanent positions. It is rare that we offer seasonal employment. Please contact us if you need assistance or have any questions regarding the status of your application. Equal Opportunity Employer Committed to Cultural Diversity 10/06

• •

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