Name *

First Last

Date Time *

MM / DD / YYYY

Start of Application Process

Present Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Number of years at address *

Phone *

### - ### - ####

Social Security Number

Are you under the age of 18 *

yes

no

Are you eligible to work
in the United States *

yes

no

Employment

Multiple Select *

Can you work evenings
and Weekends *

yes

no

What positions are
you interested in *

List all professional,
business, civic or
volunteer activities that
you are or have been
involved in and offices
held:(omit any groups
that would indicate race,
religion, color, sex, national
origin or age). *

Computer
experience/skill level *

Internet
experience/skill level *

Typewriter
experience/skill level *

Copier/Fax
experience/skill level *

State any other training, skills and qualifications which you believe are relevant to the type of employment you are seeking at the library:

Have you ever been convicted of a felony? (this will not necessarily affect your application, what you were convicted of and how long ago are important). *

yes

no

If yes, please describe all information concerning each conviction, including city, state, date and nature of the conviction.

Have you even been known by any other name (s) that the Pulaski County Public Library will need to know to verify any of the information contained in this application. *

yes

no

If yes please expand