Job Application Form - Professional

For which position are you applying?

LA-III – Programming Coordinator (32 hours per week)

Personal Information

First

Middle

Last

Suffix

Address

City/Town

State/Province

ZIP/Postal Code

Country

Phone

Have you ever served in the Armed Forces?

Yes

If yes, what branch?

Dates of service from (mm/dd/yyyy) to (mm/dd/yyyy):

Rank at discharge?

Special Training:

Can you perform the essential functions of the position you are applying for, with or without reasonable accommodation?

Yes

If hired, can you furnish proof that you are legally entitled to work in the U.S.?

Yes

Education

Include High School, College/University, Graduate School, and/or Business/Trade School.

School Attended	Year Graduated	Course of Study or Major	Type of Certification or Degree	Operations
School Attended	Year Graduated	Course of Study or Major	Type of Certification or Degree

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Employment History

Please start with your present or most recent employment and work back.

Employer	Position	Name of Supervisor	Phone Number	Employment Dates	Reason for Leaving	Operations
Employer	Position	Name of Supervisor	Phone Number	Employment Dates (mm/yyyy to mm/yyyy)	Reason for Leaving

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References

List at least three persons who have knowledge of your work performance within the last ten years. Please include professional references only. Do not include relatives.

First and Last Name	Phone Number	Email Address	City, State	Operations
First and Last Name	Phone Number	Email Address	City, State

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Cover Letter

Choose File

Upload your cover letter in .pdf, .doc or .docx format. Use the following format to name your document: FirstName-LastName-Coverletter.
One file only.
25 MB limit.
Allowed types: pdf, doc, docx.

Resumé

Upload your resume in .pdf, .doc or .docx format. Use the following format to name your document: FirstName-LastName-Resume

Choose File

One file only.
25 MB limit.
Allowed types: pdf, doc, docx.

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Applicant Signature

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Today's Date

Jefferson County Library

Job Application Form - Professional

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Equal Opportunity Employer

Personal Information

Education

Employment History

References

Please read carefully before signing.

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