Dauphin County Library System is an equal opportunity employer where employment opportunities are not in any manner affected by race, color, religious creed, sex, ancestry, national origin, age, sexual preference, disability, or any other legally protected status. All applicants are required to fully complete this application. Please inform the Human Resources Director immediately upon receiving this application if, as a result of a disability, you will need a reasonable accommodation to complete this application.
First name: Middle name: Last name:
Street address: City: State:
Armed Forces Americas (except Canada)
Armed Forces Europe, Canada, Africa, Middle East
Armed Forces Pacific
District Of Columbia
Federated States Of Micronesia
Northern Mariana Islands
Email address: *required
Position(s) for which you are applying:
Library of preference for employment. Check all that apply.
1. If you are under 18 years of age, can you provide required proof of your eligibility to work?
2. Have you ever filed an application with us before?
If Yes, give date:
3. Have you ever been employed with us before?
4. Are you currently employed?
5. May we contact your present employer?
6. Are you legally eligible for employment in the United States? Proof of citizenship or immigration status will be required upon employment.
7. On what date would you be available for work?
8. Are you available to work:
9. Can you travel if a job requires it?
10. Have you ever been convicted of a criminal offense in the nature of a felony or misdemeanor?
If yes, please indicate the date, location and nature of the conviction:
Conviction will not necessarily disqualify an applicant from employment and will be considered only to the extent that it relates to an applicant’s suitability for the position sought.
Start with your present or most recent job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
Reason for leaving:
Hourly rate or salary: Starting: Final:
Hourly rate or salary: Starting: Final:
Summarize special job-related skills and qualifications acquired from employment or other experience.
School name and location: High school: Undergraduate college/university: Graduate/professional: College / University Phone Number: College / University Address:
Highest year completed:
Undergraduate college/university - 1 year
Undergraduate college/university - 2 years
Undergraduate college/university - 3 years
Undergraduate college/university - 4 years
Undergraduate college/university - 5(+) years
Graduate/professional - 1 year
Graduate/professional - 2 years
Graduate/professional - 3 years
Graduate/professional - 4 years
Graduate/professional - 5(+) years
Diploma / degree:
Describe course of study:
Describe any specialized training, apprenticeship, skills and extra-curricular activities:
Describe any honors you have received:
State any additional information you feel may be helpful to us in considering your application:
If a DCLS employee referred you for this position please indicate who they are:
Give name, address and telephone number of three references who are not related to you. Please include previous employers. References are required.
1. Name: Address: Telephone Number: Email Address:
2. Name: Address: Telephone Number: Email Address:
3. Name: Address: Telephone Number: Email Address:
All of the information I have provided on this application and in connection with the application is correct and true. I understand that any false, misleading or incomplete answer or statements or implications made by me in connection with this application or other required documents, or the failure to disclose any relevant information, shall result in the denial of employment or termination. I further understand that nothing contained in this application or in the granting of an interview is intended to create a contract of employment, a contract for the providing of any benefit or to obligate Dauphin County Library System in any way. If an employment relationship is established, I understand that I will have the right to terminate my employment with or without cause, for any reason at any time, and that Dauphin County Library System retains a similar right. No promises, statements or representation to the contrary have been made to me, and I understand that no such promises, statements or representations are binding on Dauphin County Library System.
I hereby grant Dauphin County Library System permission to investigate my personal, educational and employment history and to contact persons, organizations, institutions or government agencies who may have knowledge of me. In consideration of my receipt of this application and being considered for employment, and intending to be legally bound, I hereby release Dauphin County Library System, its directors, officers, principals, employees and agents from any and all liability, real or potential, for seeking such information
and all other persons, corporations or organizations for furnishing such information to Dauphin County Library System.
I understand that if I receive an offer of employment, I may be required, along with other incoming employees in the same job category, to undergo a medical examination by a doctor selected by Dauphin County Library System before my employment begins, to which I hereby assent. As part of this examination, I agree to complete a health evaluation form. I understand that if the examination discloses that I have a disability, my offer of employment will not be withdrawn because of that disability, provided that, with reasonable accommodation, I will be able to perform all of the essential functions of the job for which I have received a conditional offer of employment. I understand that any information obtained regarding my medical condition or history will be collected and maintained on separate forms and in separate medical files and will be treated as a confidential medical record in accordance with applicable law.
Finally, I understand that if I am offered employment, Pennsylvania child abuse and criminal background checks and Federal FBI fingerprinting will be conducted and I will be required within three (3) business days of commencing employment to complete the applicable section of the I-9 form and provide Dauphin County Library System with specific documents to establish my identity and employment eligibility. If a position requires driving a library vehicle a DMV/Department of Motor Vehicles Records Check will be completed.
I accept the terms outlined in the Acknowledgements, Authorization and Release by my initials in the box.:
Please click the submit button only once. This form may take a moment to send, you will receive a success message momentarily. Thank you.
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