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
      (     )      
Address (street, apt. #) Phone: Home

      (     )      

City, State, Zip Code Phone: Business
     
E-mail Address

Do you have the legal right to work List any other names under which you Is your age under 16?
permanently in the United States? have been employed.
Yes No       Yes No
How were you referred to the Library?      
Name of any relative(s) employed by the Library:            
Name Relationship
Are you currently employed by KCPL? Yes No
Have you ever been employed by KCPL? Yes No
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 Temporary Full-time
Minimum salary requirement: Part-time Temporary Part-time
Substitute
     

Tell briefly why you are interested in employment with the Hours Available:
Kansas City Public Library: Morning Afternoon Evening
      Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
2. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
3. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
4. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
5. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title 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 12 1 2 3 4 5 6+

High School College
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
                             
City State No
Name:       Yes
                             
City State No
Name:       Yes
                             
City State No
Name:       Yes
                             
City State No

Please list the state and type of your current driver’s license. State:       Type:      
(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.):
     

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 Business Phone
           
Name Occupation
           
E-mail Address Business Address
(     )       (     )      
Home Phone Business Phone
           
Name Occupation
           
E-mail Address Business Address
(     )       (     )      
Home Phone Business Phone

Have you ever been convicted of a crime? (Exclude misdemeanors and Summary offenses) Yes No     
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) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
7. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
8. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
9. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title Dept. Reason for Leaving; Please explain
                 
Duties:
     
10. Name of Employer Address Phone
                 
Employed (mo/yr) Starting Salary Ending Salary Name of Supervisor
From:       To:                        
Job Title 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
Native American Indian/Alaskan Native
Asian/Pacific Islander
Other

Check if any of the following are applicable:

Vietnam Era Veteran Veteran with Disability Individual with Disability

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 (816-701-
3421). 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