EDISON TOWNSHIP PUBLIC LIBRARY
340 PLAINFIELD AVENUE
EDISON NJ 08817
APPLICATION FOR EMPLOYMENT
PLEASE COMPLETE THIS FORM IN FULL AND RETURN TO EDISONHR@LMXAC.ORG
The Edison Township Public Library is an Equal Opportunity Employer.
1) INTRODUCTION
Position applying for: ________________________________________________
Date of Application: ____________________
Name (Last, First) ___________________________________
Email address __________________________________
Residential address _______________________________________
__________________________________________
Telephone # ( ) _______________________________
Alternate Telephone # ( ) _______________________________
2) EMPLOYMENT AVAILABILITY
Are you a former employee of the Edison Public Library? ☐ Yes ☐ No
If “Yes” When? ____________ Position Held _____________________________________
Do you have any relatives currently employed by or volunteering with the Edison Public Library,
including the Foundation and the Friends? ☐Yes ☐No
Type of employment desired: ☐ Full-Time ☐ Part-Time
Please indicate all times you are available to work:
a) Sunday Monday Tuesday Wednesday Thursday Friday Saturday
b) Mornings (before noon) Afternoons (12 m – 6 pm) Evenings (6 pm to closing)
Are you currently employed by any other Township department? ☐ Yes ☐ No
If yes, ☐ Full-time ☐ Part-time Which Division: _________________________
Are you legally eligible for employment in the United States? ☐ Yes ☐ No
Are you under 18 years of age? (If “Yes” you will be required to submit working papers if offered
employment.) ☐ Yes ☐ No
Are you able to meet the attendance requirements of the position year round as advertised in the job
posting? ☐ Yes ☐ No
Date available to start work _______________________________
3) EDUCATIONAL BACKGROUND
Please list name of school with town/state, your major (if applicable), the years you attended, and
diploma or degree earned.
High School:
College Undergraduate:
College Undergraduate:
Graduate school:
Other education (specify):
4) REFERENCES
Please list three business/work references that we may contact for information concerning your
qualifications. At least one reference should be a current or former supervisor (school or volunteer
references may be acceptable when there is no recent employment history.) Do not include personal
references.
a) Name
Address
Phone number:
How do you know this person and for how long?
b) Name
Address
Phone number:
How do you know this person and for how long?
c) Name
Address
Phone number:
How do you know this person and for how long?
Please list professional, trade, business, or community organizations and any offices held. Exclude any
memberships that would reveal gender, gender identity, race, color, religion, creed, national origin,
ancestry, age, disability, sexual orientation, marital status, veterans’ status, or any other legally
protected status.
5) PREVIOUS EMPLOYMENT / SKILLS
Please list your employment history for the past 10 years. Start with present or last position and work
back. Please complete in full even if you have attached a resume. Copy this section as necessary.
Name of employer:
Address:
Phone:
Employment dates: From To
Position(s):
Reason for leaving:
Supervisor:
Please check off any software skills that you have:
☐ Word Processing (Word, Word Perfect, etc.) ☐ Spreadsheet (Excel, Lotus 123, etc.) ☐ Data Entry
☐ Publishing software (Publisher, Adobe, etc.) ☐ Integrated library system (If yes, please specify:
__________________)
☐ Other software skills:
Other skills:
Special accomplishments, awards, volunteer activities. Do not include information that would reveal
gender, gender identity, race, color, religion, creed, national origin, ancestry, age, disability, sexual
orientation, marital status, veterans’ status, or any other legally protected status.
Other information you would like us to consider. Do not include information that would reveal gender,
gender identity, race, color, religion, creed, national origin, ancestry, age, disability, sexual orientation,
marital status, veterans’ status, or any other legally protected status.
6) CONDITIONS
I understand that if I am offered and accept employment, I may be legally required to become a member
of the NJ Public Employee Retirement System or the Defined Contribution Retirement Program.
By my signature below, I certify that all of the statements contained in this application and/or on my
resume and in the information and documents I provided or will provide in support of my application for
employment (both orally and in writing), are accurate and true. I understand that if any statement or
information is found to be false, it may be grounds for rejection of my application, withdrawal of an
offer of employment or termination of employment.
I understand that the completion of this application does not indicate that there are any vacant
positions and in no way obligates the Edison Public Library or the Township of Edison to hire me.
I understand and agree that any employment that might be offered as a result of this application is for
no definite period of time and may be terminated, with or without cause and with or without prior
notice, at any time (except as may be limited by a collective bargaining agreement).
I understand that neither the hours of work that may be assigned to me at any time, nor any other act or
circumstance, shall constitute a guarantee of employment as to daily hours, weekly hours, straight time
or overtime hours.
By my signature below, I authorize the Edison Public Library to contact and obtain information from all
references, current and former employers and/or educational institutions, and otherwise to verify the
accuracy of the information contained in this application, on my resume, in any other documents I
presented and in my oral statements during the interview process. I hereby release from liability the
Edison Public Library and its employees and representatives for seeking, gathering and using such
information and release from liability all other persons, business entities and organizations for providing
such information.
I understand that if offered a position with the Edison Public Library, the offer may be conditional on me
submitting to a background check. I understand that unsatisfactory results from, refusal to cooperate
with, or any attempt to affect the results of, a background check will result in a failure of the condition
and withdrawal of any employment offer or termination of employment if already employed.
By my signature below, I acknowledge and agree that any offer of employment will be made contingent
upon confirmation of my references and licensure, if applicable. I also understand that if I am hired I will
be required to provide proof of identity and legal work authorization.
The Edison Public Library is an equal opportunity employer. This library complies with Federal and State
legislation, and our policies prohibit employment discrimination on the basis of race, gender, gender
identity, religion, creed, color, national origin, citizenship status, ancestry, age, marital status, veterans’
status, sexual orientation, domestic partnership, civil union partnership, disability, genetic data, criminal
history, and any other legally protected status.
Date: ____/____/____ Signature of Applicant: ___________________________________
