Name Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Telephone Number Email Type of Position Desired Full-Time Part-Time High School Education High School Name High School Location High School Dates Attended High School More Info College Education College Name College Location College Dates Attended College Major College Year Graduated College More Info Work Experience Employer Position Dates Employed Reason for Leaving Employer Position Dates Employed Reason for Leaving Employer Position Dates Employed Reason for Leaving Employer Position Dates Employed Reason for Leaving Work Experience More Info Skills (Operation of office machines, audio-visual equipment, knowledge of foreign language, etc.) Description I hereby authorize the Logan County Libraries to contact school, college, employment, and other relevant sources to disclose such records and other information as may be requested. I understand that upon request I may inspect any information obtained through reference checks in connection with my application for employment. I understand that any false statements in this application may be cause for discharge if I am employed. I Accept Please List Three References Name Address Phone Name Address Phone Name Address Phone Today's Date
