Hr Form 18 – Fill Out and Use This PDF

Human Resources Department

7060 West Windmill Lane

Las Vegas, NV 89113

Phone: (702) 507-6235

WEB SITE: www.lvccld.org

EMPLOYMENT APPLICATION INSTRUCTIONS

1.ALL INFORMATION MUST BE PRINTED LEGIBLY IN BLACK OR BLUE INK OR TYPED. Completion of this application and attachments are part of the selection process. Failure to fully complete this application and attachments, or failure to submit additional documentation when required, will result in your disqualification for this position.

NOTE: Completion of the EEO / Diversity Questionnaire is voluntary and will not result in a disqualification if not completed.

2.Complete the entire application packet. You may attach a resume to a completed application if you desire. Make sure the application is signed and dated before it is submitted to Human Resources. Photocopied applications with original signatures and dates are acceptable.

3.Complete a separate application for each position desired. Make sure the correct position title and recruitment number appears on each application.

4.SUBMITTED APPLICATIONS ARE THE PROPERTY OF THE LAS VEGAS-CLARK COUNTY LIBRARY DISTRICT. Please make a copy of the application for your records prior to submission. The Human Resources Department will not provide a copy of your application to you.

5.Applicants must meet all requirements for the position, and applications must be received in the Human Resources Department prior to 5:00 P.M. on the closing date. An incomplete application packet will be grounds for rejection. Qualifications will be determined based on your attached documentation, if required, and your experience as listed on the application. Please refer to the job announcement for required documentation.

6.It is your responsibility to ensure that the application is received in the Human Resources Department before the closing date and time. If you choose to mail your application, it must be postmarked by midnight on the closing date of the vacancy announcement.

7.Applications that are received late, incomplete, or electronically will be rejected.

8.Applications must be submitted to:

Las Vegas-Clark County Library District

Human Resources Department

7060 West Windmill Lane

Las Vegas, NV 89113

HR Form 18 (Revised 03/04/2011)

(1)

APPLICANT NAME:

______

EXPERIENCE: List your present job first. Also include military service and any volunteer work. The information you provide regarding your experience will be used to determine whether you meet the minimum qualifications. Answer in detail. Please provide employment history for at least the last ten (10) years. If you want prior experience considered beyond 10 years, please list it also. Also include all gaps in employment. If more space is needed, attach additional sheets. If this will be your first job, or you do not have ten years of employment history, so indicate in the appropriate area below.

DO NOT SUBSTITUTE A RESUME IN LIEU OF COMPLETING THIS SECTION.

		MO. YR.	MO. YR.	Salary	Employer		Supervisor	Phone
		TO
		Hours Per Week		Complete address, including		City, State, ZIP	Your Job Title	No. Of Employees
								You Supervised:
		Duties:
		Reason for leaving:
		MO. YR.	MO. YR.	Salary	Employer		Supervisor	Phone
		TO
		Hours Per Week		Complete address, including		City, State, ZIP	Your Job Title	No. Of Employees
								You Supervised:
		Duties:
		Reason for leaving:
		MO. YR.	MO. YR.	Salary	Employer		Supervisor	Phone
		TO
		Hours Per Week		Complete address, including		City, State, ZIP	Your Job Title	No. Of Employees
								You Supervised:
		Duties:
		Reason for leaving:
		MO. YR.	MO. YR.	Salary	Employer		Supervisor	Phone
		TO
		Hours Per Week		Complete address, including		City, State, ZIP	Your Job Title	No. Of Employees
								You Supervised:

Duties:

Reason for leaving:

HR Form 18 (Revised 03/04/2011)

(3)

APPLICANT NAME:______

REFERENCES

List name, address, and telephone number of three professional references that are not related to you.

	(1) Name			Title
	Address					Telephone No.
	(2) Name			Title
	Address					Telephone No.
	(3) Name			Title
	Address					Telephone No.
ADDITIONAL INFORMATION
	Have you ever been terminated from employment? ☐ YES		☐ NO. If “YES”, please explain:

_______________________________________________________________________________________________

_______________________________________________________________________________________________

__

Are you related to a current Las Vegas-Clark County Library District employee? ☐ YES ☐ NO If “YES,” please give name of the employee, your relationship to the employee, and at which library/location employee currently works.

NAME OF EMPLOYEE:RELATIONSHIP:LIBRARY / LOCATION:

List all names (maiden name, nicknames, aliases, etc.) you have used for educational, training, personal reference, or employment purposes:

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Have you ever been convicted of a criminal offense (other than a minor traffic violation), or are you awaiting trial for a criminal offense?

❒ YES ❒ NO Answering “YES” will not necessarily disqualify you from employment.

Criminal Offence includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of “nolo contendere” (no contest). Conviction is an adjudication of guilt and includes determinations before a court, a district justice or a magistrate which results is a fine, sentence or probation.

If “YES”, please explain: __________________________________________________________________________

_______________________________________________________________________________________________

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application (including any attached resume or cover letter) may result in refusal of employment or if employed, may be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to provide the Las Vegas-Clark County Library District any and all information concerning my previous employment and any other pertinent information they may have.

I also understand that if offered employment, I will be required to submit to and pass a pre-employment drug test prior to being employed.

SIGNATURE:	DATE:
INCOMPLETE OR ELECTRONICALLY RECEIVED APPLICATIONS WILL NOT BE CONSIDERED
	Photocopied applications with original signatures are acceptable
HR Form 18 (Revised 03/04/2011)	(4)

Human Resources Department

7060 West Windmill Lane

Las Vegas, NV 89113

Phone: (702) 507-6235

WEB SITE: www.lvccld.org

FAIR CREDIT REPORTING ACT AUTHORIZATION AND RELEASE

In considering your application for employment with the Las Vegas-Clark County Library District

and when making other employment-related decisions directly affecting you (if you are hired), the Las Vegas-Clark County Library District may wish to obtain and use a “consumer report” from a “consumer reporting agency” about you. These terms are defined in the Fair Credit

Reporting Act (FCRA), 15 U.S.C. §§ 1681- 1681u. As an applicant for employment or employee of the Las Vegas-Clark County Library District, you are a “consumer” with rights under the

FCRA.

A “consumer reporting agency” is defined as a person or business which, for monetary fees,

dues, or on a cooperative non-profit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing “consumer reports.”

A “consumer report” is defined as any written, oral or other communication by a “consumer reporting agency” bearing on a consumer’s credit worthiness, credit standing, credit capacity,

character, general reputation, personal characteristics, or mode of living used or collected to be a factor in establishing the consumer’s eligibility for employment purposes.

If a “consumer report” is obtained and if it is considered when making an employment-related

decision that directly and adversely affects you, you will be provided with a copy of the “consumer report” and a copy of a “Summary of Your Rights Under the Fair Credit Reporting Act,” published by the Federal Trade Commission before the decision is made final.

FAIR CREDIT REPORTING ACT AUTHORIZATION

By signing below, I, hereby voluntarily authorize the Las

Vegas-Clark County Library District to obtain a “consumer report” about me from a “consumer reporting agency” and to consider the “consumer reports” when making decisions regarding my

employment.

Applicant’s Signature:				Date:
Applicant’s Printed Name:
Position Applied for and Recruitment Number:

HR Form 18 (Revised 03/04/2011)

(5)