FLM APPLICATION FOR EMPLOYMENT

We consider applicants for all positions without regard to race, color, gender, national origin, age, disability, marital or veteran status. However, applicant must be a Christian and a member of Faith Landmarks Ministries.

Position(s) Applied For

Date

How Did You Learn About Us?

Name (Last, First, Middle)

Address

City

State

Zip

Day time Phone

Format: (000) 000-0000.

Mobile Phone

Format: (000) 000-0000.

Email

example@example.com

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Have you ever filed an application with us before?

If “Yes,” give Date

MM/DD/YYYY

Have you ever been employed with us before?

If “Yes,” give Date

MM/DD/YYYY

May we contact your present employer and request a reference?

If hired are you able to submit proof that you are eligible for employment in the United States? (Proof of citizenship or immigration status will be required upon employment.)

On what date would you be available for work?

MM/DD/YYYY

Are you available to work:

Are you currently on “lay-off” status and subject to recall?

Can you travel if your job requires it?

Have you been convicted of a felony within the last 7 years? Conviction will not necessarily disqualify an applicant from employment.

If “Yes,” please explain

Rows	Name and Address of School	Course of Study	Years Completed	Diploma Degree
Elementary School
High School
Undergraduate College
Graduate Professional
Other (specify)

Indicate any foreign languages you can speak, read and/or write.

Rows	FLUENT	GOOD	FAIR
SPEAK
READ
WRITE

Describe any specialized training, professional licenses, certifications, apprenticeship, skills, extracurricular activities and any job-related training received in the United States military.

1. Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

2. Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

3. Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, gender, national origin, disabilities, or any other protected status.

Employer Name #1

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Job Title

Supervisor

Reason for Leaving

Dates Employed (From - To)

Work Performed

Hourly Rate/Salary (Starting - Final)

Employer Name #2

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Job Title

Supervisor

Reason for Leaving

Dates Employed (From - To)

Work Performed

Hourly Rate/Salary (Starting - Final)

Employer Name #3

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Job Title

Supervisor

Reason for Leaving

Dates Employed (From - To)

Work Performed

Hourly Rate/Salary (Starting - Final)

Employer Name #4

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Job Title

Supervisor

Dates Employed (From - To)

Work Performed

Reason for Leaving

Hourly Rate/Salary (Starting - Final)

If you need additional space, please continue here:

List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, national origin, age, ancestry, disability, or other protected status:

Other Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.

Check Skills/Equipment Operated

PC

Word

Excel

Fax

Other

Production/Mobile Machinery (list):

Other (list)

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing, in a reasonable manner, or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A description of theactivities involved in such a job or occupation is attached.

All employees of Faith Landmarks Ministries are required to sign and abide by a Code of Honor and morality based on the Word of God. Employees are also required to allow us to check references and approve a background check through the Virginia State Police. If offered a job, are you willing to sign the code, allow references to be checked and approve the background check?

Employment at Faith Landmarks Ministries is “at will” which means that the employee or FLM may terminate employment at any time, for any reason, with or without notice.

Signature

Please verify that you are human

FLM APPLICATION FOR EMPLOYMENT

Education

Employment References

Employment Experience

Additional Information

Specialized Skills