Application for Employment

Employment Application

Please complete the form below to apply for a position with Adult & Teen Challenge.
Full Name

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State

Zip Code Country
Email Address
example@example.com
Home Phone Number
Work Phone Number
Social Security Number
Position(s) for which you are applying

Employment, Eduction, and Volunteer History
May we contact your present employer?

Yes No
Explain
Please give enough information to allow for review and evaluation of your work experience and abilities. List the positions you have held starting with your most recent job. Include relevant volunteer experience. This section must be fully completed. A resume may be attached but will not be accepted in place of this section.

Employment History

	Employer Name & Address	Employer Phone Number	Dates	Type of Work	Reason for Leaving
1
2
3
4
5

Education History

	School	Dates Attended	Degree or Certificate
1
2
3
4
5

Volunteer History

	Place	Dates Served	Duties
1
2
3
4
5

Resume (optional)

Cancel of

References

List those familiar with your capabilities in addition to the employers previously noted under employment. (Do not list relatives)
Pastor
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Years Known
Businessman
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Years Known
Layman
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Years Known
Friend
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Years Known

Do you have the legal right to work in the U.S.?

Yes No
Minimum Salary Requirements
Please identify and explain all periods of unemployment during the last five years
What type of work would you like to do?
Why are you applying for work at Adult & Teen Challenge?
Have you ever been employed by Adult & Teen Challenge?

Yes No
List job held and date/place employed
Have you ever been convicted of a crime?

Yes No
Please explain

I certify that the information on this application is correct and that if any of the information is untrue I may be disqualified from employment, or, if hired, I may be dismissed. I give Adult & Teen Challenge permission to verify my employment history and to solicit and secure other information that may be required to determine my suitability for employment. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the company as well as from the use or disclosure of such information by the company or any of its agents, employees, or representatives.

In consideration of my employment, I agree to conform to the rules and standards of the company, as amended from time to time at the company’s sole discretion. I further agree that my employment and compensation can be terminated at will, with or without cause and with or without notice, at any time, either at my option or at the option of the company. I understand that no employee or representative of the company other than the president 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. Further, the president of the company may not alter the at-will nature of the employment relationship unless he/she signs a written document in which he specifically and clearly indicates intent to do so. I also understand that all offers of employment are conditioned on the receipt of satisfactory response to reference requests and the provision of satisfactory proof of an applicant’s identity and legal authority to work in the U.S.
Signature

Clear
Date

Month Day Year
Date
Please upload a 1-2 page testimony of your relationship with Jesus Christ.

Cancel of
This company is an equal opportunity employer. It considers applicants for all positions without regard to race, color, gender, national origin, age, or any other characteristic protected by applicable state or federal civil rights law. As a Christian ministry sponsored by a Pentecostal church, Adult & Teen Challenge does reserve the right to restrict employment for religious reasons.
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Employment Application

Employment, Eduction, and Volunteer History

References

Pastor

Businessman

Layman

Friend