BOLCC Employment Application

BOLCC Employment Application
Personal Information
Desired Position
Desired Position
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
SS#
Birthdate

MonthDayYear
Date
Date Available

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employment Desired
Desired Pay Type
Desired Pay Rate

Employment Eligibility
Are you a U.S. Citizen?
If no, are you legally permitted to work in the U.S.?
Have you ever been convicted of a felony?
If yes, please explain

Education
- Name
  If you did not attend High School leave this field blank.
- Dates Attended (Started)
  
  YearMonthDay
- Dates Attended (Ended)
  
  YearMonthDay
- City
- State
- Did you graduate?
- Did(Do) you attend a college/university?
- Name
  If you did not attend college leave this field blank
- Dates Attended (Started)
  
  YearMonthDay
- Dates Attended (Ended)
  
  YearMonthDay
- City
- State
- Did you graduate?
- Degree

Experience
- Current/Previous Employer Name
- Supervisor
- City & State
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Position Held & Duties
- Reason for leaving?
- Ending Pay
- Previous Employer Name
- Supervisor
- City & State
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Position Held & Duties
- Reason for leaving?
- Ending Pay
- Previous Employer Name
- Supervisor
- City & State
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Position Held & Duties
- Reason for leaving?
- Ending Pay

Religious Affiliation
Are you a born again Christian
Are you a member of Breath of Life Christian Center

Background Check Application
By signing this application for employment, I affirm that all the information contained herein is true and complete. I give Breath of Life Christian Center Inc. permission to conduct a background check for consideration of employment. This background check may include former employers, personal references, and the criminal justice system.

In compliance with TCA§71-3-533, a fingerprint sample and criminal history records check through the Tennessee Bureau of Investigation is required for individuals selected for positions working with children.
Signature
Date

MonthDayYear
Date
Should be Empty: