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.
Employment Desired*

FulltimePart-timeTempOn Call
Desired Pay Type*

HourlySalary
Desired Pay Rate*

Employment Eligibility
Are you a U.S. Citizen?*

YesNo
If no, are you legally permitted to work in the U.S.?

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, please explain

Education

High School
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?

YesNo

College
Did(Do) you attend a college/university?*

YesNo
Name
If you did not attend college leave this field blank
Dates Attended (Started)

YearMonthDay
Dates Attended (Ended)

YearMonthDay
City
State
Did you graduate?

YesNo
Degree

Experience

Current/Previous Employer
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
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
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

YesNo
Are you a member of Breath of Life Christian Center

YesNo

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*

Clear
Date

MonthDayYear
Date
Should be Empty: