EMPLOYMENT APPLICATION

108 N. Main St., Statesboro GA 30458 (912) 764-5627

First Name

Last Name

Middle Initial

Today's Date

Date

Street Address

Apartment/Unit

City

State

ZIP

Phone

E-mail Address:

Date Available

Date

Social Security No.

Desired Salary

Position Applied for

Are you a citizen of the United States?

YES NO

If no, are you authorized to work in the U.S.?

YES NO

Have you ever worked for this company?

YES NO

If so, when ? If yes, explain

Have you ever been convicted of a felony?

YES NO

If so, when ? If yes, explain

High School

Address

Date Started

Date Ended

Did you graduate?

YES No

Degree

College

Address

Date Started

Date Ended

Did you graduate?

YES NO

Degree

Other

Address

Date Started

Date Ended

Did you graduate?

YES No

Degree

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date Started

Date Ended

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date Started

Date Ended

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

Date Started

Date Ended

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that employment by this organization is “at will” and includes no guarantee, contract, or promise of employment for any specified length of time. I further give my consent to this organization to perform a criminal background check and social security number verification with my information.

Signature

Clear

Date

FIRST BAPTIST CHURCH STATESBORO

APPLICANT INFORMATION

EDUCATION

REFERENCES

PREVIOUS EMPLOYMENT

DISCLAIMER AND SIGNATURE