APPLICATION FOR EMPLOYMENT

FIRST NAMEMIDDLE INITIALLAST NAME

LIST OTHER NAMES OR ALIAS' YOU'VE USED IN THE PAST

PRESENT ADDRESS

Street Address Line 2

CITYSTATE

ZIP

Email

example@example.com

PHONE NUMBER*

ARE YOU UNDER 18 YEARS OF AGE?*

YesNo

DRIVER'S LICENSE NUMBER

DRIVER'S LICENSE STATE

DRIVER'S LICENSE EXPIRATION DATE

Date

EMPLOYMENT IS CONDITIONED ON THE SUCCESSFUL PASSAGE OF A CRIMINAL BACKGROUND INVESTIGATION. A CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FOR EMPLOYMENT. VERIFICATION OF YOUR LEGAL RIGHT TO WORK IN THE UNITED STATES WILL BE REQUIRED.

PLEASE UPLOAD YOUR COVER LETTER

PLEASE UPLOAD YOUR RESUME

POSITION DESIRED OR AREA OF INTEREST*

REFERRED BY / HOW DID YOU LEARN ABOUT THE POSITION?*

SALARY/WAGE DESIRED*

I AM LOOKING FOR*

Part-Time EmploymentFull-Time EmploymentTemporary EmploymentOther

HAVE YOU EVER PREVIOUSLY APPLIED TO WORK AT DIVINE SHEPHERD LUTHERAN CHURCH (DSLC) OR LITTLE LAMB PRESCHOOL AND CHILDCARE (LLPC)?*

YesNo

IF YES, GIVE POSITION PREVIOUSLY APPLIED FOR

HAVE YOU EVER PREVIOUSLY BEEN EMPLOYED BY DSLC OR LLPC?*

YesNo

IF YES, GIVE POSITION PREVIOUSLY HELD

DATES OF PREVIOUS EMPLOYMENT WITH DSLC OR LLPC

Date Employment Began

Date Employment Ended

LIST THE NAME(S) OF ANY FRIENDS OR RELATIVES CURRENTLY EMPLOYED BY DSLC OR LLPC

ARE YOU ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING WITH OR WITHOUT REASONABLE ACCOMODATION?*

YesNo

CAN YOU WORK OVERTIME?*

YesNo

WHAT IS YOUR CURRENT EMPLOYMENT STATUS?*

EmployedSelf-EmployedUnemployedStudent

IF EMPLOYED, MAY WE CONTACT YOUR PRESENT EMPLOYER?

YesNo

COMMENTS/OTHER PERTINENT INFORMATION

HAVE YOU EVER WORKED FOR A CHURCH OR MINISTRY ORGANIZATION?

YesNo

IF YES, PLEASE DESCRIBE YOUR EXPERIENCE

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?

YesNo

IF YES, PLEASE EXPLAIN BELOW

A conviction record will not necessarily be a bar to employment, and factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. DSLC/LLPC will abide by individual state disclosure laws.

EDUCATION

	Name, City & State of School	Major	Units Completed/GPA	Degrees/Diplomas
HIGH SCHOOL
COLLEGE
COLLEGE
OTHER

SPEAK

READ

WRITE

LIST PROFESSIONAL CERTIFICATES OR LICENSES YOU CURRENTLY HOLD

LIST LOCATION AND EDUCATIONAL COURSES YOU ARE CURRENTLY ENROLLED IN?

HAVE YOU EVER SERVED IN THE U.S. ARMED SERVICES?*

YesNo

IF YES, LIST MILITARY DUTIES AND TRAINING

ARE YOU CURRENTLY SERVING AS A VOLUNTEER FOR ANY CHURCH OR ORGANIZATION?*

YesNo

IF YES, LIST THE ORGANIZATION YOU VOLUNTEER FOR AND YOUR VOLUNTEER POSITION

ARE YOU AN ACTIVE MEMBER OR ATTENDER OF A LOCAL CHURCH?*

YesNo

IF YES, LIST THE CHURCH YOU CURRENTLY ATTEND

PLEASE LIST JOB RELATED ORGANIZATIONS, CLUBS, PROFESSIONAL SOCIETIES, OR OTHER ASSOCIATIONS TO WHICH YOU BELONG. (You may omit those which indicate your race, color, national origin, ancestry, gender or age.)

ORGANIZATION NAME & LOCATION*

TYPE OF BUSINESS

POSITION(S) HELD*

START DATE*

Date

END DATE

Date

DESCRIPTION OF DUTIES*

NAME OF SUPERVISOR*

PHONE NUMBER*

REASON FOR LEAVING*

ORGANIZATION NAME & LOCATION

TYPE OF BUSINESS

POSITION(S) HELD

START DATE

Date

END DATE

Date

DESCRIPTION OF DUTIES

NAME OF SUPERVISOR

PHONE NUMBER

REASON FOR LEAVING

ORGANIZATION NAME & LOCATION

TYPE OF BUSINESS

POSITION(S) HELD

START DATE

Date

END DATE

Date

DESCRIPTION OF DUTIES

NAME OF SUPERVISOR

PHONE NUMBER

REASON FOR LEAVING

FIRST AND LAST NAME OF REFERENCE #1*

RELATIONSHIP TO YOU & YEARS KNOWN*

Email

example@example.com

PHONE NUMBER*

FIRST AND LAST NAME OF REFERENCE #2*

RELATIONSHIP TO YOU & YEARS KNOWN*

Email

example@example.com

PHONE NUMBER*

FIRST AND LAST NAME OF REFERENCE #3

RELATIONSHIP TO YOU & YEARS KNOWN

Email

example@example.com

PHONE NUMBER

We appreciate your interest in Divine Shepherd Lutheran Church/Little Lamb Preschool and Childcare and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of our organization. Qualified applicants are considered for all positions without regard to applicable protected classes.

1. I authorize all corporations, companies, employers, former employers, landlords, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts, branches of military service, and persons to release information they may have about me to the organization with which this form has been filed, or their agent, and I hold harmless and release all parties involved from any liability and responsibility for doing so. I also authorize the procurement of an investigative consumer report and understand that it may contain information about my background, mode of living, character, and personal reputation. This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested. Further information may be available upon written request within a reasonable period of time.

2. I understand that my employment is conditioned on the successful passage of a criminal background check and that any offer of employment made to me will be predicated upon the truthfulness of my written and verbal statements and information derived through the pre-employment background process. I further understand that if it is determined that any statement - verbal or written - or other information provided by me is not truthful, any offer of employment extended to me may be withdrawn and, if employed, I may be subject to termination.

3. I understand this Application for Employment is not to be construed as an offer of employment or a guarantee of employment. I further understand that my employment with this organization does not constitute any form of contract - implied or expressed - and such potential employment may be terminable at-will either by myself or by the employer upon notice to one party by the other.

4. Divine Shepherd is part of a church body and as a church retains the right to give preference in hiring to persons who are members of a Lutheran Church-Missouri Synod congregation.

I acknowledge that I have read all the above statements and that I understand them.

Applicant's Signature*

Date*

Date

APPLICATION FOR EMPLOYMENT

PLEASE INDICATE ANY LANGUAGES OTHER THAN ENGLISH THAT YOU

EMPLOYMENT HISTORY

REFERENCES

ACKNOWLEDGEMENTS