Application for Employment - General

Application for Employment
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
I certify that I am a US citizen, permanent resident, or a foreign national with authorization to work in the United States.*

YesNo
Have you ever been convicted of or entered a plea of guilty, no contest, or had a withheld judgment to a felony?*

YesNo
If yes, explain.

Education and Training

Education

	Name of School	Location (City, State)	Dates Attended	Diploma or Degree Earned
1.
2.
3.
4.
5.

List any special training or educational experiences you have had.

File Upload - Resume & Cover letter*

Resume and Cover letter
Cancelof
How did you hear about the Pregnancy Resource Center? What appeals to you most about this ministry?

Work Experience
How many former/current work experiences would you like to enter?*

Employer #1
Name of Employer
Job Title
Supervisor
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibilities
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for leaving
May we contact this employer?

YesNo

Employer #2
Name of Employer
Job Title
Supervisor
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibilities
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for leaving

Employer #3
Name of Employer
Job Title
Supervisor
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibilities
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for leaving

Employer #4
Name of Employer
Job Title
Supervisor
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibilities
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for leaving

Employer #5
Name of Employer
Job Title
Supervisor
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Responsibilities
From:

MonthDayYear
Date
To:

MonthDayYear
Date
Reason for leaving

What special gifts, talents, skills or personality traits would you bring to this ministry?

Christian Walk
Do you consider yourself a Christian?*

YesNo
If so, how long have you been a Christian?
If yes, please explain what it means to be a Christian:
If you are a Christian, please give a brief statement (testimony) about how you came to know Christ as your personal Lord and Savior and tell how your life has changed since then.
What church do you attend and what ways are you involved there?
How do you currently put your faith into action?

Authorization for Verification

I certify that all of the information that I have included on this application is true, complete, and correct to the best of my knowledge, information, and belief. By submitting this application, I authorize the Pregnancy Resource Center of the New River Valley to verify any education and employment included on this application.
Signature*

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Date*

MonthDayYear
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