The Pregnancy Center of Dillon County Employment Application

The Pregnancy Center of Dillon County

Employment Application
Position Sought
Name

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Social Security
Are you over 18 years old? Are you legally eligible for employment in the United States? (If offered Employment, you will be required to provide documentation to verify eligibility)
Have you ever been convicted of a crime other than a minor traffic offence? (including while in the military
If yes explain
High School
Number of years completed
Diploma
G.E.D.
College andor Vocational School
Number of years completed
Schools
Major
Degrees Earned
Date

DayMonthYear
Date
Describe other training or degrees
Employment History: List most recent employment first. May we contact your present employer?
Employer
Date Started

DayMonthYear
Date
Date Ended

DayMonthYear
Date
Address
PositionDuties
Telephone
Format: (000) 000-0000.
Salary
Supervisor Name
Reason for leaving
Employer
Date Started

DayMonthYear
Date
Date Ended

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position/Duties
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Salary
Supervisor name
Reason for leaving
Name
Date Started

DayMonthYear
Date
Date Ended

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position/Duties
Phone Number
Format: (000) 000-0000.
Salary
Supervisor's name
Reason for leaving
1 What is your reason for seeking employment here
2 What special skills talents gifts or personality traits would you bring to this ministry
3. This organization is a pro-life Christian ministry. We believe that our faith in Jesus Christ empowers us, enables us, and motivates us to provide crisis pregnancy services in this community. Please write a brief statement about how your faith would affect your work if hired?
References: Please provide at least two employment references and at least two personal references (including your pastor): Name Relationship Address Phone # Years
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Years Acqainted
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Years Acquainted
Name
Relationship
Address
Phone
Format: (000) 000-0000.
Years Acquainted
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Years Acquainted
Name
Relationship
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Years Acquainted
APPLICANT'S CERTIFICATION AND AGREEMENT I certify that the facts set forth in this employment application are true and complete to the best of my knowledge, and I authorize my prospective employer to verify their accuracy and to obtain reference information on my work performance and character. I give permission to my prospective employer to conduct a criminal background check to the extent that the position for which I am applying may involve interaction with minors. I release my prospective employer and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any employment decisions made based upon such information. I understand that, if employed, any falsified statements or omissions of material information on this application may lead to my prompt dismissal. If I am offered and accept employment, I agree to fully adhere to the policies and rules of my prospective employer. However, I understand that neither the existence of such policies and rules nor anything said during my interview process shall be deemed to create an express or implied employment contract.

I UNDERSTAND THAT ANY EMPLOYMENT THAT MAY BE OFFERED TO ME WILL

BE FOR AN INDEFINITE DURATION AND ON AN AT-WILL BASIS. I understand that

either my prospective employer or I will have the right to terminate any such employment at any time with or without notice or cause. I further certify that I have read and that I am in full agreement with the pregnancy center's Statement of Faith and Statement of Principle.
Signature
Date

YearMonthDay
Date
Should be Empty: