Recruitment Application Form

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

E-mail*

example@example.com

Are You a U.S. Citizen or Authorized to Work in the United States?*

YesNo

Position Applying For

Date You Can Start*

Date

Salary Desired ($)*

Have you ever worked at Valley Rescue Mission before?*

YesNo

Have You applied with the Valley Rescue Mission before?*

YesNo

If yes, please list the date and position you applied for:

Do you have any relatives who have worked at Valley Rescue Mission?*

YesNo

If yes, please list your relatives name:
Please identify the relation to you:

High School

Name of High School Attended

Number of Years Attended

Graduated?

YesNo

College

Name of College/University Attended

Number of Years Attended

Area of Study/Degree

Graduated?

YesNo

Graduate School

Name of Graduate School Attended

Number of Years Attended

Area of Study/Degree

Graduated?

YesNo

Trade School/Other

Name of Trade/Technical/Other School Attended

Number of Years Attended

Area of Study/Degree

Graduated?

YesNo

Skills*

List any relevant skills

Qualifications*

List any relevant certifications or qualifications

Current Employer

Name of Current Employer or NONE if not Employed

Position

Current Salary ($)

Reason for Leaving?

Start Date

Date

May We Contact?

YesNo

Previous Employer*

Name of Previous Employer

Position

Previous Salary ($)

Reason for Leaving?*

Start Date*

Date

End Date*

Date

Previous Employer

Name of Previous Employer

Position

Previous Salary ($)

Reason for Leaving?

Start Date

Date

End Date

Date

Reference 1

Name of Reference

Relationship

Years Acquainted

Phone Number

Please enter a valid phone number.

Email

example@example.com

Reference 2

Name of Reference

Relationship

Years Acquainted

Phone Number

Please enter a valid phone number.

Email

example@example.com

Reference 3

Name of Reference

Relationship

Years Acquainted

Email

example@example.com

Phone Number

Please enter a valid phone number.

Cover Letter

Resume*

Important Notice: Equal Employment Opportunity

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment. Valley Rescue Mission (the “Mission") is a faith-based, Christian non-profit organization. The Mission does not discriminate on the basis of race, color, sex, age, height, weight, disability, marital status, veteran status, national origin, or any other protected class, subject to its ministerial exception to select and employ suitable candidates who will adhere to and personify the Mission's beliefs/tenets and beneficent purposes of Valley Rescue Mission. All qualified and suitable candidates meeting the requirements of the applicable job description will be considered. The Mission does not discriminate against any disabled person who can perform the essential duties of the position in question with or without reasonable accommodation, and the Mission's policy is, upon request from an employee/candidate, to provide reasonable accommodation(s) that do not represent an undue hardship/burden to the Mission.

Statement of Faith

Valley Rescue Mission is a Christ-centered organization, and we are looking to hire individuals whose spiritual beliefs and moral code of conduct are in agreement with that of Valley Rescue Mission. Please read to ensure you understand our Mission.&#13;&#10;&#13;&#10;STATEMENT OF FAITH&#13;&#10;I believe in the Virgin birth and absolute Deity of Jesus Christ.&#13;&#10;I believe in one God, eternally existing as Father, Son and Holy Spirit.&#13;&#10;I believe that Jesus Christ died on the cross as a substitutionary sacrifice for our sins and that his shed blood is the only means for the remission of sins.&#13;&#10;&#13;&#10;I affirm the Divine inspirations, truthfulness and authority of both Old and New Testament Scriptures in their entirety as the only written word of God, without error in all that affirms (including what it teaches concerning history, the Cosmos, and moral absolutes) and is the only infallible rule of faith and practice. &#13;&#10;&#13;&#10;I believe that man was created in God’s image; man sinned as recorded in Genesis, causing physical and spiritual death.&#13;&#10;&#13;&#10;I believe that Jesus Christ was resurrected bodily from the tomb, and that His personal bodily return to earth will be in power and glory.&#13;&#10;&#13;&#10;I believe that sin had its origin in Adam and as a result, the entire human race is born with a sinful nature and is spiritually dead.&#13;&#10;&#13;&#10;I believe that when a person receives the Lord Jesus Christ by faith, the Holy Spirit regenerates that person and they are born again into the family of God, and through this new birth, they receive the gift of eternal life. &#13;&#10;&#13;&#10;I believe that those who believe on the Lord Jesus are saved and the process of sanctification (being set apart unto a holy life) begins by the work and power of the Holy Spirit in that life. &#13;&#10;&#13;&#10;I believe in a future Heaven for the saved and that it is not obtained as a result of good works, but by grace.  I believe in the maintaining of good works and holy living as a result of salvation. &#13;&#10;

If you agree to the above Statement of Faith and agree to support the activities of Valley Rescue Mission and to abide by the constitution and by-laws governing this organization, please sign below. Signature is not required to be considered for employment.

By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misre

presentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.

If chosen as an employee of Valley Rescue Mission you are required to provide verification of citizenship or authorization to work in the United States. If chosen as an employee, you will be required to consent to a criminal background check as well as consent to drug screening.You understand that your job offer is contingent upon the results of these findings.

If any of this information is unclear or may you have questions concerning this applications or the requirements therof, you ay conatc Angela Winter Reed, Human Resource Coordinator at (706)322-8267 ext. 210.

By signing below, you acknowledge and agree with the information shown above and have no questions concerning this document.

Signature

Date

Employment Application

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Required):

Acknowledgement: