Application for Employment
Position that you are applying for:
*
Please Select
Child Care Coordinator
Youth Director
Tech/AV Coordinator
Legal Name
*
First Name
Last Name
Preferred Name
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
E-mail
*
example@example.com
Cell Number
*
Format: (000) 000-0000.
Other Number
Format: (000) 000-0000.
Education
What is the highest level of education that you have completed?
*
Please Select
High School Diploma or Equivalent
Technical/Vocational Certificate
Some College
Associate Degree
Bachelor's Degree
Master's Degree
Doctoral or Professional Degree
High School
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
High School Year of Graduation
*
Trade School
*
College/University
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Graduation Year
*
Major or Certificate Earned
*
Graduate School
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Graduation Year
*
Masters Degree
*
Doctoral School
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Graduation Year
*
Doctorate Degree
*
Employment Questions
Are you authorized to work in the United States?
*
Yes
No
Have you ever been convicted of a felony or misdemeanor?
*
Yes
No
Please explain with the date and nature of each offense:
*
A conviction does not necessarily exclude you from employment.
Have you ever been discharged or asked to resign?
*
Yes
No
Please explain:
*
A conviction does not necessarily exclude you from employment.
Have you ever been denied the opportunity to work with children?
*
Yes
No
Please explain:
*
A conviction does not necessarily exclude you from employment.
Employment History
Are you currently employed
*
Yes
No
1. Employer's Name
*
Title
*
Date Started
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Do you have additional employment history to add?
*
Yes
No
2. Name of Employer
*
Title
*
Date Started
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Do you have additional employment history to add?
*
Yes
No
3. Name of Employer
*
Title
*
Date Started
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Do you have additional employment history to add?
*
Yes
No
4. Name of Employer
*
Title
*
Date Started
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Do you have additional employment history to add?
*
Yes
No
5. Name of Employer
*
Title
*
Date Started
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
References
Please include three references
1. Name
First Name
Last Name
Relationship
Phone Number
Format: (000) 000-0000.
2. Name
First Name
Last Name
Relationship
Phone Number
Format: (000) 000-0000.
3. Name
First Name
Last Name
Relationship
Phone Number
Format: (000) 000-0000.
What is your current church membership?
*
Please describe your goals and ideas for a thriving Youth Program.
What impact do you hope to foresee with the Youth in our congregation?
If given the task to do a community outreach project for youth, give us an example of what that may look like?
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