NewB Employment Application

APPLICATION FOR EMPLOYMENT
Full Name*

First NameMiddle NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone Number
Social Security Number*
Position or Type of Work Applied For*
Are you 18 years of age or older?*

YesNo
Desired Salary?
GENERAL INFORMATION
Type of position?

Full TimePart TimeTemporary
What days and hours are you available to work?
On what date are you available to start work?

MonthDayYear
Are you willing to work overtime?

YesNo
If under 18 years of age, can you provide a valid Work Permit, high school diploma, or equivalent?

YesNo
What languages do you speak, read, or write fluently?
If hired, can you verify that you have the legal right to work in United States?

YesNo
Years at current address?
If less than 5 years at current address, list previous address
Are you presently on layoff from another job and subject to recall?

YesNo
If so, please explain:
Have you ever served in the Armed Forces?

YesNo
If so, what branch?
Do you have any special skills, training, or experience which may help you qualify for employment?

YesNo
If so, please explain:
Do you have any certificates of licenses which may help you qualify for employment?

YesNo
If so, please list:
What church do you regularly attend?
Are you a member?

YesNo
Are you involved in ministry work?

YesNo
If so, please list:
Do any of your relatives work for this church?

YesNo
If so, who?
Have you applied for work at this church before?

YesNo
If so, when?
Have you ever worked for this church before?

YesNo
If so, when?
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses?

YesNo
If so, please explain (NOTE: Conviction will not necessarily disqualify applicant)
How did you find out about this employment opportunity?
EMPLOYMENT EXPERIENCE

Please state with your most recent job and include all periods of employment, self-employment, job-related military service, and volunteer work.
From:
To:
Employer's Name / Address / Telephone
Start Pay
Last Pay
Job Title
Reason for Leaving
Describe the Work You Did
From:
To:
Employer's Name / Address / Telephone
Start Pay
Last Pay
Job Title
Reason for Leaving
Describe the Work You Did
From:
To:
Employer's Name / Address / Telephone
Start Pay
Last Pay
Job Title
Reason for Leaving
Describe the Work You Did
From:
To:
Employer's Name / Address / Telephone
Start Pay
Last Pay
Job Title
Reason for Leaving
Describe the Work You Did
May we contact the employers listed above?

YesNo
If not, please indicate which ones you do not wish to contact:
Last year of school completed. Please check one.

High School 9High School 10High School 11High School 12GEDCollege 1College 2College 3College 4Post Graduate 1Post Graduate 2Post Graduate 3Post Graduate 4
For Childcare/Preschool Applicants Only: If attended college, do you have a least 15 credit hours in Early Childhood?

YesNo
PERSONAL REFERENCES

Please do not list relatives or former employers
1. Name and occupation
Address
Phone Number

Area CodePhone Number
2. Name and occupation
Address
Phone Number

Area CodePhone Number
3. Name and occupation
Address
Phone Number

Area CodePhone Number
CERTIFICATION AND ACKNOWLEDGMENT
I certify that the information provided herein is true and correct to the best of my knowledge. I understand that, if employed, falsified statements on this Application for Employment form will be considered grounds for termination.
I authorize the church and its affiliates to thoroughly investigate my work experience and any other matters related to my suitability for employment. I further authorize my former employers to disclose to the church and its affiliates any and all information they may have concerning and all claims, demands, or liabilities arising out of, or in any way related to, such disclosure.
I acknowledge that, prior to or during my employment, the church may require any legal testing and/or examination, including but not limited to, medical, physical, drug and/or alcohol, psychological, and skill aptitude.
I also acknowledge that, if employed, both the church and I have the right to terminate the employment relationship. Employment At Will remains in effect throughout my employment with the church and may not be modified by an oral or implied agreement.
You consent and agree that your use of an electronic device to enter this information constitutes your signature, acceptance and agreement as if actually signed by you in writing.
Applicant Signature*

Clear
Date*

MonthDayYear
Should be Empty:

APPLICATION FOR EMPLOYMENT

GENERAL INFORMATION

EMPLOYMENT EXPERIENCE

PERSONAL REFERENCES

CERTIFICATION AND ACKNOWLEDGMENT