Employment Application

We are an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Human Resource Representative.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Confirmation Email

Specific Position(s) applying for*

Referral source

Are you seeking?

Full time employmentPart-time employmentTemporary

Have you previously been employed by the Indiana Conference?*

YESNO

Have you previously been employed denominationally employed?*

YESNOOther

Do you have relatives employed by the denomination?*

YESNOOther

Are you fluent in a foreign language?*

YESNO

If yes, what language(s)?

The Indiana Conference requires its employees to be baptized, tithe-paying members in good standing of the SDA Church. Please list below.*

Have you been convicted of a felony/misdemeanor (other than traffic violations)?*

YESNO

If so, provide the location, date and result/outcome for each conviction:

Highest level of education completed:*

Please complete the appropriate sections*

	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College
Graduate

Please list your three most recent employers, list the most recent first

Employment Record #1 (most recent)*

Start date*

MonthDayYear

End date

MonthDayYear

Are you currently employed?*

YESNO

May we contact this employer?*

YESNO

Phone number*

Area CodePhone Number

Wages START:*

Salary or Hourly*

Wages END:*

Salary or Hourly*

Work performed:*

Skills/Licenses*

Reason for leaving*

List any additional information you would like us to consider:

Employment Record #2*

Start date*

MonthDayYear

End date

MonthDayYear

May we contact this employer?*

YESNO

Phone number*

Area CodePhone Number

Wages START:*

Salary or Hourly*

Wages END:*

Salary or Hourly*

Work performed:*

Skills/Licenses*

Reason for leaving*

Employment Record #3 (put N/A if it does not apply)

Start date

MonthDayYear

End date

MonthDayYear

May we contact this employer?

YESNO

Phone number

Area CodePhone Number

Wages START:

Salary or Hourly

Wages END:

Salary or Hourly

Work performed:

Skills/Licenses

Reason for leaving

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

Reference #1*

Reference #2*

Reference #3*

Upload your resume, click Choose File

Upload a File

Upload a cover letter, click Choose File

Upload a File

*By clicking the submit button I hereby Certify that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge, and that any information I have provided is subject to verification. I understand that incomplete, false or misleading information given in this application, in my interview(s) or otherwise in the application process will void this application or will subject me to discharge at any time if I am employed.

I expressly acknowledge and understand that in the absence of a written contract signed by human Resources to the contrary, my status, if I am hired, will be that of an employee at will having no contractual right, express or implied, to remain in the Indiana Conference's employment. I expressly acknowledge further that neither any verbal communication nor any written communication made to me during the application and/or interview process or during my employment with the Indiana Conference, nor any provision in the policy book constitutes the term of an implied employment agreement. In Consideration of any employment offered, I specifically agree that my employment may be terminated, with or without cause or notice, at any time, at the option of either the Indiana Conference or myself. I understand that only Human Resources or Conference Administration may enter into any other agreement for my employment with the Indiana Conference or make any agreement with me contrary to the foregoing.

*I expressly agree that my prior employer(s) and current employer may be contacted for the purpose of investigating my background, and I understand that information regarding my prior and current employment(s) may be used by the Indiana Conference in considering this application. I further agree to cooperate fully in acquiring any requested information. I hereby permit my present and prior employer(s) to disclose to the Indiana Conference information in their possession or subject to their control including information contained in my personnel file(s). In this regard, I expressly release the Indiana Conference from any and all liability of whatever kind and nature which, at any time, may result from obtaining and making an employment decision based upon the requested information. Additionally, I understand that the Indiana Conference may request, and I hereby expressly give my permission for the Indiana Conference to obtain a criminal history background check on me as part of the application process.

By entering your name, you agree to accept the terms of the above document with an electronic signature.*

I agreeI do not agree

You must agree to accept the terms of the document in order to submit an application.

Type signature*

Date*

MonthDayYear