Careers

(This type of application should be completed by all who seek any position that will involve the supervision and/or custody of children or youth. You should tailor the application to the specific circumstances in your congregation. However, the employment application should include sections for personal identification, job qualifications, experience and background for the past 5-10 years, references, a criminal history, and a waiver/consent to a periodic criminal records check or fingerprinting.)

Applicant Information

Last name

First name

Middle name

Date

Address

City

State

Zip Code

Phone Number

Alternate Phone Number

Best Contact Time

Email

Social Security Number

Driver's License Number/Issuing State

Date of Birth

Position Applying For

Type of Work Desired

Full-TimePart-TimeTemporary/Contract

When are you able to begin work?

Will you work overtime?

YesNo

In case of emergency notify

Emergency Contact Phone

If hired, can you provide evidence that you are authorized and of legal age to work in the United States?

YesNo

Name of Nearest Relative

Nearest Relative Phone Phone

Education

High School

School Name/Location

Course of Study

Number of Years Attended

Degree/Diploma

Business/Technical

School Name/Location

Course of Study

Number of Years Attended

Degree/Diploma

College

School Name/Location

Course of Study

Number of Years Attended

Degree/Diploma

Other

School Name/Location

Course of Study

Number of Years Attended

Degree/Diploma

Professional Organizations

First-Aid Training

YesNo

CPR Training

YesNo

Employers

(List all jobs and contracts held by you during the past five continuous years)

Current Employer

Company Name

Phone

Address

City

State

Zip

Position Held

From

To

Starting/Ending Salary

Reason For Leaving

Supervisor

previous employer

Company Name

Phone

Address

City

State

Zip

Position Held

From

To

Starting/Ending Salary

Reason For Leaving

Supervisor

previous employer

Company Name

Phone

Address

City

State

Zip

Position Held

From

To

Starting/Ending Salary

Reason For Leaving

Supervisor

previous employer

Company Name

Phone

Address

City

State

Zip

Position Held

From

To

Starting/Ending Salary

Reason For Leaving

Supervisor

previous employer

Company Name

Phone

Address

City

State

Zip

Position Held

From

To

Starting/Ending Salary

Reason For Leaving

Supervisor

Military status

Have you ever been convicted of a criminal offense?

YesNo

Do you currently have any criminal actions pending in which you are the Defendant? (Not Applicable to California Applicants)

YesNo

Are you currently on probation or parole?

YesNo

If you answered "Yes" to any of the above questions, please explain the nature of the offense and provide the date of the offense and the county and state in which it occurred.

Personal References

Name

Address

Phone

Occupation

Relationship

Name

Address

Phone

Occupation

Relationship

Name

Address

Phone

Occupation

Relationship

Application Statement

I certify that this employment application was completed by me and that all of the information on this
application is true and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or
omission of facts called for herein will result in my disqualification from further consideration or dismissal from
employment if I am hired. I have reviewed the Authorization for Criminal Records Verification and Fingerprint
Information and acknowledge that I understand the terms set forth therein. I understand that this employment
application is not valid without my signature.

Signature (type name)

Date