Employment Application Applicant Information Full Name:
Date: Last
First
M.I.
Address: Street Address
Apartment/Unit #
City
Phone:
(
State
)
ZIP Code
E-mail Address:
Date Available:
Social Security No.:
Desired Salary:
$
Position Applied for: YES
Are you a citizen of the United States? Have you ever worked for this or any other church?
NO
YES
NO
YES
NO
YES
If no, are you authorized to work in the U.S.? If yes, when, where?
Have you ever been convicted of a felony? If yes, explain:
Education & Training High School:
Address: YES
From:
To:
College:
Degree:
Address: YES
From:
To:
Did you graduate? List Training Courses:
To:
Did you finish?
Certific -ations:
NO
Degree:
YES
From:
NO
Did you graduate?
NO
Other:
References Please list three professional references. Full Name:
Relationship:
Company:
Phone:
(
)
Phone:
(
)
Phone:
(
)
Address: Full Name:
Relationship:
Company: Address: Full Name: Company: Address:
Relationship:
NO
Previous Employment Company:
Phone:
Address:
(
)
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities: From:
To:
Reason for Leaving: YES
NO
May we contact your previous supervisor for a reference? Company:
Phone:
Address:
(
)
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities: From:
To:
Reason for Leaving: YES
NO
May we contact your previous supervisor for a reference? Company:
Phone:
Address:
(
)
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities: From:
To:
Reason for Leaving: YES
NO
May we contact your previous supervisor for a reference?
Military Service Branch: Rank at Discharge:
From:
To:
Type of Discharge:
Disclaimer, Consent and Signature I certify that my answers are true and complete to the best of my knowledge. By signing this application, I am giving my consent to participate in a recruiting process that includes background checks, a credit check and assessment of my qualifications, experience and determination of my knowledge, skills and abilities as determined by Druid Hills United Methodist Church and its Selection Committee relevant to the position for which I have applied. If this application leads to employment, I understand that any false or misleading information or material omission of information discovered during the application process or as determined during an interview may result in my discharge. Signature: