Date

YYYY

Name

First Name

Last Name

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permanent Address

(If different from present address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone

(###)

###

####

Home Phone

(###)

###

####

Social Security Number

Employment Desired

Position applying for:

Availability: When can you begin work?

Personal Information

Have you ever applied to/worked for Sierra Presbyterian Church or another church before?

Yes

If yes, where and when?

Do you have any friends or relatives working for Sierra Presbyterian Church?

Yes

Name(s)/ Relationship(s)

Why are you applying for work at Sierra Presbyterian Church?

If hired, would you have a reliable means of transportation to and from work?

Yes

Are you at least 18 years old? (If under 18, are you willing to verify that you are a minimum legal age)?

Yes

If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?

Yes

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

Yes

If no, describe the functions that cannot be performed: (Note: We comply with the ADA and consider reasonable accommodation measures the may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests."

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.)

Yes

If yes, state nature of the crime(s), when and where convicted, and disposition of the case. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however, be considered.)

Fingerprinting Requirements We are committed to providing a safe environment for all children and youth. Therefore, all employees are required to be fingerprinted. All offers of employment are contingent upon clearance from the Department of Justice and the FBI. Failure or inability to meet and/or comply with any of the security requirements are grounds for termination of employment or rejection of an applicant.

Education, Training and Experience

Highschool Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of years completed

Did you graduate?

College/University Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of years completed

Did you graduate?

Type of Degree

Vocational School Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you graduate? Add any additional information.

Employment History

List below all present and past employment starting with your most recent employer (last eight years is sufficient). Account for all period of unemployment. You must complete this section even if attaching a resume.

Name of Employer

Type of Business

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Supervisor's Name

Dates of Employment (From/To)

Weekly Pay (Starting/Ending)

Your Position and Duties

Reason for Leaving

May we contact this employer for a reference?

Yes

Name of Employer

Type of Business

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Supervisor's Name

Dates of Employment (From/To)

Weekly Pay (Starting/Ending)

Your Position and Duties

Reason for Leaving

May we contact this employer for a reference

Yes

Name of Employer

Type of Business

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Supervisor's Name

Dates of Employment (From/To)

Weekly Pay (Starting/Ending)

Your Position and Duties

Reason for Leaving

May we contact this employer for a reference?

Yes

Please Read Carefully, Initial Each Paragraph and Sign Below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize the church to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the church any and all letters, reports and other information related to my work records, without given me prior notice of such disclosure. In addition, I hereby release Sierra Presbyterian Church, my former employers and all others persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the church. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Sierra Presbyterian Church, and that no promises or representations contrary to the foregoing are binding on Sierra Presbyterian Church unless made in writing and signed by me and the church’s designated representative.

Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by Sierra Presbyterian Church, I am entitled to copies of any such public records obtained by Sierra Presbyterian Church unless I mark the line below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the line below.

I waive receipt of a copy of any public record described in the paragraph above.

Yes

YYYY

Applicant's Signature

Thank you for submitting your application to Sierra Pres!