Employment Application at Almena United Methodist Church

27503 CR 375      Paw Paw, MI  49079       269-668-2811

 

Name__________________________________________________SS# ________________________

            (first)                                (middle)                           (last)

Address____________________________________________________________________________

                        (street)                               (city)                                                    (state)                      (zip)

Telephone Numbers: primary____________________________  secondary:______________________________

Are you at least 18 years old?    □ yes    □ no     If no, birth date___________________________

Do you have the legal right to remain and work in the United States:        □ yes    □no

Have you ever been convicted of a felony?          □ yes    □ no      If yes, please explain on back of this sheet.

Personal Interests:

 

 

Job related organizations, clubs or professional societies: (omit those which indicate sex, race, religion, color, national origin, ancestry and/or age)

 

 

 

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

 

Name_______________________________ Phone 1______________   Phone 2______________

 

Address__________________________________________ Relationship to you________________

 

AVAILABILITY FOR WORK What hours are you available for work?

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From
To

 

Salary/Wages desired:_________________    When are you able to start working?_____________________

Do you plan to work elsewhere or attend school while employed here?      □ yes    □no

Do you have any obligations that would affect working this schedule?       □yes     □no

Would you work overtime on occasion, if necessary?                               □ yes    □ no

 

EDUCATION

	Name  of school	Years Completed	Field of study	Degree/Diploma
High School		9   10   11   12
Technical School
College/University		1    2     3     4
Other

 

EXPERIENCE   Start with most recent employer, attach a resume if desired.  No need to repeat details if on resume.

 

Employer_____________________________________Phone_______________    From:_________ To:__________

Supervisor name_______________________  Position________________________________________________

 

Responsibilities_________________________________________________________________________________

 

Reason for leaving_________________________________________May we contact? □ yes         □ no       

////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Employer_____________________________________Phone_______________    From:_________ To:__________

Supervisor name_______________________  Position________________________________________________

 

Responsibilities_________________________________________________________________________________

 

Reason for leaving_________________________________________May we contact? □ yes         □ no 

    

////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

 

Employer_____________________________________Phone_______________    From:_________ To:__________

Supervisor name_______________________  Position________________________________________________

 

Responsibilities_________________________________________________________________________________

 

Reason for leaving_________________________________________May we contact? □ yes         □ no 

List any other experiences, skills, or training which you feel would qualify you to work with the Almena UMC:

 

 

REFERENCES

List two references who are not related to you or are not previous employers.

Name	Address	Occupation	Phone
Name	Address	Occupation	Phone

 

APPLICANT’S STATEMENT

I represent that the information on this application is correct to the best of my knowledge and understand that any misstatement or omission of information may be grounds for rejection of application from subsequent employment.  I authorize the references listed above to give you any and all information they may have.  I hereby release all parties including Almena United Methodist Church, its officers, directors, agents and successors from all liability for any statement or information provided.

                    In consideration of my employment, I agree to conform to the policies and procedures of Almena United Methodist Church, and I understand that the policies, procedures, wages and benefits of the church may change from time-to-time.  I understand that nothing in this application is intended to imply or create an employment relationship or contract for employment.  I further understand that, if hired, my employment with Almena United Methodist Church is “at-will” and can be terminated at any time, with or without cause and with or without notice.  I also understand that no manager, supervisor or any other representative, other than the Pastor and SPRC chairperson, has the authority to enter into any agreement of employment. 

                    This application was designed to comply with the Federal Civil Rights Act, Title VII, the Age Discrimination Act of 1967, the Americans with Disabilities Act, The Civil Rights Act of 1991 and State Fair Employment Practice Laws.  Therefore, no question answered is or will be used to discriminate adversely in matters of race, color, marital status, national origin, religion, age, sex, disability, Vietnam Era Veteran status, or any other characteristics protected by state or local laws.

 

______________________________________________________                                          _____________________________________________

Signature                                                                                                                                       Date