Job Application
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:______________________________
(area) (number) (area) (number)
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_____________________________________Home Phone______________ Work/Cell Phone______________
Address_______________________________________________ Relationship to you_________________________
AVAILABILITY FOR WORK What hours are you available for work?
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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
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Name of school |
Years Completed |
Field of study |
Degree/Diploma |
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High School |
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9 10 11 12 |
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Technical School |
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College/University |
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1 2 3 4 |
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Other |
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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
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Employer__________________________________________________Phone_______________ From:__________
To:____________
Supervisor name_______________________ Position__________________________________________________
Responsibilities_________________________________________________________________________________
Reason for leaving_________________________________________May we contact? □ yes □ no
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Employer__________________________________________________Phone_______________ From:__________
To:____________
Supervisor name_______________________ Position__________________________________________________
Responsibilities_________________________________________________________________________________
Reason for leaving_________________________________________May we contact? □ yes □ no
SKILLS Computer Software (list all applicable)__________________________________________________________
_________________________________________________________________________________________________
Currently First Aid certified? □ yes □ no Currently CPR certified for infants & adults? □ 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.
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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.
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Signature Date