Employee Application

Personal Data

Name

Phone

This address will receive a confirmation email

Address

Social Security Number

Other names under which you have worked?

Are you a citizen of the U.S?

Yes No

If employed, can you submit proof of legal right to work in the U.S.?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, please give the date, location, and disposition of your case.

Emergency Contact

Name

Relationship

Phone

Address

Position Desired

Position Desired?

Status

Full time Part time Per diem

Shift length

8 hour flexible

Hours

Salary requirement

Names of relatives employeed

If an offer is extended, when would you be available for work?

How did you become aware of the position for which you are applying? Please give individual source

Do you have a reliable method of transportation to use if you are hired to work in this facility?

Yes No

Employment Experience

Please complete all of the following even if you are also submitting a resume. Please show all periods of employment, military service, and volunteer service for the past ten years. Please explain all periods of unemployment. Begin with your most current employer and use additional paper if necessary.

Have you ever involuntarily left any job within the past ten years?

Yes No

Name and Address of Employer

Name

Phone

Address

Supervisor

Job Titles & Duties

Reason for leaving

May we contact

Yes No

Dates employed

Salary

Status

Full time Part time Per diem Temporary

Name and Address of Employer #2

Name

Phone

Address

Supervisor

Job titles & Duties

Reason for leaving

Dates employed

May we contact

Yes No

Salary

Status

Full time Part time Per Diem Temporary

Name and Address of Employer #3

Name

Phone

Address

Supervisor

Job titles & Duties

Reason for leaving

May we contact Yes No

Dates employed

Salary

Status Full time Part time Per diem Temporary

Name and Address of Employer #4

Name

Phone

Address

Supervisor

Job titles & Duties

Reason for leaving

May we contact Yes No

Dates employed

Status Full time Part time Per diem Temporary

Education and Training

List all Schools Name/Address, Course/Major, Diploma/Degree

Church Life

Describe your church background and involvement

Are you a member of a church?

Yes No

How long?

Describe your relationship with Christ?

References (Please don't list relatives)

Name

Phone

This address will receive a confirmation email

Name

Phone

This address will receive a confirmation email

Name

Phone

This address will receive a confirmation email

Additional Information

Please use the space below for any additional information necessary to describe your full qualifications or periods of employment

Do you speak, read, or write in any language other than English? If yes, please describe

Please read carefully

PLEASE DO NOT RESPOND TO THE FOLLOWING QUESTION UNTIL AFTER YOU HAVE READ AND/OR DISCUSSED THE JOB DESCRIPTION OF THE POSITION FOR WHICH YOU ARE APPLYING.

Do you believe you would be able to perform the essential functions of the hob for which you are applying?

Please explain your answer

Are you in full agreement with the Baptist Faith & Message? (https://bfm.sbc.net/bfm2000/)

Yes No Option

Please write out your testimony.

I hereby certify that the answers to the foregoing questions are true to the best of my knowledge and agree to have any of the statements checked. I am aware that a more detailed investigation concerning background and credit may also be conducted if applicable to the job for which I am applying and hereby authorize such an investigation. I understand that employment is contingent upon satisfactory completion of reference checks and that, upon my written request, information on the nature and scope of an inquiry, if one is made, will be provided to me. I understand that any omission, misrepresentation, or falsification can be grounds for refusal of employment. I further understand that, if employed, any false statements or misrepresentations herein or in conjunction with the application process may be cause for dismissal.

Yes No

Date

Employee Application

Description

Please Fix the Following