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Employment Application

Date__________________________
Name________________________________________________________________________________
Address______________________________________________________________________________
Telephone#s__________________________________________________________________________
Birthday______________________________________________________________________________
Drivers License Number __________________________________________________ State__________
Are you:

Married

Separated

Divorced

Widowed

Single

Spouses Name ________________________________________________________________________


Do you have children? __________________________________________________________________
If yes, please list names and ages_________________________________________________________
_____________________________________________________________________________________
Which position are you applying for? ______________________________________________________
What do you see as your primary responsibility to a child in this age range? ______________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Give names and address and telephone number of three references who are not related to you and
are not previous employers.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Education

Name and
Location

Type of Diploma

High School
Trade School
Technical School
College

Dates Attend

Did you Graduate

List any special skills or training _________________________________________________________


_____________________________________________________________________________________

EMPLOYMENT EXPERIENCE
1. Employer ______________________________________________________________________
Telephone_______________________ Dates Employed________________to____________________
Address______________________________________________________________________________
Supervisor _________________________________Start Salary___________ Ending Salary__________
Reason for Leaving ____________________________________________________________________
____________________________________________________________________________________
Work Performed_______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2. Employer ______________________________________________________________________
Telephone_______________________ Dates Employed _______________to____________________
Address______________________________________________________________________________
Supervisor _________________________________Start Salary___________ Ending Salary__________
Reason for Leaving _____________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Work Performed ______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
3. Employer ______________________________________________________________________
Telephone_______________________ Dates Employed________________ to____________________
Address______________________________________________________________________________
2

Supervisor ________________________________Start Salary___________ Ending Salary___________


Reason for Leaving _____________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Work Performed ______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

SPIRITUAL JOURNEY
Do you regularly attend weekend services? ________________________________________________
Where do you attend church? ___________________________________________________________
Are you a member of your church? _______________________________________________________
Have you accepted Jesus Christ as Lord and Savior and are you committed to have the character of
Jesus live through you? _________________________________________________________________
Have you been baptized? ___________________ When? ______________________________________
Whether we are devoted Christian believers, uncertain about God or somewhere in between, we are
all on a Spiritual Journey. Please take a few minutes to describe how and when you decided to trust
Christ alone for your salvation or where you are with your belief in God today.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

PERSONAL SITUATIONS
Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography or any
other addictions: or has anyone ever suggested that you may have problems with any of the above?
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever been arrested, convicted or pleaded guilty to a crime? (Felony or misdemeanor)
_____________________________________________________________________________________
_____________________________________________________________________________________

APPLICANTS STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application of employment as may be
necessary in arriving at an employment decision. The applicant understands that neither this
document nor any offer of employment from the employer constitute a contract unless a specific
document that affect is executed by the employer and the employee in writing.
In the event of employment, I understand that false or misleading information given in my application
or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and
regulations of the employer.

________________________________________________
Signature of Applicant

____________________________
Date