South Newington Baptist Church

SOUTH NEWINGTON BAPTIST CHURCH
EMPLOYMENT APPLICATION

South Newington Baptist Church is a religious organization that does not discriminate against applicants for employment on the basis of race, age, sex, national origin, disability, veteran's status, or marital status. South Newington Baptist Church reserves the right to discriminate on the basis of religion to the full extent permitted by the law. This application will be current for thirty (30) days only. If you are contacted after thirty (30) days, you must fill out a new application in order to be hired.

Date

Position requested (check all that apply)

Nursery worker

After-school Program

Summer Day Camp

Other

If other, please specify

First Name

Last Name

Other Names Used

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Have you lived anywhere else in the past five years?

Yes

No

Phone Number

SSN

Previous address

Apartment, suite, etc.

City

State

Zip/Postal Code

EMPLOYMENT HISTORY

Company

May we contact your employer?

Yes

No

Dates

From

To

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Position

Supervisor

Phone Number

Duties

Reason for leaving

I have more job history to list

Company

May we contact your employer?

Yes

No

Dates

From

To

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Position

Supervisor

Phone Number

Duties

Reason for leaving

I have more job history to list

Company

May we contact your employer?

Yes

No

Dates

From

To

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Position

Supervisor

Phone Number

Duties

Reason for leaving

I have more job history to list

Company

May we contact your employer?

Yes

No

Dates

From

To

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Position

Supervisor

Phone Number

Duties

Reason for leaving

I have more job history to list

EDUCATION

Number of years

School Name

City, State

Did you graduate?

Yes

No

Major/ Degree

I have more educational experience to report

Number of years

School Name

City, State

Did you graduate?

Yes

No

Major/ Degree

I have more educational experience to report

Number of years

School Name

City, State

Did you graduate?

Yes

No

Major/ Degree

I have more educational experience to report

Number of years

School Name

City, State

Did you graduate?

Yes

No

Major/ Degree

I have more educational experience to report

BACKGROUND INFORMATION

Are you legally eligible for employment in the US?

YES

NO

Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment, sexual abuse or other immoral behavior or conduct, involving adults or children? Have you ever been the subject of an investigation or allegation of sexual misconduct, sexual abuse or sexual harassment involving adults or children?

YES

NO

If yes, please describe the circumstances and relevant facts.

Were you a victim of sexual abuse/molestation while a child? (If you prefer, you may refuse to answer this question, or discuss your answer in confidence rather than on this form. Answering yes or failing to answer will not automatically disqualify an applicant.)

YES

NO

Are you over 18 years of age?

YES

NO

Contact for notification in case of emergency and their relationship to you

Phone Number

Are there any days/hours you would not be available to work?

Have you previously worked for us? (If yes, give dates)

Do you have any friends or relatives employed by us? (If yes, please list)

Who referred you to us?

Do you have any other skills you wish to mention?

CHURCH ACTIVITY

Name of church where you are currently a member:

If a member of South Newington Baptist Church, how long have you been attending?

More church info

I have more church attendance info to report

List other churches you have attended over the past five years:

Church name

Phone Number

Contact Person

Years Attended

More church info

I have more church attendance info to report

List other churches you have attended over the past five years:

Church name

Phone Number

Contact Person

Years Attended

More church info

I have more church attendance info to report

List other churches you have attended over the past five years:

Church name

Phone Number

Contact Person

Years Attended

More church info

I have more church attendance info to report

REFERENCES
(Please include complete address, city, state, zip code)
* One reference must be a person of the opposite sex, one a family member, and the rest non-family members.

Personal Reference:

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Phone Number

Professional / Civic Reference:

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Phone Number

Family Member Reference:

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Phone Number

APPLICANT STATEMENT
Please read carefully before signing.

I hereby authorize you to contact any references or organizations listed in this application and authorize such references or organizations to release any information contained in their files or records concerning me. In consideration of the receipt and evaluation of this application by Everyday Bible School, I release Everyday Bible School, all of its agents, and all such references and organizations from any and all liability for any damage that may result from furnishing such information to you. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application, except what may be required by law.

I understand and agree that if I am offered conditional employment with Everyday Bible School, my appointment is for no definite period and may, regardless of the date or method of payment of my wages or salary, be terminated by either party at any time without previous notice or cause and is subject to change in wages, conditions, benefits and operating policies.

I agree that if Everyday Bible School employs me, in the future a potential employer may contact Everyday Bible School or its representatives concerning my work record and my work performance at Everyday Bible School.

I hereby consent to and authorize persons employed by Everyday Bible School to divulge any and all information they consider relevant to any person representing him or herself to be an employer or potential employer of mine with respect to my work and/or performance of my job at Everyday Bible School. This consent specifically includes any information related to any allegation or investigation of child abuse or sexual abuse or molestation in any form.

I agree to a medical examination or inquiry, if requested if I receive a conditional offer of employment, including the analysis for the detection of the use of illegal drugs or controlled substances. I understand that testing positive for drugs or controlled substances could prevent my employment or continued employment by Everyday Bible School.

I understand and agree that in the performance of my duties as an employee of Everyday Bible School, or after I leave Everyday Bible School, that I must hold in confidence any and all information that I come in contact with regarding my employer or its business.

I understand and agree that it is critical to the mission and ministry of Everyday Bible School that all employees conform to the highest standards of safety, interpersonal conduct, and sexual morality. I affirm that I will strictly comply with Everyday Bible School policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal.

My responses above are true and correct. I understand and agree that any false answers or statements made by me on this application or any supplement thereto, or any false statements made to the representative(s) of Everyday Bible School during the interview process will be sufficient grounds for not hiring, or immediately discharging me, no matter when discovered.

I HAVE CAREFULLY READ, UNDERSTAND AND AGREE TO THE FOREGOING “APPLICANT STATEMENT” AND FURTHER UNDERSTAND AND AGREE THAT A COPY OF THIS APPLICATION SHALL BE AS VALID AS THE ORIGINAL.

Signature