Application for Employment
Second Baptist Church
100 North Main St.
Suffield, Connecticut 06078
Tel: (860) 668-1661
Date ___________
Full Name ____________________________________Social Security No._________________
Last, Middle initial, First
Home Phone: ___________________________ Mobile Phone: ______________________
Email Address: ___________________________
Current Address
______________________ ______________________ _____ ____________
Street and number city state zip
Previous Address (if you have lived at current address less than one year)
_______________________ ______________________ _____ ____________
Street and number city state zip
Employment is subject to verification of minimum legal age
Education:
Elementary _____________________________________________________
Name of school date of attendance
High School ____________________________________________________
Name of school date of attendance
College ____________________________________________________
Name of school date of attendance
Post-Graduate____________________________________________________
Name of school date of attendance
Person who should be notified in case of emergency:
Name ___________________________________ Relationship _________________
Address ___________________________________ Phone # ___________________
Previous Employment: (not less than five years employment experience, most recent employment first)
Company (name, address, tel. no)
Supervisor (name & title)
Type of work (description, full time, part time)
Dates employed
Reason for leaving
_____________________________________________________________________________
Company (name, address, tel. no)
Supervisor (name & title)
Type of work (description, full time, part time)
Dates employed
Reason for leaving
_____________________________________________________________________________
Company (name, address, tel. no)
Supervisor (name & title)
Type of work (description, full time, part time)
Dates employed
Reason for leaving
______________________________________________________________________________
Company (name, address, tel. no)
Supervisor (name & title)
Type of work (description, full time, part time)
Dates employed
Reason for leaving
______________________________________________________________________________
Provide at least five (5) references, excluding relatives and former employers:
Name address phone #
1.
2.
3.
4.
5.
Have you read the job description for the job you seek?
Training/Certification
Describe any special training or skills that may be related to the position for which you are applying:
Other
Have you ever been discharged for cause by a previous employer? If so, please explain
Covenants between persons serving as paid staff and Second Baptist Church (the “Church”) require honesty, integrity, and truthfulness for the health of the Church. To that end, please certify by signing below as follows:
- The information set forth in this application is true and complete.
- You understand that any misrepresentation or material omission herein may be grounds for rejection of, or consideration for, or termination of either your application for employment to, or your subsequent employment by the Church, as the case may be.
- While your application for employment by the Church is pending, you acknowledge your duty to amend your responses and information you have provided herein by immediately sending written notice to the Personnel Committee of the Church upon discovering any original inaccuracy or inaccuracy by reason of subsequent events or change in circumstance.
Grounding your relationship with the Church on the basis of an open exchange of relevant information builds the foundation for a continuing and healthy covenant between paid staff and the Church they seek to serve. To that end please certify by signing below as follows:
- You authorize the Church and/or its agents to make inquiries regarding all statements you have set forth herein.
- You authorize all entities, persons, former employers, supervisors, courts, law enforcement, and other public agencies to respond to inquiries of the Church concerning you, to supply verification of statements you have made, and to comment on and state opinions regarding your background, character and suitability for the job to which you are applying.
In order to meet the Church’s goal of providing the highest quality and safest care, and the least risk of child abuse, please certify by signing below as follows:
- You authorize the Church and/or its agents to circulate, distribute, and otherwise share information gathered in connection with this application on a “need to know” basis for the purposes stated above.
- You understand that the Church will share with you information it has gathered about you, subject to your written request for it.
Signed _______________________________
Name _______________________________
Date: _______________________________
