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:         _______________________________

 

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Suffield, Connecticut

100 North Main Street

Suffield, CT 06078

860-668-1661

Office Hours: Mon-Fri. 9:00 AM - 1:00 PM

Copyright © 2017 - 2027 Second Baptist Church