DUBLIN UNITED METHODIST CHURCH

P.O. Box 577, (GPS: 424 East Main Street), Dublin, VA 24084, (540) 674-5128,

Application for Employment: Director of Discipleship

Conditions of employment are stated at the end of this form.Please read carefully before you sign this application.
DATE APPLICATION RECEIVED (TO BE COMPLETED BY DUBLIN UNITED METHODIST CHURCH) ______

Please fill out all sections

Applicant Information

  1. Applicant Name ______
  2. Social Security Number: ______
  3. Home Phone ______Best Phone to reach you ______
  4. Email Address ______
  5. Current Address, Number and street : ______
    City ______State & Zip ______
  6. How did you find this job opening at Dublin United Methodist Church?:______

Employment Position:

  1. What days and hours are you available?______
  2. If hired, on what date can you start working? ______/ ______/ ______
  3. Are you available to work overtime? [ ] Y or [ ] N
  4. Hourly rateor salary desired: $______

Personal Information:

  1. Have you ever applied to / worked for Dublin United Methodist Church or the Learning Circle? [ ] Y or [ ] N

If yes, please explain (include date): ______

  1. Do you have any friends, relatives, or acquaintances working for Dublin United Methodist Church or the Learning Circle? [ ] Y or [ ] N If yes, state name & relationship: ______

______

  1. Current Church affiliation: ______
  2. Position of service or leadership held in church: ______

______

  1. If hired, would you have transportation to/from work? [ ] Y or [ ] N
  2. Are you over the age of 18? [ ] Y or [ ] N
  3. If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? [ ] Y or [ ] N
  4. If hired, are you willing to submit to and pass a controlled substance test? [ ] Y or [ ] N
  5. Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? [ ] Y or [ ] NIf no, describe the functions that cannot be performed
    ______

(Note: Dublin United Methodist Church complies with what the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.)

  1. Have you ever been discharged from a job? [ ] Y or [ ] N
  2. Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N

If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case.______

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense.)

Education, Training and Experience

High School:
School name: ______School city, state, zip:______

Number of years completed: ______Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: ______

College / University 1:
School name: ______School city, state, zip:______

Number of years completed: ______Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: ______

College / University 2:
School name: ______School city, state, zip:______

Number of years completed: ______Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: ______

Military:
Branch: ______Rank in Military:______
Total Years of Service: ______Skills/duties: ______
Related details:______

  1. Do you speak, write or understand any foreign languages? [ ] Y or [ ] N If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be. ______
  2. Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?[ ] Y or [ ] N If yes, please explain ______

______

Employment History

Are you currently employed? [ ] Y or [ ] N

If you are currently employed, may we contact your current employer? [ ] Y or [ ] N

Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment.If you have attached a resume with this information, this section may be omitted.

  1. Name of Employer:______
    Name of Supervisor:______
    Telephone Number:______
    Business Type:[ ______
    Address:______
    City, state, zip:______Length of Employment (Include Dates):______
    Position & Duties:______
    Starting Salary: ______Ending Salary: ______

Reason for Leaving: ______
May we contact this employer for references? [ ] Y or [ ] N

  1. Name of Employer:______
    Name of Supervisor:______
    Telephone Number:______
    Business Type:[ ______
    Address:______
    City, state, zip:______Length of Employment (Include Dates):______
    Position & Duties:______
    Starting Salary: ______Ending Salary: ______

Reason for Leaving: ______
May we contact this employer for references? [ ] Y or [ ] N

  1. Name of Employer:______
    Name of Supervisor:______
    Telephone Number:______
    Business Type:[ ______
    Address:______
    City, state, zip:______Length of Employment (Include Dates):______
    Position & Duties:______
    Starting Salary: ______Ending Salary: ______

Reason for Leaving: ______
May we contact this employer for references? [ ] Y or [ ] N

References

Please list two or more persons who have knowledge of your work performance within the last five years. Please include professional references only.

  1. Name - First, Last: ______
    Telephone Number:______
    Address:______City, state, zip:______
    Occupation: ______Number of Years Acquainted: ______
  1. Name - First, Last: ______
    Telephone Number:______
    Address:______City, state, zip:______
    Occupation: ______Number of Years Acquainted: ______
  1. Name - First, Last: ______
    Telephone Number:______
    Address:______City, state, zip:______
    Occupation: ______Number of Years Acquainted: ______

Applicant’s Statement

I certifythattheinformationonthisapplicationanditssupportingdocumentsareaccurateandcomplete.I understandandagreethatfailureto fullycompletetheform,ormisrepresentationoromissionoffacts,representsgroundsforeliminationfromconsiderationforemployment,orterminationafteremploymentifdiscoveredatalaterdate.I authorizeDublin United Methodist Church toinvestigate,withoutliability,allstatementscontainedinthisapplicationandsupportingmaterials.Iauthorizereferencesandformeremployers,withoutliability,tomakefullresponsetoanyinquiriesinconnectionwiththisapplicationforemployment. Iagreeto submittoa physicalexam,criminalandcreditbackgroundinvestigation,and/orscreeningfor illegalsubstancesuponconditionalofferofemployment.Iunderstandthatthis documentisNOTanofferofemployment,andthatan offerofemployment,iftendered, doesNOTconstituteacontractforcontinuedguaranteedemployment.Iunderstand thatstaffemployeesofDublin United Methodist Churchserveat-will,andtheemploymentrelationshipmaybeterminatedatanytimebyeitherparty,foranyornoreason.

If employed,Iwillberequiredto furnishproofofeligibilityto workintheUnitedStates. Iunderstandthatif employedonatemporarybasis,I wouldbepaidforhoursworkedonly,andwouldbeineligibleforbenefitsincludingpaidtimeoff.If employedonaregular,benefits-eligiblebasis,IunderstandthatI wouldbe offereda benefitpackage,if applicableatthetime.

IunderstandthatanybenefitsI receivemaybesubjecttochangeordiscontinuationatanytimewithoutpriornotice.Iunderstandthatthefirst90daysofregularemploymentrepresenta provisionalperiodduringwhichmyemploymentmaybeterminatedwithout rightofappeal.

Applicant's Signature:______Date:______

Please return this completed application to Dublin United Methodist Church by surface mail or email. If you have further questions, please contact the church office.

DUBLIN UNITED METHODIST CHURCH

P.O. Box 577, (GPS: 424 East Main Street), Dublin, VA 24084, (540) 674-5128

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