Job Application Form:
Instructions: Print clearly in black ink or type. Answer all questions. Sign and date form before returning.
Personal Information:
First Name: ______
Middle Name: ______
Last Name: ______
Social Security Number: ______-____-______
Street address:
______
City, State & Zip code:
______, ______
Phone number:
(______) ______- ______
Are you eligible to work in the United States?
Yes ______No ______
If you are under age 18, do you have employment/age certificates?
Yes ______No ______
Have you been convicted of or pleaded no contest to a felony within the last five years?
Yes ______No ______
If yes, please explain: ______
______
Position/Availability:
Position Applied for: ______
Days/Hours available:
Monday ______
Tuesday ______
Wednesday ______
Thursday ______
Friday ______
Saturday ______
Sunday ______
Hours available: from _____ to ______.
What date are you available to begin work? ______
Education:
Name and address of school – degree/diploma – graduation date:
______
______
______
______
Skills and Qualifications: Licenses, Skills, Training, Awards;
______
______
______
Employment History:
Present or Last Position:
Employer: ______
Address: ______
Supervisor: ______
Phone: ______
Email: ______
Position title: ______
From: ______to ______
Responsibilities: ______
______
Salary: ______
Reason for leaving: ______
______
======
Previous Position:
Employer: ______
Address: ______
Supervisor: ______
Phone: ______
Email: ______
Position title: ______
From: ______to ______
Responsibilities: ______
______
Salary: ______
Reason for leaving: ______
______
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May we contact your present employer?
Yes ______No ______
References:
Name/ title, address, phone number:
______
______
______
I certify that information contained in this application is true and complete
I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.
Signature: ______
Date: ______
Please complete and mail to:
St. John Lutheran Church
5977 Lower Tug Fork Rd
Melbourne, KY 41059