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Staff Application

First Presbyterian Church

Employment Application

 

Applicant Information

Last Name

 

First

 

M.I.

Date

 

Street Address

 

Apartment#

 

City

 

State

 

ZIP

 

Home Phone

 

Cell:

 

Date Available

 

Email:

 

 

 

Position Applied for:

Custodian

Are you a citizen of the United States?

YES 

NO 

If no, are you authorized to work in the U.S.?

YES 

NO 

Have you ever worked for this company?

YES  

NO  

If so, when?

 

Have you ever been convicted of a felony?

YES  

NO  

If yes, explain

 

 

Education

High School

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

College

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

Other

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

 

References

Please list three professional references.

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 


 

Previous Employment (include Volunteer service, if Applicable to position)

Company


Phone

(           )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

 

 

 

 

 

 

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

Signature

 

Date

 

 

ĉ
David Hawkins,
Aug 20, 2013, 1:20 PM
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