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EMPLOYMENT APPLICATION
(This type of application should be completed by all who seek any position that will involve the supervision and/or custody of children or youth. You should tailor the application to the specific circumstances in your congregation. However, the employment application should include sections for personal identification, job qualifications, experience and background for the past 5-10 years, references, a criminal history, and a waiver/consent to a periodic criminal records check or fingerprinting.)
APPLICANT INFORMATION:
Name
First
Middle
Last
Date
Month
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Day
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2019
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1921
1920
Address
City
State
ZIP Code
Telephone
Alternate Telephone
Best Contact Time
E-Mail Address
Social Security Number
Driver's License No./Issuing State
Date of Birth
Month
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12
Day
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Year
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2021
2020
2019
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2015
2014
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2012
2011
2010
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1930
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1921
1920
Position Apply For
Type of Work Desired
Full-Time
Part-Time
Temporary/Contract
When Are You Available to Begin Work?
Will You Work Overtime?
Yes
No
If hired, can you provide evidence that you are authorized and of legal age to work in the United States?
Yes
No
In Case of Emergency Notify
Telephone
Name of Nearest Relative
Telephone
EDUCATION:
HIGH SCHOOL:
SCHOOL NAME/LOCATION
COURSE OF STUDY
NO. YEARS ATTENDED
DEGREE/DIPLOMA
BUSINESS/TECHNICAL:
SCHOOL NAME/LOCATION
COURSE OF STUDY
NO. YEARS ATTENDED
DEGREE/DIPLOMA
COLLEGE:
SCHOOL NAME/LOCATION
COURSE OF STUDY
NO. YEARS ATTENDED
DEGREE/DIPLOMA
GRADUATE:
SCHOOL NAME/LOCATION
COURSE OF STUDY
NO. YEARS ATTENDED
DEGREE/DIPLOMA
OTHER:
SCHOOL NAME/LOCATION
COURSE OF STUDY
NO. YEARS ATTENDED
DEGREE/DIPLOMA
EMPLOYERS:
(List all jobs and contracts held by you during the past five continuous years)
CURRENT EMPLOYER:
Company Name
Phone
Address
City
State
ZIP Code
Position Held
From
To
Starting/Ending Salary
Reason for Leaving
Supervisor
PREVIOUS EMPLOYER:
Company Name
Telephone
Address
City
State
ZIP Code
Position Held
From
To
Starting/Ending Salary
Reason for Leaving
Supervisor
Previous employeer 2
More Previous Employeer
PREVIOUS EMPLOYER:
Company Name
Telephone
Address
City
State
ZIP Code
Position Held
From
To
Starting/Ending Salary
Reason for Leaving
Supervisor
Previous employeer 3
More Previous Employeer
PREVIOUS EMPLOYER:
Company Name
Telephone
Address
City
State
ZIP Code
Position Held
From
To
Starting/Ending Salary
Reason for Leaving
Supervisor
Previous employeer 4
More Previous Employeer
PREVIOUS EMPLOYER:
Company Name
Telephone
Address
City
State
ZIP Code
Position Held
From
To
Starting/Ending Salary
Reason for Leaving
Supervisor
MILITARY STATUS:
Have You Served in the U.S. Armed Services?
Yes
No
Branch
Start Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
End Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Rank/Rate at Discharge
Type of Service
Type of Discharge
Special Training/Experience Received in the U.S. Armed Services
Draft Status
Reserve Status
CRIMINAL HISTORY:
Have you ever been convicted of a criminal offense?
Yes
No
Do you currently have any criminal actions pending in which you are the Defendant? (Not Applicable to California Applicants)
Yes
No
Are you currently on probation or parole?
Yes
No
If you answered "Yes" to any of the above questions, please explain the nature of the offense and provide the date of the offense and the county and state in which it occurred.
PERSONAL REFERENCES:
Name
Phone
Occupation
Relationship
Address
Reference 2
Add another reference
Reference Two
Name
Phone
Occupation
Relationship
Address
Reference 3
Add another reference
Reference Three
Name
Phone
Occupation
Relationship
Address
APPLICANT STATEMENT:
(Read and Sign Below)
I certify that this employment application was completed by me and that all of the information on this application is true and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts called for herein will result in my disqualification from further consideration or dismissal from employment if I am hired. I have reviewed the Authorization for Criminal Records Verification and Finger print Information and acknowledge that I understand the terms set forth therein. I understand that this employment application is not valid without my signature.
Print Name
Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
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29
30
31
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
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1923
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1920
Signature