An LCMS Congregation
 
 
 

  Employment Application

Concordia Lutheran Church is an equal opportunity employer and does not discriminate against qualified applicants or employees on account of race, color, sex, age, national origin, or disability.


Personal Information Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

* First name:
* Middle name:
* Last name:
* Are you at least 21 years of age? Yes    No

* Have you ever used another name for work, school or other purposes? If so, identify name(s) and dates used and circumstances:
* Last 4 of SSN:

Present Address
* Address:
* City:
* State: * Zip:

Permanent Address Check this box if Present Address and Permanent Address are the same.
* Address:
* City:
* State: * Zip:

* Cell phone: include area code
* Home phone: include area code Check this box if same as cell phone.
   Work phone: include area code
* Email Address:
* Referred by:

Employment Desired Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

Full-Time   Part-Time   Seasonal   Substitute   Other   
* If none of the above, what hours/day can you work?

* Position:
* Date you can start: Use Calendar
* Salary desired:
* Have you worked for this company before? Yes    No
   If so, when?
   Reason for leaving?
* Do you plan to work for another business while employed by Concordia Lutheran Church? If so, please indicate business, position and days/hours of the week employed.

Education History Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

High School
* Name:
* Location:
* Years attended:
   Course of Study:
   Did you graduate? Yes    No
* Degree or Diploma:

College Check this box if you did not attend college.
* Name:
* Location:
* Years attended:
   Course of Study:
   Did you graduate? Yes    No
* Degree or Diploma:

Trade, Business, or Correspondence School Check this box if you did not attend trade school.
* Name:
* Location:
* Years attended:
   Course of Study:
   Did you graduate Yes    No
* Degree or Diploma:


General Information Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

Please state all languages (including English) that you speak, read and write proficiently:
 SpeakReadWrite
English            
           
           
   Comments:
* Subjects of special study / research work:
* Equipment:
* Skills:


Work History Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

List last three employers, beginning with the last one first
* Name:
* Address:
   Telephone:
* Name of Supervisor:
* From:
* To:
   Hourly wage: per hour OR
   Annual wage: per year
* Position:
* Reason for leaving:

* Name:
* Address:
   Telephone:
* Name of Supervisor:
* From:
* To:
   Hourly wage: per hour OR
   Annual wage: per year
* Position:
* Reason for leaving:

* Name:
* Address:
   Telephone:
* Name of Supervisor:
* From:
* To:
   Hourly wage: per hour OR
   Annual wage: per year
* Position:
* Reason for leaving:
* Have you even been terminated from employment or asked to resign by any employer? If yes, please provide employer, location, dates and describe circumstances:

References Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

List names of three persons, not related to you, whom you have known at least one year
* Name:
* Relationship:
   Phone: include area code
* Years known:

* Name:
* Relationship:
   Phone: include area code
* Years known:

* Name:
* Relationship:
   Phone: include area code
* Years known:

Criminal History Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

Check this box if this section does not pertain to you.

You must include information on ALL convictions, pleas, and alternative disposition programs that have occurred during your lifetime. Please disclose any criminal offense that may appear on your record, even if you are uncertain of the exact date or how the criminal offense was classified. State the approximate date and your understanding of the criminal classification.

Have you at any time (check all that apply)
pled guilty   
nolo contendere(no contest)   
or have been convicted of any criminal offenses (misdemeanor or felony) other than parking tickets?   

Have you ever been subject to judicial or non-judicial punishment under the Uniform Code of Military Justice? If yes, provide complete information on all criminal offense(s), date(s), location(s) (city and state) and disposition:

Have you at any time served any of the following for any criminal offense? (Check all that apply) If the alternative disposition program in which you participated is not specifically listed below, you MUST disclose it by checking the last option and describing the program. Failure to disclose any type of alternative disposition program will be considered falsification and result in your ineligibility for employment.
pretrial diversion    deferred adjudication    deferral of prosecutions   
suspended sentence    community supervision    expungement of conviction   
shock incarceration    community-based punishment    postponed judgment   
probation    unconditional discharge    restorative justice program   
community control program    pretrial intervention    indeterminate commitment   
pretrial release    probation without adjudication of guilt    supervised release   
any other type of disposition program    conditional discharge    probation prior to judgment   

If yes, provide complete information on the criminal offense, nature of alternative disposition program and dates of commencement and completion:

(Conviction of a crime is not an automatic bar to consideration of employment, except where state law prohibits employment.)

Additional Information Please complete EVERY field. If information does not pertain to you, please answer with 'N/A'

Provide any additional information you believe will assist Concordia Lutheran Church in considering your application, including membership in professional or civil organizations, specialized training, apprenticeships or other qualifications.

Application Process

Applications for employment will be actively considered for the positions listed for 180 days after submission to Concordia Lutheran Church. Applicants seeking other positions or consideration after this time period has expired must submit another application. Concordia Lutheran Church may not interview all applicants for a vacancy. Those applications to be interviewed will be contacted by Concordia Lutheran Church.

Authorization I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release the company form all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

* Signed: Enter your name as your signature
* Date: May 23, 2017



 


2017-05-23 03:39:26