Fellowship Staff Application

Name *

First Name

Last Name

Date

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you 18 years or older?

The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

Yes

No

Date you can start:

MM

DD

YYYY

Are you employed now?

Yes

No

May we talk to your current employer?

Yes

No

Have you applied here before?

Yes

No

Are you related to an employee?

Yes

No

Have you been discharged or asked to resign?

Yes

No

Have you been convicted of a felony or misdemeanor?

Yes

No

Have you ever been denied the opportunity to work with children?

Yes

No

Are you a U.S citizen or authorized to work in the U.S?

Yes

No

Can you verify your idenitity and eligibility to work in the United States?

Yes

No

Physical Limitations: Can you perform the functions of this job with reasonable accommodation?

Yes

No

Emergency Contact

First Name

Last Name

Address 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Signature

To the best of my knowledge, the facts in this application are true and complete. If hired, untrue statements in this application may be grounds for dismissal.I authorize the investigation of all statements in this application. The church may contact all references, employers, public agencies, and educational institutions to verify the accuracy of all information provided by me in this application, my resume, or job interviews. As allowed by law, references may give information concerning my previous employment and any pertinent information. I release all parties from all liability for any damage that may result from furnishing this information to you.I agree that if hired that there will be no contract between me and the church. I will be an at-will employee as allowed by my state. My employment may be terminated at any time.I understand that the church does not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting an applicant as prohibited by applicable law. Our church operates in compliance with the provisions of all applicable federal and state non-discrimination regulations including, Titles VI and VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1967, the Equal Pay Act, the Americans with Disabilities Act of 1990 and any applicable sections of the state labor code. These prohibit discrimination on the basis of the applicant’s age, race, color, sex, religion, national or ethnic origin, and physical or mental disability. As a Christ centered, Bible believing church, we may exercise preference on the basis of religion in our employment decisions.I certify that I understand and accept the terms in this application.

First Name

Last Name

Date of signature

MM

DD

YYYY