Application

Last Name

 

First Name

 

Middle        Initial          

Date

 

Street Address

 

Apartment/Unit #

 

City

 

State

 

ZIP

 

Phone

 

E-mail Address

 

Date Available

 

Social Security No.

 

 

 

Are you a citizen of the United States?

YES / NO

If no, are you legally entitled to work in the United States?

 

Have you ever been convicted of a felony or a crime?

YES / NO

If yes, please explain

 

 

Address

 

Dates

to

Did you graduate?

YES/NO

Degree

 

 

Address

 

Dates

to

Did you graduate?

YES/NO

Degree

 

 

Address

 

Dates       to

Did you graduate?

YES/NO

Degree

                

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

E mail

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

E mail

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

E mail

 

Company

 

Phone

(           )

Address

 

Supervisor Name

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

Start Date

 

End Date

            

Reason for Leaving

 

May we contact your previous supervisor for a reference?

Yes /No

 

Company

 

Phone

(         )

Address

 

Supervisor

Name

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

Start Date

 

End Date

             

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES/NO

 

Company

 

Phone

(         )

Address

 

Supervisor

Name

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

Start Date

 

End Date

             

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES/NO

 

Name, Date and Address

 

Name, Date and Address

 

Branch

 

From

 

To

 

Rank at Discharge

 

Type of Discharge

 

If other than honorable, explain

 

 

PLEASE READ CAREFULLY BEFORE SIGNING BELOW.

1.       All information provided on this Application for Employment form is complete and accurate to the best of my knowledge.

2.       Applicants employed by Our Redeemer Lutheran Church (MLC) will be expected to understand, respect and support the mission of ORLC and abide by the rules and policies of the Evangelical Lutheran Church in America (ELCA).

3.       ORLC has my permission to investigate, at its discretion, my past employment history, persona references, and any other information contained in this application. 

4.       Misrepresentation of facts in this application will disqualify me from further consideration or, if I am employed by ORLC, may be sufficient cause for dismissal.

5.       Federal laws require that employers hire only individuals who are authorized to be lawfully in the United States. In compliance with such laws, all offers of employment are subject to verification of each applicant’s identity and employment authorization. I understand that it will be necessary for me to submit such documents as are required by law to verify my identification and employment authorization on the first day of employment.

6.       I understand that nothing contained in this form or in the granting of an interview is intended to create a contract between ORLC either for employment or for the providing of any benefits. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon ORLC unless made in writing.