EMPLOYMENT APPLICATION

(PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE)

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is Mountain View Lutheran Church’s policy to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, age, marital status, national origin, citizenship, sexual orientation, disability, veteran status, or any other status protected under state and federal law. Please let us know if you need any special accommodation[s] to participate in the application process.

Once Mountain View Lutheran Church has offered you a conditional offer of employment, you may – depending on your job duties - be subject to successful completion of a drug and/or alcohol test. You must also have (a) a valid driver’s license; (b) an acceptable driving record; and (c) reliable transportation to and from work.

PERSONAL INFORMATION

Name Last First Middle Last Name First Name Middle Init.	Social Security # Social Security Number
Home Phone Home Phone	Work Phone Work/Cell Phone
Please list below your current address and your two other most recent addresses:
Current: Street City State Zip Since (Mo/Yr) Street City State Zip Code Mo./Yr.
Previous: Street City State Zip Since (Mo/Yr) Street City State Zip Code Mo./Yr.
Previous: Street City State Zip Since (Mo/Yr) Street City State Zip Code Mo./Yr.
EMERGENCY CONTACT NAME Contact Name	EMERGENCY PHONE Contact Phone

EDUCATION RECORD

High School Attended Click here to enter text.	City, County & State Click here to enter text.	Did you earn a Diploma: Yes ☐ No ☐
Undergraduate College Attended Click here to enter text.	City, State City State	Areas of Study Click here to enter text.	Degree/Certificate/Diploma Click here to enter text.
Undergraduate College Attended Click here to enter text.	City, State City State	Areas of Study Click here to enter text.	Degree/Certificate/Diploma Click here to enter text.

EMPLOYMENT INFORMATION

Position Applied For: Click here to enter text.	Date You Can Start Work: Click here to enter text.	Desired Salary: $Click here to enter text.
Do you Prefer: Full-Time ☐ Part-Time ☐	Can You Work: Weekends Evenings ☐ ☐
Please answer all of the following questions. When necessary, note question number and use an extra piece of paper to provide explanations:
1) Are you at least 18 years of age and legally eligible for work in the United States? YES ☐ NO ☐
2) Will you work overtime when necessary? YES ☐ NO ☐
3) Have you received a job description or aware of the essential functions of the job you are applying for: YES ☐ NO ☐
4) Do you understand the job requirements? YES ☐ NO ☐ (If no, please explain)
5) Are you currently bound by a non-competition, non-solicitation, confidentiality or trade secret agreement? YES ☐ NO ☐ (If yes, please explain)
6) Have you ever been discharged or asked to resign from a job? YES ☐ NO ☐ (If yes, please explain)
7) Have you ever been warned, disciplined, or discharged for sexual harassment, fighting, assault, or related offenses? YES ☐ NO ☐ (If yes, please explain)
8) Have you been convicted of any criminal offense by this state or any other jurisdiction in the last 10 years? Conviction will not necessary disqualify an applicant from employment. YES ☐ NO ☐ (If yes, please explain) Click here to enter text. NOTE: Answering “Yes” to this question is not an automatic bar to employment. Factors to be considered include the nature and gravity of the offense or conduct, the time that has passed since the offense or conduct and/or completion of the sentence, and the nature of the job held or sought.

EMPLOYMENT HISTORY

MAY WE CONTACT YOUR PRESENT EMPLOYER? YES ☐ NO ☐
Please list below your last three employers beginning with the most recent:
Most Recent Employer Click here to enter text.	City City	State State	Zip Code Zip Code	Phone Phone
Position Held Dates From/To Position Dates	Supervisor Click here to enter text.
Duties: Click here to enter text. Reason For Leaving: Click here to enter text.
Next Most Recent Employer Position Dates	City City	State State	Zip Code Zip Code	Phone Phone
Position Held Dates From/To Position Dates	Supervisor Click here to enter text.
Duties: Click here to enter text. Reason For Leaving: Click here to enter text.
Next Most Recent Employer Click here to enter text.	City City	State State	Zip Code Zip Code	Phone Phone
Position Held Dates From/To Position Dates	Supervisor Click here to enter text.
Duties: Click here to enter text. Reason For Leaving: Click here to enter text.
Next Most Recent Employer Click here to enter text.	City City	State State	Zip Code Zip Code	Phone Phone
Position Held Dates From/To Click here to enter text.	Supervisor Click here to enter text.
Duties: Click here to enter text. Reason For Leaving: Click here to enter text.

PERSONAL REFERENCES

List names & telephone numbers of references who are not related to you, e.g., co-workers, business associates, former supervisors

Name: Click here to enter text. Phone: Click here to enter text. Address: Click here to enter text. Occupation: Click here to enter text. How Long Known: Click here to enter text.
Name: Click here to enter text. Phone: Click here to enter text. Address: Click here to enter text. Occupation: Click here to enter text. How Long Known: Click here to enter text.
Name: Click here to enter text. Phone: Click here to enter text. Address: Click here to enter text. Occupation: Click here to enter text. How Long Known: Click here to enter text.
May we contact your references? Yes ☐ No ☐

JOB-RELATED SKILLS

Please use this space to list any special skills you may have that relate to the position applied for:
Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Including date granted, name of organization, and any other relevant information. 1. Click here to enter text. 2. Click here to enter text. 3. Click here to enter text.

APPLICANT’S CERTIFICATION AGREEMENT

1. I authorize Mountain View Lutheran Church to solicit information regarding my character, criminal background, general reputation, credit history, previous employment and similar background information, and to contact any and all references and previous employers I have given. I hereby release all parties and persons connected with any such request for information from claims, liabilities, and damages for any reason arising out of the furnishing of such information, including but not limited to defamation, invasion of privacy or similar causes of action. If employed by Mountain View Lutheran Church, I release Mountain View Lutheran Church from any liability for future references it may provide regarding my work history at Mountain View Lutheran Church. If I am refused employment on the basis of a background report, I have a right, upon written request from me within a reasonable time, to a complete and accurate disclosure of the nature and scope of the investigations requested by Mountain View Lutheran Church. 2. I agree, if I am offered and accept a position, to conform to all existing and future Company policies, rules and regulations and I understand that Mountain View Lutheran Church reserves the right to change wages, hours and working conditions within Mountain View Lutheran Church’s sole discretion. I ALSO UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY OR NO REASON, WITH OR WITHOUT NOTICE. I also understand that no official of Mountain View Lutheran Church other than the Senior Pastor has any authority to enter into an agreement for a specified period of time or make any agreement contrary to the foregoing. 3. I further understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986, as amended. 4. If employed, I agree that if Mountain View Lutheran Church advances any paid leave before it has been accrued, or advances or loans me any money during the course of my employment, Mountain View Lutheran Church is authorized to deduct from my wages sufficient funds to repay such loans or advances. 5. I further certify that I am not engaged in any outside activity or business that could be considered in conflict with the interest of Mountain View Lutheran Church or its members. I will not become engaged in such activity or business during my employment if Mountain View Lutheran Church employs me. 6. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation or omission of facts on this application (or on any required documents) may result in denial of employment or immediate termination of employment, regardless of when or how discovered. 7. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully. Signature Date

Human Resource Use Only:

Date of Interview:	______________________________

Date of Offer:	______________________________

Start Date:	______________________________

Department:	______________________________

Wage Rate:	______________________________