Sample Application Form for Church Personnel


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NameSample Application Form for Church Personnel
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Sample Application Form for Church Personnel

Instructions: This form is to be completed by all applicants for any position who will regularly

be responsible for the supervision of children or youth. This form is being used to help

__________________ [parish] provide a safe and secure environment for those children and

youth who participate in our programs and use our facilities. At the same time, we feel a need to

protect our workers as well as the church itself.

Today’s Date ______________________________

Name ___________________________________________ Date of Birth _________________

Mailing Address _______________________________________________________________

City ___________________________________________ State _______ Zip ______________

Physical Address ______________________________________________________________

City ___________________________________________ State _______ Zip ______________

How long at current address _____________________________________________________

Home phone _____________________________ Work phone __________________________

Cell phone _______________________________ E-mail ______________________________

Best time to contact you ________________________________________________________

Driver’s License number ________________

Name on Driver’s License ______________________________ State of Issue _____________

Are you legally eligible to work in this country? _______________________________________

Note: If you are chosen for a paid position, you will be required to show documents verifying

your employment eligibility and identity to complete the INS Form I-9 as required by the

Immigration Reform and Control Act.

Please list your address for the past seven years. (Continue on reverse of necessary)

For what position are you applying?

What interests you about the position for which you are currently applying?

What has prepared you for the position for which you are currently applying?

22

Employment History - Please complete for your current and prior employers, covering the past

ten years, beginning with your current employer. (Continue on reverse of necessary)

Company Name _______________________________________________________________

Address _____________________________________________________________________

City ____________________________________________ State _______ Zip _____________

Phone number ___________________________________

Immediate supervisor’s name ____________________________________________________

Immediate supervisor’s phone number _____________________________________________

Position held _________________________________________________________________

Dates of employment - from _________________________ to __________________________

Reason(s) for leaving position ____________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Company Name _______________________________________________________________

Address _____________________________________________________________________

City ____________________________________________ State _______ Zip _____________

Phone number ___________________________________

Immediate supervisor’s name ____________________________________________________

Immediate supervisor’s phone number _____________________________________________

Position held _________________________________________________________________

Dates of employment - from _________________________ to __________________________

Reason(s) for leaving position ____________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Company Name _______________________________________________________________

Address _____________________________________________________________________

City ____________________________________________ State _______ Zip _____________

Phone number ___________________________________

Immediate supervisor’s name ____________________________________________________

Immediate supervisor’s phone number _____________________________________________

Position held _________________________________________________________________

Dates of employment - from _________________________ to __________________________

Reason(s) for leaving position ____________________________________________________

____________________________________________________________________________

____________________________________________________________________________

23

Volunteer Experience - Please include all experience working with children or youth.

Organization _________________________________________________________________

Contact person __________________________________ Phone _______________________

Duties ______________________________________________________________________

Dates - from _______________________________to ________________________________

Organization _________________________________________________________________

Contact person __________________________________ Phone _______________________

Duties ______________________________________________________________________

Dates - from _______________________________to ________________________________

Organization _________________________________________________________________

Contact person __________________________________ Phone _______________________

Duties ______________________________________________________________________

Dates - from _______________________________to ________________________________

Organization _________________________________________________________________

Contact person __________________________________ Phone _______________________

Duties ______________________________________________________________________

Dates - from _______________________________to ________________________________

Education

Name of School ________________________________ Dates _________________________

Address _____________________________________________________________________

City __________________________________________ State ________ Zip _____________

Type of School _________________________________ Program completed?_____________

Name of Program or Degree _____________________________________________________

Name of School ________________________________ Dates _________________________

Address _____________________________________________________________________

City __________________________________________ State ________ Zip _____________

Type of School _________________________________ Program completed?_____________

Name of Program or Degree _____________________________________________________

Name of School ________________________________ Dates _________________________

Address _____________________________________________________________________

City __________________________________________ State ________ Zip _____________

Type of School _________________________________ Program completed?_____________

Name of Program or Degree _____________________________________________________

24

Professional/Civic References - Particularly those who have observed you working with

children or youth

Name ______________________________________________________________________

Address ____________________________________________________________________

City __________________________________________ State _________ Zip ____________

Phone number _________________________ How long have you known this person _______

Relationship to you ____________________________________________________________

Name ______________________________________________________________________

Address ____________________________________________________________________

City __________________________________________ State _________ Zip ____________

Phone number _________________________ How long have you known this person _______

Relationship to you ____________________________________________________________

Personal References

Name ______________________________________________________________________

Address ____________________________________________________________________

City __________________________________________ State _________ Zip ____________

Phone number _________________________ How long have you known this person _______

Relationship to you ____________________________________________________________

Name ______________________________________________________________________

Address ____________________________________________________________________

City __________________________________________ State _________ Zip ____________

Phone number _________________________ How long have you known this person _______

Relationship to you ____________________________________________________________

Family References

Name ______________________________________________________________________

Address ____________________________________________________________________

City __________________________________________ State _________ Zip ____________

Phone number _________________________ How long have you known this person _______

Relationship to you ____________________________________________________________

Name ______________________________________________________________________

Address ____________________________________________________________________

City __________________________________________ State _________ Zip ____________

Phone number _________________________ How long have you known this person _______

Relationship to you ____________________________________________________________

25

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