Application for Employment

Adventure Christian Church of North Natomas
1500 N. Market Blvd. Sacramento, CA 95834

Please answer all questions completely. We are an Equal Opportunity Employer. No question on this application is intended to be discriminatory under any applicable Federal, State, or Local Fair Employment Practices Las. All employment offers are contingent upon proof of your legal right to work in the U.S.

Personal Information

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email Address

Are you able to provide proof of your eligibility to work in the USA?

Yes

No

If under the age 18, do you have a work permit?

Have you ever worked under a different name?

Yes

No

If Yes, what name did you work under?

Have you ever been convicted of a felony?

Yes

No

If yes, list offense, date, and disposition case: (Convictions will not necessarily disqualify you for employment)

Employment Interest

Position Desired

Date Available

Salary Desired

Would you be willing to work overtime?

Yes

No

If hired, would you have reliable transportation to and from work?

Yes

No

If required for the position, do you have a valid driver's license?

Yes

No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

Yes

No

If No, describe the functions that cannot be performed:

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination and to skill and agility tests.)

Education Information

High School

Did you Graduate (High School)?

Yes

No

Name of High School

Address of High School (City and State)

Course of Study (High School)

Year(s) Completed (High School)

1

2

3

4

Grade Average (High School)

Business/Technical School

Did you Graduate (Business/Technical School)?

Yes

No

Name of Business/Technical School

Address of Business/ Technical School (City and State)

Course of Study (Business/Technical School)

Year(s) Completed (Business/Technical School)

1

2

3

4

Grade Average (Business/Technical School)

College

Did you Graduate (College)?

Yes

No

Name of College

Address of College (City and State)

Course of Study (College)

Year(s) Completed (College)

Grade Average (College)

Graduate Work

Did you Graduate (Graduate Work)?

Yes

No

Name of Graduate College

Address of Graduate College (City and State)

Course of Study (Graduate Work)

Year(s) Completed (Graduate Work)

Grade Average (Graduate Work)

List any specialized training or courses you have completed which will aid in evaluating your qualifications for the position you are seeking. If applying for a teaching position, list all additional courses of study or training earned in early childhood education, child development, and elementary education with the dates completed.

Additional Skills & Training Information

Employment History

Up to 3 Employers

Employer #1 Name (First & Last)

Phone Number (Employer #1)

Employer #1 Address (State/City/Zipcode included)

Date Started (Employer #1)

Date Ended (Employer #1)

Job Title (Employer #1)

Starting Pay (Employer #1)

Ending Pay (Employer #1)

Duties (Employer #1)

Reason for Leaving (Employer #1)

Supervisor Name & Title (Employer #1)

May we contact this employer (Employer #1)

Yes

No

Employer #2

Employer #2 Name (First & Last)

Phone Number (Employer #2)

Employer #2 Address (State/City/Zipcode included)

Date Started (Employer #2)

Date Ended (Employer #2)

Job Title (Employer #2)

Starting Pay (Employer #2)

Ending Pay (Employer #2)

Duties (Employer #2)

Reason for Leaving (Employer #2)

Supervisor Name & Title (Employer #2)

May we contact this employer (Employer #2)

Yes

No

Employer #3

Employer #3 Name (First & Last)

Phone Number (Employer #3)

Employer #3 Address (State/City/Zipcode included)

Date Started (Employer #3)

Date Ended (Employer #3)

Job Title (Employer #3)

Starting Pay (Employer #3)

Ending Pay (Employer #3)

Duties (Employer #3)

Reason for Leaving (Employer #3)

Supervisor Name & Title (Employer #3)

May we contact this employer (Employer #3)

Yes

No

Professional / Personal References

Please Provide 3

Reference #1

Name (Reference #1)

Phone Number (Reference #1)

Reference #1 Address (State/City/Zip included)

Relationship to You (Reference #1)

Years Known (Reference #1)

Reference #2

Name (Reference #2)

Phone Number (Reference #2)

Reference #2 Address (State/City/Zip included)

Relationship to You (Reference #2)

Years Known (Reference #2)

Reference #3

Name (Reference #3)

Phone Number (Reference #3)

Reference #3 Address (State/City/Zip included)

Relationship to You (Reference #3)

Years Known (Reference #3)

Previous Addresses

Please Provide Up to 3 Most Recent Previous Addresses

Address #1

Previous Address #1 (City/State/Zip included)

Date Moved In (Address #1)

Date Moved Out (Address #1)

Address #2

Previous Address #2 (City/State/Zip included)

Date Moved In (Address #2)

Date Moved Out (Address #2)

Address #3

Previous Address #3 (City/State/Zip included)

Date Moved In (Address #3)

Date Moved Out (Address #3)

Applicant's Certification and Agreement

I understand that Adventure Christian Church of North Natomas does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, sex, age or disability.

I hereby certify that the facts set forth in this initial application are true and complete to the best of my knowledge. I understand that discovery of falsification of any statement or a significant omission of fact may prevent me from being hired, or if hired, may subject me to immediate dismissal regardless of the time elapsed before discovery. If I am released under these circumstances, I further understand that I will be paid, and receive benefits, only through the day of release.

I authorize any person, school, current employer (except as expressly noted), past employer(s), and organizations named in this application form (and accompanying resume or other documentation, if any) to provide Adventure Christian Church of North Natomas with relevant information and opinion,
personal or otherwise, that may be useful in making a hiring decision. I release all parties from all liability for any damage that may result from furnishing information and opinions to you. I further authorize those given as references and my former employers to disclose to Adventure Christian Church of North Natomas any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. I waive the right to ever personally view any reference given to Adventure Christian Church of North Natomas.

I understand that this is only an employment application and that no employment contract is being offered at this time. I understand that all offers of employment are contingent upon my providing satisfactory documentary proof of my identity and legal right to live and work in the United States.

I hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this application.

Signature #1 of Applicant

Date Signed #1

Authorization to Release Reference Information

I have applied for a position with Adventure Christian Church of North Natomas. I have authorized them to thoroughly investigate references, work records, evaluations, and other matters related to my suitability for employment.

I authorize Adventure Christian Church of North Natomas to conduct a criminal records check. If the position I am applying for involves working with children, I understand that I must submit to a fingerprint check by the FBI and possibly other federal and state authorities. I agree to cooperate fully in providing and recording as many sets of my fingerprints as are necessary for such an investigation.

I authorize references and my former employers to disclose to Adventure Christian Church of North Natomas any and all employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure.

In addition, I hereby release Adventure Christian Church of North Natomas, my former employers, references, and all other parties from any claims, demands, or liabilities arising out of, or in any way related to such investigation or disclosure.

I hereby acknowledge that I have read the above statements and understand them.

Applicant's Name:

Applicant's Social Security Number

Signature #2 of Applicant

Date Signed #2