APPLICATION FOR EMPLOYMENT

CENTRAL LUTHERAN CHURCH

PERSONAL (Please print or type)						Date _____________

Name ________________________________________	Social Security # _______________
	Last			First			M.I.

Present Address _______________________________________________________________
		           #	Street			City		State		Zip

Telephone: Home _________________________________  Business ____________________

POSITION DESIRED

Please indicate the type of position you are applying for:

_______________________________________
If employed by Central Lutheran Church, indicate the date you will be able to start work: ___________

EDUCATION PREPARATION

Have you received a high school diploma or its equivalent?   _____ Yes _____ No

School Name, Address*	Years Attended	Year of Completion/
Graduation	Credits	Diploma/
Degree	Major	Minor	

							
							
*College, technical/business school, and post-graduate

List other training, licenses, skills or qualifications that you feel would pertain to the position for which you are applying.  Please identify:

APPLICABLE WORK EXPERIENCE
List the most recent first.  Use a separate section to indicate change in job description even though in the same place of work.

Name of work site:

Address: Street				City					State		Zip_________

Position Title:							Nature of work:_____________________________

Dates: From			To			___FT  ___PT (If PT, # hrs/wk): _____________________
Special Assignments/Achievements (List)

_________________________________________________________________________________________
Supervisor Name:				Title:					Telephone_______________

Reason for Leaving:
Name of work site:

Address: Street				City					State		Zip_________

Position Title:							Nature of work:_____________________________

Dates: From			To			___FT  ___PT (If PT, # hrs/wk): _____________________
Special Assignments/Achievements (List)

_________________________________________________________________________________________
Supervisor Name:				Title:					Telephone_______________

Reason for Leaving:
Name of work site:

Address: Street				City					State		Zip_________

Position Title:							Nature of work:_____________________________

Dates: From			To			___FT  ___PT (If PT, # hrs/wk): _____________________
Special Assignments/Achievements (List)

_________________________________________________________________________________________
Supervisor Name:				Title:					Telephone_______________

Reason for Leaving:
Volunteer Experience (church-related and other):

My six top leadership skills (in order of my personal priority) are:

1. ____________________________	2. ______________________________			
My abilities include:					My abilities include:

3. ____________________________	4. ______________________________
My abilities include:					My abilities include:

5. ____________________________		6. ______________________________
My abilities include:					My abilities include:

Significant Events: (Describe how persons and events shaped your approach to parish ministry)

OTHER WORK EXPERIENCE
List the most recent first.  Use a separate section to indicate change in job description even though in the same place of work.

Dates	Name and Address of
Employer	Supervisor's Name, Title,
and Telephone Number	Reason for Leaving	
From	To				

___ Full Time  ___ Part Time (Hours/Week: ___)
Major job duties:

Dates	Name and Address of
Employer	Supervisor's Name, Title,
and Telephone Number	Reason for Leaving	
From	To				

___ Full Time  ___ Part Time (Hours/Week: ___)
Major job duties:

Dates	Name and Address of
Employer	Supervisor's Name, Title,
and Telephone Number	Reason for Leaving	
From	To				

___ Full Time  ___ Part Time (Hours/Week: ___)
Major job duties:

Dates	Name and Address of
Employer	Supervisor's Name, Title,
and Telephone Number	Reason for Leaving	
From	To				

___ Full Time  ___ Part Time (Hours/Week: ___)
Major job duties:

May we contact the employers listed above during the application review process?  ___ Yes  ___No
If no, indicate below which one(s) you do not wish us to contact.

All employers may be contacted during the final stage of the selection process for those applicants seriously considered for the position.

Please use the space below to summarize additional information you feel necessary to fully describe your qualifications.  (Attach resume if you so desire.)  As part of this, please include your core convictions concerning your Christian faith.

PLEASE READ CAREFULLY

Applicant's certification and agreement

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand that a background check will be made prior to hiring for criminal felony convictions or sexual misconduct.

Signature of applicant _________________________________	Date _________________

Thank you for completing this application form and for your interest in employment with us.

Submitted by Central Lutheran Church, Mondovi,  Wisconsin