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