Fillable Printable Employment Application Form

Employment Application Form

Date:

Last name: First name: Middle Name:

Mailing address:

City: State: Zip:

Telephone # (work): (home): (mobile):

Email Address:

May we call you at your current employment? Yes □ No □

EmploymEnt ApplicAtion

The Archdiocese is committed to providing equal employment opportunities for all persons without discrimination based on race,

color, sex, national origin, age, disabilities, veteran status, or on-the-job injuries. As a religious organization, however, the Archdiocese

is not subject to various anti-discrimination laws based on religion or religious belief and may make hiring and other employment

decisions based on religious belief or practice.

GEnErAl informAtion

Position applied for:

Available to work: Full-time □ Part-time □ Temporary □

Do you have a legal right to work in the US?.......................................................................................Yes □ No □

Are you at least 18 years of age?............................................................................................................Yes □ No □

Religious affiliation:

Have you ever worked or volunteered for the Catholic Church or a similar organization?................Yes □ No □

If yes, where?

How did you learn about us? Advertisement □ Friend □ Walk-in □ Relative □ Other □

Employment Application 1/14

EducAtion

Name & Address of School Major Years Completed Degree(s)

High School

College

Other (Specify)

1. Please summarize any skills, training, licenses, and/or certicates that may qualify you as being able to perform job-related func-

tions in the position you are applying for:

2. Why do you want to be considered for employment here?

3. Please list any job-related professional trade, business, civic activities, organization, and/or associations. (You may choose to omit

those that indicate race, color, national origin, ancestry, or disability, etc.)

4. Are you able to perform all the essential functions of the job you are applying for with or without reasonable accommodation?

Yes □ No □ If no, please explain:

5. Have you ever been convicted of a crime? ........................................................................................................Yes □ No □

(A conviction is not an automatic bar to employment. Each case will be considered on its own merits)

6. Are you currently charged with a crime and awaiting trial? .............................................................................Yes □ No □

7. Does the position you are applying for involve working with or around children? ....................................Yes □ No □

8. If yes, have you ever been the subject of allegations related to misconduct with children?.......................Yes □ No □

If yes, please explain:

Employment Application 1/14

EmploymEnt History

Please list your present and past work experience for the last 10 years beginning with your current job. We will contact your current/

most recent employer only after an offer has been extended unless you indicated below that we may contact them now. You may

includevolunteer activities/positions. Attach an additional page if necessary. Please complete this section even if you have submitted

a resume.

Name of employer:

Telephone #:

Address:

Employment Dates:

Rate of Pay:

Position: Supervisor:

Description of duties: Ok to contact? Yes □ No □

Reason for

leaving:

(From) (To)

(Start) (Final)

Name of employer:

Telephone #:

Address:

Employment Dates:

Rate of Pay:

Position: Supervisor:

Description of duties: Reason for

leaving:

(From) (To)

(Start) (Final)

Name of employer:

Telephone #:

Address:

Employment Dates:

Rate of Pay:

Position: Supervisor:

Description of duties: Reason for

leaving:

(From) (To)

(Start) (Final)

Have you ever been suspended, or asked to resign a position? Yes □ No □

Is there anything else you would like to tell us about yourself that would help qualify you for this job?

Current EmployerPrevious EmployerPrevious Employer

Employment Application 1/14

cErtificAtion And AutHorizAtion

InformatIon release

I certify that the information in this application is true and correct to the best of my knowledge, and I agree to allow the

Employer to verify any of this information, unless I indicate in writing to the contrary. I authorize the references and other persons listed

on this application, as well as other persons contacted, to verify this and other information I supply in connection with this application, to

provide any and all information concerning my previous employment, and/or to supply any other pertinent details they may have. I also

release and discharge to the extent permitted by law the Archdiocese, its employees, any individual or agency obtaining information for

the Archdiocese, my personal and professional references, and my former employers, from any and all claims, damages, losses, liabilities,

costs, and other expenses from disclosing information in connection with this application. I understand that any misrepresentation,

falsication, or substantial omission on this application may result in my failure to receive an offer or, if I am hired, my dismissal from

employment.

Applicant Date

at-WIll employment statement

I understand that, if I am hired, in the absence of a written employee agreement that states otherwise, I may terminate my

employment with the Archdiocese at any time, for any reason. The Archdiocese may do the same. This application does not constitute

an agreement or contract for employment for any specied period or denite duration.

Applicant Date

Background check statement

I understand that all offers of employment are contingent upon providing satisfactory proof of my identity and legal authority

to work in the United States and successful completion of a criminal background check. A background check may include my driving

records, court records (civil and criminal), educational and professional credentials, and personal and professional references. This

information, which may come from public or private sources, may contain details on my character, experience, work habits, and/or

reasons for termination from past employers.

Applicant Date

profEssionAl rEfErEncEs

Please provide the names of at least 3 people who have known you in a professional capacity for at least 5 years (other than family

members):

Name/Job Title Organization Telephone # Years

Known