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Online Employment Application

Saint James Lutheran Church and School Online Employment Application:

Beacuse we are a church body St. James retains the right to give preference in hiring to persons who are member in good standing of a Lutheran Church -- Missouri Synod congregation.

You must complete all fields marked with a red astericks.

You may save this application and return to it later by scrolling to the bottom and providing your email and clicking "save and return later".

Personal Data:

Name

1. First Name*

2. Middle Name*

3. Last Name*

Phone Number

4. Primary Phone Number*

5. Alternate Phone Number

Present Address

6. Street Address*

7. City*

8. State*

9. Zip Code*

Previous Address

10. Street Address*

11. City*

12. State*

13. Zip Code*

14. Are You 18 years or older?* Yes No

Work Preference:

15. Position You Are Applying For (select one)*

16. Referred By

17. Interested in* Full Time Part-Time Summer

18. Date available for work*

St. James Lutheran Church Information:

19. Have you been employed by St. James previously?* Yes No

20. If yes, when:

21. Have you previously applied to St. James?* Yes No

22. If yes, give date:

23. Do you have relatives employed by St. James?* Yes No

24. If yes, relatives name:

Other:

25. Are you a citizen of the United States or do you have a valid authorization to work in the United States?* Yes No

26. Have you ever been convicted, plead guilty or plead "no contest" in any crime, other than traffic violations in the past?* Yes No

27. If yes, please explain (if no type NA)*

28. Have you ever been discharged or asked to resign by a previous employer?* Yes No

29. If yes, please explain (if No type NA)*

Personal References:

Reference 1:

30. Reference First Name*

31. Reference Last Name*

32. Reference Phone Number*

33. Reference Business/Profession*

34. Reference Length of Acquaintance*

Reference 2:

35. Reference First Name*

36. Reference Last Name*

37. Reference Phone Number*

38. Reference Business/Profession*

39. Reference Length of Acquaintance*

Reference 3:

40. Reference First Name*

41. Reference Last Name*

42. Reference Phone Number*

43. Reference Business/Profession*

44. Reference Length of Acquaintance*

Reference 4:

45. Reference First Name*

46. Reference Last Name*

47. Reference Phone Number*

48. Reference Business/Profession*

49. Reference Length of Acquaintance*

Employment History:

List your complete employment record including temporary, regular and part-time in date order with most recent first. List military service, if applicable, as part of employment record. Please answer "NA" to any not applicable fields.

Most Recent Employer:

50. Are you currently working for this employer?* Yes No

51. If yes, may we contact this employer? Yes No

52. Company Name*

53. Company Phone Number*

Company Address:

54. Street Address*

55. City*

56. State*

57. Zip Code*

58. Starting Position Title:*

59. Ending Position Title:*

60. Supervisors Name:*

61. Supervisors Title:*

Dates of Employment:

62. Start Date:*

63. End Date (if current state current):*

64. Beginning Salary:*

65. Ending Salary:*

66. Full-Time or Part-Time* Full-Time Part-Time

67. Brief Job Description:*

68. If you were employed under a different name, give that name in full.*

Next Most Recent Employer:

69. Are you currently working for this employer?* Yes No

70. If yes may we contact this employer? Yes No

71. Company Name*

72. Company Phone Number*

Company Address:

73. Street Address*

74. City*

75. State*

76. Zip Code*

77. Starting Position Title:*

78. Ending Position Title:*

79. Supervisors Name:*

80. Supervisors Title:*

Dates of Employment:

81. Start Date:*

82. End Date (if current state current):*

83. Beginning Salary:*

84. Ending Salary:*

85. Full-Time or Part-Time* Full-Time Part-Time

86. Brief Job Description:*

87. If you were employed under a different name, give that name in full.*

Next Most Recent Employer:

88. Are you currently working for this employer?* Yes No

89. If yes may we contact this employer? Yes No

90. Company Name*

91. Company Phone Number*

Company Address:

92. Street Address*

93. City*

94. State*

95. Zip Code*

96. Starting Position Title:*

97. Ending Position Title:*

98. Supervisors Name:*

99. Supervisors Title:*

Dates of Employment:

100. Start Date:*

101. End Date (if current state current):*

102. Beginning Salary:*

103. Ending Salary:*

104. Full-Time or Part-Time* Full-Time Part-Time

105. Brief Job Description:*

106. If you were employed under a different name, give that name in full:*

Unemployment:

Account for all periods of two weeks or more for which you have been without work in the last five years. If not applicable please enter "NA" to the following questions:

Please enter from and to unemployed:

107. Start Date Unemployed:*

108. End Date Unemployed:*

109. Brief reason for unemployment:*

110. Start Date Unemployed:*

111. End Date Unemployed:*

112. Brief reason for unemployment:*

Education:

Please fill out education information completly. If not appicable please enter "NA":

113. High School Name:*

114. High School Address*

115. Graduate:* Yes No

116. If yes, graduation date:*

117. Grade Point Average:*

118. Business/Trade School Name:*

119. Business/Trade School Address*

120. Graduate:* Yes No

121. If yes, graduation date:*

122. Grade Point Average:*

123. Degree/Major*

124. College/University Name:*

125. College/University Address*

126. Graduate:* Yes No

127. If yes, graduation date:*

128. Grade Point Average:*

129. Degree/Major*

130. Graduate Degree College/University Name:*

131. Graduate College/University Address:*

132. Graduate:* Yes No

133. If yes, graduation date:*

134. Grade Point Average:*

135. Graduate Degree Earned*

Authorization and Release:

In connection with my application for employment, I understand that an investigative consumer report may be re-quested that will include information as to my character, work habits, performance and experience, along with reasons for termination of past employment. I understand that, as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: workers’ compensation injuries, driving record, criminal record, education, credentials, credit and references. I voluntarily and knowingly authorize the company, and/or its agents, to verify any aspect of the information contained in my employment application or through public or private sources. I further understand that misrepresentations or omissions in my employment application may be cause for rejection or subsequent dismissal if I am hired.

Medical and workers’ compensation will only be requested in compliance with the Federal Americans with Disabilities Act (ADA). According to the Fair Credit Reporting Act (FCRA), I am entitled to know if employment is denied because of information obtained by my prospective employer by a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information.

I voluntarily and knowingly authorize any former employer, person, firm, corporation, school or government agency, its officers, employees and agents to release to you or your agents any and all information concerning my former employment. I understand that the employment information may include, but is not necessarily limited to, performance evaluation and reports, job descriptions, disciplinary reports, letters of reprimand and opinions regarding my suitability for employment possessed by it.

I voluntarily and knowingly fully release and discharge, absolve, indemnify and hold harmless you, your agents and any former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney’s fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to you, your agents, or consumer reporting agency.

I hereby authorize you to procure a consumer report as part of the pre-employment background investigation. If hired, this authorization shall remain on file and shall serve as an ongoing authorization for you to procure consumer reports at any time during my employment period.

Signature Date

136. Electronically Sign By Typing Your Full Name Here:*

137. Today's Date:*

The following information is required by law-enforcement agencies and other entities for positive identification process when checking public records. It is confidential and will not be used by any other purposes.

Full Legal Name:

138. First Name:*

139. Middle Name:*

140. Last Name:*

141. Other names used (include maiden name, aliases and nicknames):*

Current Address:

142. Street Address:*

143. City:*

144. State:*

145. Zip Code:*

146. Telephone Number:*

147. Social Security Number:*

148. Date of Birth:*

149. Driver's License or State ID Number:*

150. Type (choose one):*

151. State Issued In:*

Acknowledgement of Understanding Consent:

This organization does not discriminate in hiring or employment on the basis of race, color, national origin, sex, age or disability. Because we are a church body, St. James Lutheran Church retains the right to give preference in hiring to persons who are members in good standing of an LCMS congregation.

It is understood that this application is not an obligation to provide employment. The application will be kept active for three months and it must be renewed to be active for a longer period.

I hereby certify that the statements made in this employment application are true and complete, to the best of my knowledge, and I authorize investigation of those statements. I understand that falsification, misrepresentation or omission of facts will be sufficient cause for elimination of any consideration for employment or cause for dismissal from St. James, if I have been employed.

St. James has the right, exercisable at any time, and without notice, to change wages, to change or eliminate benefits and policies, as well as to terminate, with or without cause, the employment relationship. I understand that no manager or representative of St. James Lutheran Church, other than the Human Resources Committee has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.

I understand that all employees of St. James Lutheran Church are expected to respect the official doctrines of the Lutheran Church--Missouri Synod and to pursue lifestyles that are morally in harmony with its teachings.

I agree that I have read and understand the above acknowledgments and agreements and recognize all of the above as conditions of employment.

Signature Date

152. Electronically Sign By Typing Your Full Name Here:*

153. Today's Date:*

* Enter Your Email Address:

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