Application For Employment

The Church Council of Greater Seattle considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

(PLEASE PRINT)

Position (s) Applied For

Date of Application

How Did You Learn About Us?
q Newspaper (specify) ______________________	q Bulletin Board (Specify) ______________________	q Web-site (specify) ______________________
q Friend/Relative	q Walk-In	q Other (Specify) ___________________

Last Name		First Name		Middle Name
Address	Number	Street	City	State	Zip Code
Telephone Number				Social Security Number

Education

	Name and Address of School	Course of Study	Years Completed	Diploma Degree
High School
Undergraduate College
Graduate Professional
Other (Specify)

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

1.	Employer		Dates Employed			Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly/Rate/Salary
			Starting		Final
	Job Title	Supervisor
	Reason for Leaving
2.	Employer		Dates Employed			Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly/Rate/Salary
			Starting		Final
	Job Title	Supervisor
	Reason for Leaving
3.	Employer		Dates Employed			Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly/Rate/Salary
			Starting		Final
	Job Title	Supervisor
	Reason for Leaving
4.	Employer		Dates Employed			Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly/Rate/Salary
			Starting		Final
	Job Title	Supervisor
	Reason for Leaving

If you need additional space, please continue on a separate sheet of paper.

May the above employers be contacted for employment information / references?

q Yes q No

If neither box is checked, permission to contact will be assumed.

List professional, trade business or civic activities and offices held.

You may exclude membership which would reveal gender, religion, national origin, age ancestry, disability or other protected status:

Additional Information

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills Check Skills/Equipment Operated

___FAX	___Multiline Phoning	Other (list):
___PC	___Excel
___Calculator	___Word
___Typing Speed	___Desktop Publishing

State any additional information you feel may be helpful to us in considering your Application.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable	q YES
Accommodation, the activities involved in the job or occupation for which you have	q NO
Applied?

References (Former or current employers):

1.		( )
	(Name)	Phone #
	(Address)
2.		( )
	(Name)	Phone #
	(Address)
3.		( )
	(Name)	Phone #
	(Address)

Applicant’s Statement

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I authorize contact of all current and previous employers for the purpose of obtaining employment information / references.

I understand that a criminal history check will be conducted and that my employment may be contingent on the results.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

____________________________________ ____________

Signature of Applicant Date