Application


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APPLICATION FOR EMPLOYMENT Jersey Baptist Church (JBC) 13260 Morse Road SW, Pataskala, OH 43062

Position Desired _____________________________________ Date Applied ____________ Work Location________ ¨ Full-Time ¨ Part-Time (Hours desired per week) ______ Personal Information (Include all addresses for the past 10 years) Name _____________________________________________ Social Security No. _______________ FIRST

MIDDLE

LAST

Home Phone (____)____________ Work Phone (____)___________ E-mail ___________________ Current Address ___________________________________________________________________ STREET

CITY

STATE

ZIP CODE

Prior Address (______) ______________________________________________________________ LAST DATE

STREET

CITY

STATE

ZIP CODE

Prior Address (______) ______________________________________________________________ LAST DATE

STREET

CITY

STATE

ZIP CODE

Prior Address (______) ______________________________________________________________ LAST DATE

STREET

CITY

Have you ever been convicted of a crime?

STATE

ZIP CODE

¨Yes ¨No If yes, attach an explanation

Education and Training Name/Location

No. Years Completed

Honors Received, Diploma/Degree

Course of Study

Secondary School Military Service Trade, Technical, College/University Graduate or Professional

Employment (Do not substitute a resume for this section. Please attach a resume.) Present Employer _____________________________________ Phone Number (____)___________ Address___________________________________________________________________________ STREET

CITY

STATE

ZIP CODE

Position(s) held_____________________________________________________________________ Employment dates: Begin ____________ End ____________ Pay: Begin $ _______ End $_________ Supervisor/Manager__________________________________________ May We Contact?

¨Yes ¨No

Reason for Leaving__________________________________________________________________ Description of Primary Duties__________________________________________________________ Previous Employer _____________________________________ Phone Number (____)___________ Address___________________________________________________________________________ STREET

CITY

STATE

ZIP CODE

Position(s) held_____________________________________________________________________ Employment dates: Begin ____________ End ____________ Pay: Begin $ _______ End $_________ Supervisor/Manager__________________________________________ May We Contact?

¨Yes ¨No

Reason for Leaving__________________________________________________________________ Description of Primary Duties__________________________________________________________

It is Jersey Baptist Church’s policy to recruit, hire, promote, compensate, train and extend other privileges of employment without regard to age, race, color, gender, nationality, or ancestry.

REFERENCES (Prefer at least one reference from a JBC staff member or lay leader) Name & Address ____________________________________________________________________ Relationship _______________________________________________________________________ Length of Time Known __________ Home Phone (____)__________Work Phone (____)___________ Name & Address ____________________________________________________________________ Relationship _______________________________________________________________________ Length of Time Known __________ Home Phone (____)__________Work Phone (____)___________ Name & Address ____________________________________________________________________ Relationship _______________________________________________________________________ Length of Time Known __________ Home Phone (____)__________Work Phone (____)___________

CHRISTIAN BACKGROUND Briefly describe your walk with God and your growth as a disciple of Jesus:

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Are you a member of JBC?

¨Yes ¨No If yes, when did you join? ____________________________

Do you regularly worship at JBC?

¨Yes ¨No If yes, since when? ____________________________

If you attend another church, which one? ________________________________________________ Describe your current ministry and service involvement _____________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ AGREEMENT I attest that the information provided by me in this Application for Employment is true, correct and complete to the best of my knowledge. If any information is discovered to be incomplete, false, or misleading, I understand that my application for employment will be disqualified from further consideration, or that if I am already employed, the discovery of any misstatement or omission of fact on this application or other employment records shall be grounds for discipline, up to and including termination. I understand that information regarding my background, including a check of criminal records and prior employment, may be conducted in connection with considering my application. I hereby release Jersey Baptist Church (JBC) and any person or entity providing requested information from any and all claims arising from information discovered in the scope of a background check. I understand that I may be required to submit to a pre-employment drug/alcohol screen, and that I may be disqualified from further consideration in the application process if the screen is positive for the presence of alcohol or illicit substances. I also understand and agree that, if hired, my employment is at will, which means that I may terminate my employment at any time for any or no reason at all, and that JBC may terminate my employment at any time for any or no reason. I further understand and agree that no representative of JBC 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, unless it is in writing and signed by the Senior Pastor of JBC or his/her designated representative.

Signature _____________________________________________________ Date _______________

It is Jersey Baptist Church’s policy to recruit, hire, promote, compensate, train and extend other privileges of employment without regard to age, race, color, gender, nationality, or ancestry.