CALVARY ASSEMBLY OF GOD

APPLICATION FOR EMPLOYMENT

Because Calvary Assembly of God is a Christian organization, employment decisions are made based on religion. Applications are considered without regard to race, color, sex, age, national origin, marital status, handicap, disability or veteran status. The receipt of this application does not mean that job openings exist and does not obligate us in any way. This Application will become inactive after three (3) months. To be considered for employment thereafter, a new application must be submitted. We appreciate your interest in our organization.

PERSONAL INFORMATION

Today's Date: 9/8/2008
Last Name First Name Middle Initial Social Security No. - -
Present Address City State Zip
How long have you lived at the above address? Home or nearest phone - -
Previous address City State Zip
How long did you live there?
Are you over the age of 18? Yes No If no, employment is subject to verification that you are of minimum legal age.
What languages can you read, speak and write fluently?
Are you a eligible to work legally within the United States? Yes No (proof will be required)

EMPLOYMENT INFORMATION

Position applying for Are you able to perform this specific job? Yes No
Shift Preference What income do you expect? Type of employment
What days and hours if part time? Days Hours from to
Have you ever applied for a job with us before? Yes No When? (month and year)
Have you ever been bonded? Yes No
Have you ever been refused bond? Yes No If yes, please state reason and date
Have you ever been convicted of a crime other than a minor traffic violation? Yes No
If yes, please state the crime, date, court and place where offence occurred
Have you ever been involuntarly discharged or requested to resign from a position? Yes No If yes, please explain
Does your present employer know of your plans to change employment? Yes No Why do you desire to make a change?
Have you ever held a position of trust (handling money or confidential material)? Yes No
How much time have you lost from work during the past two years?
Do you have steady transportation to work? Yes No
List any other experiences, skills, or qualifications which you feel would especially fit you for work with this organization

EDUCATION INFORMATION

Schooling Years Completed Degree Received and Major Subject Name of School Location Did you graduate?
Grammar or High School
Trade, Business, or Correspondance
College
Graduate School
Describe any other specialized or professional training (such as business, technical or nursing school). Include study courses given through public or private employment. State whether degree or certificate was received.
Can you submit copies of educational certificates, degrees or awards if requested? Yes No

MILITARY SERVICE RECORD

Were you ever in the U.S. Armed Forces? Yes No If yes, which branch?
Dates of duty: From To
List Duties in the Service including special training:

PRIOR WORK RECORD

(Start with most recent or present employer)

1. Name, Address of most recent Employer Phone
- -
Immediate Supervisor (name & position) Date Hired Starting Rate
Your Job & Duties Date Left Last Rate
Reason for Leaving
2. Name, Address of most recent Employer Phone
- -
Immediate Supervisor (name & position) Date Hired Starting Rate
Your Job & Duties Date Left Last Rate
Reason for Leaving
3. Name, Address of most recent Employer Phone
- -
Immediate Supervisor (name & position) Date Hired Starting Rate
Your Job & Duties Date Left Last Rate
Reason for Leaving

REFERENCES

(Do not list relatives or former employers)

Name Address Phone
- -
Name Address Phone
- -
Name Address Phone
- -

The facts set forth above in my application for employment are true and complete. I understand that if employed, any false statements on this application shall be considered sufficient cause for dismissal. I hereby authorize Calvary Assembly of God to make any investigation of my personal history and background checks through any investigative agencies or bureaus of your choice. In making this application for employment I also understand that an investigative background check may be made whereby information is obtained as to my character, general reputation, personal characteristics and mode of living. I understand that I have a right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative report.

I authorize the use of any information in this application to verify my statements and I authorize all past employers, doctors, all references, and other persons to answer any and all questions concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I agree to be employed on a 90 day probationary period and understand that I may be dismissed at any time during this period at the discretion of the employer.

By initialing here, I acknowledge I have read this document and understand its contents.

Date: 9/8/2008