Employment Application Employment Application Application for Church Secretary Position Date MM slash DD slash YYYY Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone--HomePhone--CellEmail Social Security NumberDate Of BirthDate Available To StartAre You a Citizen of the United States? Yes No Have you ever been convicted of a criminal offense? Yes No If Yes, please describe charges and any dispositionDo you currently have any criminal charges pending against you? Yes No If yes, what are the charges?Is there any physical or mental limitation that would prevent you from performing any type of work, or have you been advised by a physician not to perform certain types of work? Yes No If yes, please explainEducation-High SchoolNameNumber Years AttendedType of DegreeYear of Degree Education-Business, Trade or Vocational SchoolNameNumber Years AttendedType of DegreeYear of Degree Education-CollegeNameNumber Years AttendedType of DegreeYear of Degree Education-Post Graduate / Oher TrainingNameNumber Years AttendedType of DegreeYear of Degree List any special qualifications and skills with office equipment and machineryEmployment History- Beginning with most recent, list the last three employers.Name, address, PhonePosition, Job PerformedDates EmployedReason for leaving May inquiry be made of your present or most recent employer regarding your character, qualifications and record of employment? Yes No If presently employed, why do you desire to change your present position?If presently unemployed, what have you done since your last job?Have you ever been fired from any job or quit after being informed that you would be fired? Yes No If Yes, explain circumstances.References-List two people who are not related to you and who have knowledge of your qualifications to which we can refer.NameAddressPhoneOccupation Note:By submitting this application, I hereby declare that may answers are true, and understand that misrepresentation or omission of the facts called for herein will be sufficient cause for dismissal. I hereby authorize the investigation by Bethany Baptist Church of any and all statements contained in this application. I agree to accept and abide by all regulations, policies and practices of bethany Baptist Church relating to its employees. Also, by submitting this application, I understand that this will be considered my electronic signature.