Information Training

List your previous experience beginning with your most recent position.

Employer/Company:

Address: Phone:

Starting Job Title: Starting Salary:

Last Job Title: Final Salary:

Dates Employed: From: To:

Immediate Supervisor:

Duties:

Reason For Leaving:

Employer/Company:

Address: Phone:

Starting Job Title: Starting Salary:

Last Job Title: Final Salary:

Dates Employed: From: To:

Immediate Supervisor:

Duties:

Reason For Leaving:

Employer/Company:

Address: Phone:

Starting Job Title: Starting Salary:

Last Job Title: Final Salary:

Dates Employed: From: To:

Immediate Supervisor:

Duties:

Reason For Leaving:

EMPLOYMENT APPLICATION

AN EQUAL OPPORTUNITY EMPLOYER M/F/D/V

APPLICANT INFORMATION

WORK EXPERIENCE

Voluntary Involuntary

May we contact this employer? Yes or No

Voluntary Involuntary

May we contact this employer? Yes or No

Voluntary Involuntary

May we contact this employer? Yes or No

Full Name: Date:

Last First M.I.

Address:

Street Address Apartment #

City State Zip Code

Phone: Email:

Date Available: Social Security: Desired Salary:

Position Applied For:

If hired, can you provide the documents required to prove that you are authorized to work in the US? Yes or No Have you ever worked for MPC before? Yes or No If yes, when? Have you ever been convicted of a felony and/or misdemeanor? Yes or No If yes, explain:

Have you ever been dismissed or forced to resign from any employment? Yes or No If Yes, please explain School Name, City & State for Each School # Years Completed Graduated? Degree/Field High School

College

Additional Training

Additional Training

Indicate the type of skills you possess

Computer skills: hardware/software

List any professional Designations

Other special knowledge, skills or qualifications

If you were referred by an employee or church member, may we contact them? Yes or No Signature Date

Walk-in Applicant

MPC Website

Other Website

Employee Referral

Church Member

ADDITIONAL EMPLOYMENT HISTORY

EDUCATION AND TRAINING

REFERRAL SOURCE - CHECK ALL THAT APPLY

APPLICANT STATEMENT AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge. I give Mountain Park Church the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability Mountain Park Church and its representatives for seeking such information and all other persons, corporations or orga- nizations for furnishing such information. I understand that a criminal background check will be conducted on me as part of the application process and I consent to any such check. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that I will be required to provide documentation to establish identity and employment eligibility. I understand that just as I am free to resign at any time, Mountain Park Church reserves the right to terminate my employment with or without cause and without prior notice. I understand that no representative of Mountain Park Church has the authority to make any assurances to the contrary. I certify, by my written or electronic signature below, that I have read and understood all statements.

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