Church Background Check

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Employment Application First Baptist Church Tullahoma

Name: Date: Present Address: Permanent Address: Phone: E-Mail: Are you 18 years or older? Yes No.

If under 18 years old, can you provide a work permit? Yes No The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age. Position Desired

Position: Date you can start: Salary: Are you employed now? Yes No May we talk to your current employer? Yes No

Have you applied here before? Yes No If yes, for what position? Are you related to an employee? Yes No If yes, to whom? Education Name and Location Dates Attended Degree Major High School

College

Graduate

US Military rank or membership in the National Guard or Reserves: 2 of 3

Employment History

Dates Name and Employer’s Address Salary Position Reason for Leaving Have you been discharged or asked to resign? Yes No If yes, explain on a separate sheet. Have you been convicted of a felony or misdemeanor? Yes No If yes, please explain on a separate sheet the date and nature of each offense. A conviction does not necessarily exclude you from employment.

Have you ever been denied the opportunity to work with children? Yes No References

Name Address Phone Years Known

1

2

3

Are you a U.S. citizen or authorized to work in the United States? Yes No Can you verify your identity and eligibility to work in the United States? Yes No Physical Limitations

Can you perform the functions of this job with reasonable accommodation? Yes No If you need accommodation, please describe on a separate sheet. Emergency Contact

Name: Address: Phone: E-Mail: Relationship:

3 of 3

Signature

To the best of my knowledge, the facts in this application are true and complete. If hired, untrue statements in this application may be grounds for dismissal.

I authorize the investigation of all statements in this application. The church may contact all references, employers, public agencies, and educational institutions to verify the accuracy of all information provided by me in this application, my resume, or job interviews. As allowed by law, references may give information concerning my previous employment and any pertinent information. I release all parties from all liability for any damage that may result from furnishing this information to you. I agree that if hired that there will be no contract between me and the church. I will be an at-will employee as allowed by my state. My employment may be terminated at any time. I understand that the church does not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting an applicant as prohibited by applicable law. Our church operates in compliance with the provisions of all applicable federal and state non-discrimination regulations including, Titles VI and VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1967, the Equal Pay Act, the Americans with Disabilities Act of 1990 and any applicable sections of the state labor code. These prohibit discrimination on the basis of the applicant’s age, race, color, sex, religion, national or ethnic origin, and physical or mental disability. By signing this document I give written permission for the church to conduct a background check (and keep it on file) and if hired I will participate in ongoing risk management training to include issues of health and safety, sexual harassment and misconduct, best practices, church policies, proper reporting of incidents, and other important items that help to insure the security and safety of the church and its members and guests. As a Christ centered, Bible believing church, we may exercise preference on the basis of religion in our employment decisions.

I certify that I understand and accept the terms in this application. Signature: Date: