Christ’s Church on the River

9098 Riverside Dr.

Parker, AZ 85344

928-667-3891

 

Employment Application

Applicant Information
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Date Available Social Security No.
Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO
Have you ever been convicted of a felony? YES NO If yes, explain
Education
College Address
From To Did you graduate? YES NO Degree
Other Address
From To Did you graduate? YES NO Degree
References
Please list three professional references.
Full Name Relationship
Company Phone ( )
Address
Full Name Relationship
Company Phone ( )
Address
Full Name Relationship
Company Phone ( )
Address

 

Previous Employment
Employer Phone ( )
Address
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Employer Phone ( )
Address
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Employer Phone ( )
Address
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Military Service
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
Additional Information
Describe any specialized training, foreign languages, job-related skills, qualifications or other information you feel may be helpful to us in considering your application.

 

 

 

 

 

 

 

 

 

Please Read and Sign Below
I certify that answers given herein are true and complete to the best of my knowledge and understand all answers must be true and complete to the best of my knowledge to be considered for employment, which consideration is a privilege or benefit.

I authorize investigation of all statements contained in or related to this application for employment. I understand all answers given herein are made to Christ’s Church on the River, its agents and public servants reviewing this application, and authorize disclosure of information contained in the application or discovered by investigation to Christ’s Church on the River and my employing officer, agency, or department, and as otherwise provided by law.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand making false statements or omissions in connection with this application for the privilege of employment consideration is a crime punishable as provided in Title 13, Arizona Revised Statues.

I understand, also, that in the event of employment, I am required to abide by all lawful rules and regulations of Christ’s Church on the River and my employing officer, agency, or department.

_______ BY INITIALING, YOU AGREE THAT YOU HAVE READ AND FULLY UNDERSTAND THE ABOVE AND AGREE TO ITS CONTENTS AS STATED.

 

 

 
_________________ __________________________________________________
Date Applicant’s Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment Applicant’s

Authorization for Background

Investigation and Release from Liability

 

I, _________________________________, hereby authorize Christ’s Church on the River employees or agents, to investigate my background, including but not limited to, my employment, criminal and academic history and my credentials.

I further authorize any present or former employer, college, university, school, person or legal entity, its officers, agents, or employees, to provide and speak with Christ’s Church on the River, its officers, employees or agents, concerning any information, records, files or opinions they may have regarding my present or past employment or academic histories, including, but not limited to, my ability to work with others, reputation for honesty, disciplinary actions, work habits and performance.

I herby release from liability and agree to hold harmless under any and all possible causes of legal action, Christ’s Church on the River, its officers, employees and agents, as well as any present for former employer, college, university, school, person or legal entity, its officers, agents, or employees, for any statements, acts, or omissions made in the course of the investigation.

This release from liability shall apply to any right of action that might accrue to myself, my heirs, assigns and personal representatives.

A photo copy of this document shall have the same effect as the original.

_____ BY INITIALING, YOU AGREE THAT YO HAVE READ AND FULLY UNDERSTAND THE ABOVE AND AGREE TO ITS CONTENTS AS STATED.

 

 

 

 

___________________________ ___________________

Signature of Applicant Date

___________________________

Applicant’s Printed Name