X Applicant Signature: Date:

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1 Welcome: Application/Disclosures and Reference Check Form Saint Catherine of Siena Parish thanks you for submitting this Application for Employment. The Parish is an Equal Opportunity Employer and your application will be reviewed by the appropriate management. If an interview is to be arranged, you will be contacted at the telephone # you provide so we ask that you indicate the best time to contact you. If you do not have a telephone, please specify the most appropriate way to contact you. Applications are retained on file for 30 days. After 30 days, they will no longer be retained for consideration. Once you complete the application forms, we ask that you do not contact the Human Resources by phone to follow up. Complete and sign the following: the Application (pgs 2 4); the Church Employee/Volunteer Criminal Background Check Authorization Form (p.6); Only Sign the Reference Check (p.5) as previous employers will complete the form. The SIGN OFF lines on all the forms are marked with an X. Be advised that if you are offered a position, it will be conditional on the following: Should the job for which you are under consideration require driving a Parish vehicle; we may conduct a check of your driving record. The Parish conducts a criminal background check. Thank you for your interest. X Applicant Signature: Date: 1

2 Application for Employment. Your Name: Position Applying for: Address: City State Zip Home Phone: Alternate Phone?; ? Best Time to Call? EDUCATION: Name of School Location Course of Study Degree [?] High School: College: Technical Sch. Other: EMPLOYMENT RECORD List Chronologically 1. Employer Name: Address: Supervisor: Dates of Employment: / / To / / Job Duties: Last Wage Supervisor: Reason for Leaving: 2. Employer Name: Address: Supervisor: Dates of Employment: / / To / / Job Duties: Last Wage Supervisor: Reason for Leaving: 2

3 3. Employer Name: Address: Supervisor: Dates of Employment: / / To / / Job Duties: Last Wage Supervisor: Reason for Leaving: Q. Are you seeking work Full time? Part time? Seasonal/Intern Q. What is your availability for work? Q. Are you available to travel if required? Yes No Q. Have you filed an application here before? Yes No Q. Have you worked at another Parish or in ministry? Yes No Q. If you are under age 18, can you provide proof of eligibility to work? Yes No Q. Are you prevented from lawful employment in the USA because of Visa/Immigration status? Yes No Q. Have you ever been convicted of a misdemeanor or felony? Yes No Explain: Q. Describe any special skills, training, language proficiency etc. that may not be apparent based on the information provided. Include any PC skills or technical proficiencies. Q. List any professional certifications, awards, licenses etc. that you feel we should be aware of. If you have a state license that maybe relevant to the position for which you are applying, please indicate the state issue and when it expires. Q. May we contact your past employers? Yes No 3

4 Q. May we contact your present employer? Yes No List references [do not list relatives or family relations] Name Relationship How long known? Contact Info I certify that all answers provided herein are true and complete to the best of my knowledge. I understand and agree that any misrepresentation or omission on this application or on any related papers or via statements made during any oral interview may [a] result in refusal of employment or [b] be grounds for dismissal. I authorize Saint Catherine of Siena Parish [aka the Parish] or its agent to investigate my history and may verify all data in my application for employment, related papers, or oral interviews. I allow such investigation and release from liability the Parish and/or any person or company giving of such information. I understand that this application is not, and is not intended to be, a contract of employment. I understand and agree that, if hired, my employment is at will for no definite period of time. If hired as an employee, I may resign at any time and the Parish, as the employer, may cease my employment at any time with or without cause and without prior notice and shall not be liable for wages, salary or any other benefits except those earned up to the date of termination. I understand that, if offered employment, I will be required to consent to a background investigation screening process. I understand that Federal Law prohibits the employment of unauthorized aliens and that all persons hired must submit satisfactory proof of employment eligibility and identify within 3 days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. I have read, agree to and understand the above. X Applicant s Signature: Date: 4

5 Shaded Section is To Be Completed By Previous Employer Employee Reference Check Verify Employee Name Dates of Employment From To Was this person Full time Part time Nature of work performed Excellent Avg Not Satisfactory Overall job performance Ability to follow instructions Attendance and punctuality Ability to work without supervision Communication skills Quality of work Ability to Problem Solve Ability to get along with others Organizational skills (if applicable) Supervisory skills (if applicable) Nature of separation: Resigned Laid off Discharged Eligible for Rehire? Additional comments Signature Person Completing Form: Title: Date I authorize Saint Catherine of Siena Parish [aka the Parish] or its agent to investigate my work history and may verify all data in my application for employment, related papers, or oral interviews. I allow for reference checks to be made and release from liability the Parish and/or any person or company giving of such information. X Applicant s Signature: Date: 5

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