First Presbyterian Church, Salina, KS

PERSONAL INFORMATION

NAME (Last , First, Middle)

SOCIAL SECURITY NUMBER

PRESENT ADDRESS (Apt No. City State Zip)

PERMANENT ADDRESS (Apt No. City State Zip)

ARE YOU 18 YEARS OR OLDER?

YES

PHONE NUMBER (with area code)

EMAIL ADDRESS

DESIRED EMPLOYMENT

POSITION

DATE YOU CAN START

SALARY DESIRED

ARE YOU EMPLOYED NOW?

YES

IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?

YES

EVER APPLIED TO THIS COMPANY BEFORE?

YES

WHEN?

EVER WORKED FOR THIS COMPANY BEFORE?

YES

WHEN?

REASON FOR LEAVING?

NAME OF LAST SUPERVISOR AT THIS COMPANY?

HIGH SCHOOL

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

DID YOU GRADUATE?

YES

SUBJECTS STUDIED

COLLEGE

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

DID YOU GRADUATE?

YES

SUBJECTS STUDIED

TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

DID YOU GRADUATE?

YES

SUBJECTS STUDIED

GENERAL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK

SPECIAL TRAINING

SPECIAL SKILLS

FORMER EMPLOYERS

(List below last three employers, Starting with the most recent)

NAME OF PRESENT OR LAST EMPLOYER

ADDRESS (City, State, Zip)

STARTING DATE

LEAVING DATE

JOB TITLE

WEEKLY STARTING SALARY

WEEKLY FINAL SALARY

MAY WE CONTACT YOUR SUPERVISOR?

YES

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

NAME OF PRESENT OR LAST EMPLOYER

ADDRESS (City, State, Zip)

STARTING DATE

LEAVING DATE

JOB TITLE

WEEKLY STARTING SALARY

WEEKLY FINAL SALARY

MAY WE CONTACT YOUR SUPERVISOR?

YES

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

NAME OF PRESENT OR LAST EMPLOYER

ADDRESS (City, State, Zip)

STARTING DATE

LEAVING DATE

JOB TITLE

WEEKLY STARTING SALARY

WEEKLY FINAL SALARY

MAY WE CONTACT YOUR SUPERVISOR?

YES

NAME OF SUPERVISOR

TITLE

PHONE

DESCRIPTION OF WORK

REASON FOR LEAVING

REFERENCES

Below, give the names of three persons you are not related to, whom you have known at least one year.

NAME

ADDRESS

BUSINESS

YEARS ACQUAINTED

PHONE NUMBER

EMAIL ADDRESS

NAME

ADDRESS

BUSINESS

YEARS ACQUAINTED

PHONE NUMBER

EMAIL ADDRESS

NAME

ADDRESS

BUSINESS

YEARS ACQUAINTED

PHONE NUMBER

EMAIL ADDRESS

SERVICE RECORD

BRANCH OF SERVICE

DISCHARGE DATE RANK

ANYTHING ADDITIONAL YOU WOULD LIKE TO SHARE

HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 5 YEARS?

YES

IF YES, EXPLAIN (Will not necessarily exclude you from consideration)

AUTHORIZATION

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.”

I AGREE

YES

DATE

SIGNATURE

Application for Employment