Employment Employment Application Name* First Middle Last Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birthdate* MM slash DD slash YYYY Home PhoneCell PhonePosition Applying For* Describe Availability*Please write a short paragraph telling how you became a Christian*Have you ever been arrested or convicted of a crime (other than moving violations)?* Yes No If yes, please explain*Are you currently employed?* Yes No If so, may we contact your current employer?* Yes No Education*SchoolName, Address, City, State, Zip# Years CompletedDid you Graduate? (Yes or No)Degree or Diploma Employment History*List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume. Dates EmployedCompany Name, Address, City, State, ZipJob Title & DutiesReason for LeavingMay we contact this employer for reference? (Yes or No)Supervisor's Name, Phone & Ext. References*NamePhoneOccupationAddress# Years Acquainted Please read carefully, check each paragraph, and sign below.* I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Lifeway Church to thoroughly investigate any references, work record, education, and other matters related to my suitability for employment and further, authorize the references I have listed to disclose to our ministry any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release our ministry, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. Signature*Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. Δ