Community of the Cross Lutheran Church

Community of the Cross Lutheran Church

10701 Bloomington Ferry Rd. Bloomington, MN 55438

Phone: 952-941-1247 •

EMPLOYMENT APPLICATION

Name: ______Date:______

FirstMiddleLast

Present Address: ______How Long? ______

Street/Box City State Zip

Phone:______Cell Phone: ______Email: ______

Position Applying For: ______

Education: H.S. Graduate? Y/NCollege Graduate? Y/NAttend School Now? Y/N

College / Institute / Trade School / High School: ______

Military Service: Dates of Active Duty: ______National Guard? Y/N

Degree(s) Held: ______

Training Received: ______

Have you ever had any reports of physical, sexual, emotional abuse or child neglect filed against you? Y/N

Please Explain: ______

Have you ever been charged with a felony, misdemeanor, or gross-misdemeanor? Y/N

Please Explain:______

Previous Employment: (Please begin with the most recent, including present)

Employer’sName ______

Position ______

Dates of Employment: ______Supervisor ______

Pay: $______Month/Year Reason for leaving ______

Employer’s Name ______

Position ______

Dates of Employment: ______Supervisor ______

Pay: $______Month/Year Reason for leaving ______

Employer’s Name ______

Position ______

Dates of Employment: ______Supervisor ______

Pay: $______Month/Year Reason for leaving ______

**PLEASE CONTINUE TO BACK SIDE OF THIS APPLICATION**

References (Please list professional references)

Name: ______Phone: ______

Address: ______

Relationship: ______

Name: ______Phone: ______

Address: ______

Relationship: ______

Name: ______Phone: ______

Address: ______

Relationship: ______

Fair Credit Reporting Act Disclosure: In making this application it is acknowledged that we may request

Information regarding your character, employment, and background. Additional information may be requested to better access qualifications for specific positions. Upon written request, information concerning the above will be obtained. False or incomplete information in this application is grounds for termination of employment consideration or employment, if already employed.

I certify that the above information is accurate and complete AND hereby authorize any person, employer, or organization named in this application to provide CCLC with any information and opinions requested in connection with this job application:

______

SignatureDate

Community of the Cross Lutheran Church: An Equal Opportunity Employer