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SANDY GROVE BAPTIST CHURCH OF LUMBERTON, NC, INC.PRIVATE APPLICATION FOR EMPLOYMENT(Please Print)INSTRUCTIONS: PLEASE READ EACH ITEM CAREFULLY. BE SURE TO GIVE ACCURATE AND COMPLETE INFORMATION. FAILURE TO DO SO MAY RESULT IN THE REJECTION OF YOUR APPLICATION.A separate completed application must be submitted for each position for which you are applying. APPLICATIONS ARE ACCEPTED FOR POSTED VACANCIES ONLY. A resume may be attached in addition to a completed application. 1. 2. Month ____ Day Year Position Applying for: Date of Application: 3. Last Name: (Nickname)FirstMiddle 4. Address: Street City State Zip Code 5. 6. Telephone Number(s): E-mail Address:====================================================== 7. Do you have relatives employed by the Sandy Grove Baptist Church of Lumberton, NC, Inc.? Yes_____ No_____ Name____________________________Dept._______________________Relation________________ 8. Have you been employed with Sandy Grove Baptist Church before? Yes_____ No_____ If yes, please give position(s) and date(s) of employment.... Position Held Date Employed _________________________________________ _________________ _________________________________________ _________________ 9. Are you seeking: ______ Part time Employment______ Full time EmploymentIn accordance with Sandy Grove’s Personnel Policy, any applicant who is offered a position with the Sandy Grove Baptist Church of Lumberton, NC, Inc. must submit to a Urinalysis Drug Screening. A Negative result from this screening is a condition of employment. Refusal to submit to the screening or a positive result will be grounds for denial of employment with Sandy Grove Baptist Church of Lumberton, NC, Inc..10. EDUCATION Name and Address Course of Study Years Diploma/Degree of School Completed Year Received Elementary School High School University Graduate Professional Other (Specify) 11. ADDITIONAL INFORMATIONDescribe any equipment that you can operate, specialized training, apprenticeship, skills, and/or extra-curricular activities which are relevant to the job you are applying for. Other Qualifications List professional, trade, business, or civic activities and offices held. You may exclude membership which would reveal your gender, race, age, national origin, disability or other protected status. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Specialized Skills - Check Skills/Equipment Operated _____Typewriter/Keyboard_____ Data Base Programs Type: __________________________ _____Correct WPM _____ Spread Sheet Programs _____Calculator Type: __________________________ _____Computer_____ Word Processing Type: __________________________ List any additional Skills or QualificationsEMPLOYMENT HISTORYStart with your present job. Include any job related Military Service assignments and volunteer activities. Mailing address and phone number for each employer must be submitted in order for your application to be processed. An additional sheet may be attached if necessary. May we contact your present employer? Yes____ No____Name ofEmployerAddressPhone Number Date Employment Began To Starting Salary Ending Salary Reason for Leaving Name andJob TitleTitle of Supervisor Job Duties (Be Specific) ____Full Time ___ Part Time If Part-Time, number of hours per week:=======================================================Name ofEmployer _____________________________________ Address Phone Number Date Employment Began To Starting Salary Ending Salary Reason for Leaving Name andJob TitleTitle of SupervisorJob Duties (Be Specific) ___ Full Time ___ Part Time If Part-Time, number of hours per week: =======================================================Name ofEmployerAddressPhone Number Date Employment Began To Starting Salary Ending Salary Reason for Leaving Name andJob TitleTitle of SupervisorJob Duties (Be Specific) ___ Full Time ___ Part Time If Part-Time, number of hours per week: REFERENCESLIST THREE PERSONS, OTHER THAN RELATIVES OR PAST EMPLOYERS, WHO HAVE DEFINITE KNOWLEDGE OF YOUR QUALIFICATIONS OR YOUR CHARACTER. MAILING ADDRESS AND PHONE NUMBER FOR EACH REFERENCE MUST BE SUBMITTED IN ORDER FOR YOUR APPLICATION TO BE PROCESSED. NO. YEARS FULL NAME PRESENT BUSINESS OR HOME ADDRESS ACQUAINTED1.__________________________________________________________________________________________Phone Number2.__________________________________________________________________________________________Phone Number3.__________________________________________________________________________________________Phone NumberOn what date would you be available for work? ______________________________I understand that, if I am employed, I will be on probation for a period of six months and during that time I will be subject to discharge as stated in the Sandy Grove Personnel Policy concerning probationary employees.Signature of Applicant____________________________________________________ Date _______________PLEASE RETURN TO:Sandy Grove Baptist Church of Lumberton, NC, Inc.Attention: Senior Pastor1601 Martin L. King, Jr. Drive – P. O. Box 290Lumberton, North Carolina 28359Phone: 910-739-7202 – (No facsimiles please) Website: ---------------------------------------------------------------------------FOR OFFICE USE ONLY:DATE REQUESTED COMPLETED INITIAL Date Application ReceivedDriver's License VerifiedDate of InterviewCriminal HistoryDriver's HistoryReference Letters Pre-employment Drug ScreenPhysical ExamPre-employment PsychologicalAgility Test SGBC 2010SANDY GROVE BAPTIST CHURCH OF LUMBERTON, NC, INC.Name: _____________________________ Social Security No.: ___________________ Date: ___________NOTICE TO APPLICANT: The information requested below is needed for reporting procedures in accordance with Equal Employment Opportunity Commission requirements. This information in no way is used as a selection factor for employment. The applicant’s social security number is needed in order that a criminal background check and driver history can be conducted as a condition of employment. ETHNIC BACKGROUND - PLEASE CHECK______American Indian______Spanish Surname______Black______White _____Oriental______ Other (Specify) __________B. SEX - PLEASE CHECK ______Male______Female Birth Date____________________________________ Month Day YearC. DO YOU HAVE A VALID DRIVER’S LICENSE? Yes _____ No_____ Type/Class________ Driver’s License Number _________________ State _________ Expires __________Are you a citizen of the United States? _______Yes _______ No If no, give country of which you are a citizen and your alien registration number _____________________________________ _______________________________________________________ Have you been charged with or convicted of a felony within the past 7 years? Yes ____ No ____(Conviction will not necessarily disqualify an applicant from employment). Ifyes, explain The Sandy Grove Baptist Church of Lumberton, NC, Inc. has a commitment to diversity in the workforce. In that spirit applications are welcomed from all individuals including women, minorities and persons with disabilities. In compliance with the Americans With Disabilities Act of 1990, the Sandy Grove Baptist Church of Lumberton, NC, Inc. will provide an otherwise qualified applicant or employee with a disability, a reasonable accommodation that does not impose undue hardship upon Sandy Grove Baptist Church. If assistance is needed please, advise the Senior Pastor.SGBC 2010Authorization for Release of RecordsIn order to determine my suitability as a ____________________________, the Sandy Grove Baptist Church of Lumberton, NC, Inc. Senior Pastor will conduct or cause to be conducted a comprehensive personal background investigation.I, _______________________________, do hereby authorize any military organization, physician, insurance company, educational institution, governmental agency, bank or credit agency, former or present employer and any other person or entity to furnish to the Sandy Grove Baptist Church of Lumberton, NC, Inc. Senior Pastor or Designee any and all available information requested pertaining to me. I hereby release any and all persons from any civil or criminal liability whatsoever for releasing information pursuant this Authorization for Release of Records.Furthermore, I specifically authorize the Sandy Grove Baptist Church of Lumberton, NC, Inc. Senior Pastor to disclose any information obtained, discovered, or possessed by the Sandy Grove Baptist Church of Lumberton, NC, Inc. as may be required or authorized by law. I further authorize disclosure by the Sandy Grove Baptist Church of Lumberton, NC, Inc. Senior Pastor of any information in his possession to the extent that such disclosure is made to another employer as needed or requested for employment purposes. A copy of this authorization and release shall be accepted as authorization for the release of information.____________________________________________ _________________________________Printed Name (Last, First, M.I.) Last 4 digits of SS#____________________________________________ _________________________________ Applicant’s Signature Date State Of North CarolinaCounty Of Robeson I, ______________________________, a Notary Public in and for said County and State do hereby certify that ___________________________ personally appeared before me this day and acknowledged the due execution of the foregoing instrument in writing for the purposes therein expressed. Witness my hand and notary seal, this the ______ day of _______________, 20_____. __________________________________________ Notary Public My Commission Expires: ________________________________ SGBC 2010 ................
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