EMPLOYMENT APPLICATION FORM Step 1 of 5 20% Name First Middle Last Date MM slash DD slash YYYY Present Address(Required) Street Address City State / Province / Region ZIP / Postal Code Permanent Address (if different) Street Address City State / Province / Region ZIP / Postal Code Birthdate MM slash DD slash YYYY Home PhoneCell PhonePosition Applying For: Applying For: Full-Time Part-Time Describe Availability Have you ever applied for our ministry position before? No Yes When? MM slash DD slash YYYY Do you have any friends or relatives employed by our ministry? No Yes Name Position Relationship Name Position Relationship Please write a short paragraph telling how you became a Christian:Do you attend The John G Lake Apostolic Healing Center? No Yes If yes, for how long? Have you been through deliverance or inner healing? No Yes If so, by whom & when If hired, would you have a reliable means of transportation to and from work? Yes No Are you at least 18 years old? (If under 18, hire is subject to being of minimum legal age to work) Yes No If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No Have you ever been arrested or convicted of a crime (other than moving Voliations)? Yes No If yes, please explain: Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No If no, describe the functions that cannot be performed: Are you currently employed? Yes No If so, may we contact your current employer? Yes No Some of those with whom we communicate might not speak English. Do you speak, write or understand any foreign language(s)? Yes No If yes, which language? EDUCATIONHigh SchoolHigh School Name Address Street Address City State / Province / Region ZIP / Postal Code # Years CompletedDid you Graduate? Yes No Degree or Diploma College/ UniversityCollege/ University Name Address Street Address City State / Province / Region ZIP / Postal Code # Years CompletedDid you Graduate? Yes No Degree or Diploma Graduate SchoolGraduate School Name Address Street Address City State / Province / Region ZIP / Postal Code # Years CompletedDid you Graduate? Yes No Degree or Diploma Vocational/ BusinessVocational/ Business Name Address Street Address City State / Province / Region ZIP / Postal Code # Years CompletedDid you Graduate? Yes No Degree or Diploma Vocational/ Business 2Vocational/ Business Name Address Street Address City State / Province / Region ZIP / Postal Code # Years CompletedDid you Graduate? Yes No Degree or Diploma Employment HistoryList 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.Company 1Company Name PhoneSupervisor’s Name Supervisor’s Ext.#Address Street Address City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY To MM slash DD slash YYYY Your Job Title Your Duties Reason for Leaving May we contact this employer for a reference? Yes No Company 2Company Name PhoneSupervisor’s Name Supervisor’s Ext.#Address Street Address City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY To MM slash DD slash YYYY Your Job Title Your Duties Reason for Leaving May we contact this employer for a reference? Yes No Company 3Company Name PhoneSupervisor’s Name Address Street Address City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY To MM slash DD slash YYYY Your Job Title Your Duties Reason for Leaving May we contact this employer for a reference? Yes No Company 4Company Name PhoneSupervisor’s Name Address Street Address City State / Province / Region ZIP / Postal Code Employed From MM slash DD slash YYYY To MM slash DD slash YYYY Your Job Title Your Duties Reason for Leaving May we contact this employer for a reference? Yes No ReferencesReference 1Name PhoneOccupation Address Street Address City State / Province / Region ZIP / Postal Code # Years AcquaintedReference 2Name PhoneOccupation Address Street Address City State / Province / Region ZIP / Postal Code # Years AcquaintedReference 3Name PhoneOccupation Address Street Address City State / Province / Region ZIP / Postal Code # Years Acquainted ConsentConsent(Required) 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.(Required)Consent(Required) I hereby authorize 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.(Required)Consent(Required) I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and Church. In addition, I understand and agree that if I am employed my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the John G Lake Apostolic Healing Center, and that no promises or representations to the contrary are binding the John G Lake Apostolic Healing Center unless made in writing and signed by me and the Church Administrator.(Required)Consent(Required) Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgment) be conducted by Church, I am entitled to copies of any such public records obtained by the Church unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.(Required)Consent(Required) I waive receipt of a copy of any public record described in the paragraph above.(Required)PhoneThis field is for validation purposes and should be left unchanged. 746
