Explanation and Guide

Form:	Employment Application (Form 6.1)
Purpose:	This an authorized form for prospective employees to complete when applying for a job. A mandatory drug test and back-ground check are requirements before consideration can be given to a candidate for a job.

Kirkland Memorial Second Church of God in Christ, Inc.

Employment Application

KIRKLAND MEMORIAL SECOND CHURCH OF GOD IN CHRIST, INC., (the "Church") is an equal opportunity/affirmative action employment-at-will employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, physical or mental disability and any all other factors as long as any and all of these factors listed or unlisted are in adherence with the teachings of the Bible and with the Church of God in Christ doctrine as documented by the Church of God in Christ, Inc..

Personal
Last Name First Initial			Social Security #
Other Name(s) Used			Home Telephone # ( )
Address			Business or Message # ( )
Position Applied For	Referred By		Salary Desired
Have you ever interviewed with the Church or its affiliates before? ¨ Yes¨ No		If yes, list date(s), job title(s) & location(s)
Have you ever been employed by the Church or its affiliates before? ¨ Yes¨ No		If yes, list date(s), job title(s) & location(s)
Do you have any relatives employed by the Church or its affiliates? ¨ Yes¨ No		If yes, list date(s), job title(s) & location(s)
Are you at least 18 years old? ¨ Yes¨ No		If under 18, do you have a work permit?

Education
Circle Highest Grade Completed: High School 9 10 11 12 College, Trade or Business 1 2 3 4 Graduate Studies
School	Address	Major Studies	Degree, Diploma, License or Certificate
High School
College/University
Vocational, Business, Other
List Any Professional Designations
Other Special Knowledge, Skills or Qualifications
For Clerical Applicants Only:
Do you type? ¨ Yes ¨ No If yes, WPM:
Computer Skills (Hardware/Software)

Employment History

List all employments for the past 10 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.

Employed From / /	Employer Name	Supervisor Name	Starting Salary
Employed Until / /	Employer Address	Supervisor Phone #	Ending Salary
Job Title		Reason for Leaving
Duties & Responsibilities

Employed From / /	Employer Name	Supervisor Name	Starting Salary
Employed Until / /	Employer Address	Supervisor Phone #	Ending Salary
Job Title		Reason for Leaving
Duties & Responsibilities

Employed From / /	Employer Name	Supervisor Name	Starting Salary
Employed Until / /	Employer Address	Supervisor Phone #	Ending Salary
Job Title		Reason for Leaving
Duties & Responsibilities

Employed From / /	Employer Name	Supervisor Name	Starting Salary
Employed Until / /	Employer Address	Supervisor Phone #	Ending Salary
Job Title		Reason for Leaving
Duties & Responsibilities

General

Yes No

¨ ¨ May we contact your current employer for references?

¨ ¨ If hired, will you be able to work overtime?

¨ ¨ Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?

¨ ¨ Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or seals by court? (A yes response does not automatically disqualify your application.)

Certification & Authorization

The above information is true and correct. I understand that, in the event of my employment by the Church, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

I authorize the Church to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Church and will hold the Church and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Church to obtain any credit and consumer check.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Church is intended to create an employment contract between myself and the Church under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Church at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.

I hereby acknowledge that I have read and agree to the above statements.

Signature Date