Employment Application
The Presbyterian Church of Radford
Radford, Virginia
Position Applied For _______________________________
Date _______________________________
Name _______________________________
Present Address _______________________________
Permanent Address _______________________________
E-mail Address: _______________________________
Phone Number _______________________________
Education – List High Schools and Any Colleges or Universities Attended (Transcripts may be requested)
EDUCATIONAL INSTITUTION AND LOCATION
- Dates Attended
- Diploma or Degree
- Major or Minor
- Activities and Distinctions
*Please attach a separate sheet if needed
Work Experience – list all work experience since high school graduation with most recent listed first.
Name and Address of Employer/Supervisor:
Dates from (month/year):
Full-time/Part-time:
Type of Work Activity/Title:
Reason for Leaving:
Name and Address of Employer/Supervisor:
Dates from (month/year):
Full-time/Part-time:
Type of Work Activity/Title:
Reason for Leaving:
Name and Address of Employer/Supervisor:
Dates from (month/year):
Full-time/Part-time:
Type of Work Activity/Title:
Reason for Leaving:
*Please attach a separate sheet if needed
References – References should include supervisors, professors, or other individuals who have first-hand knowledge of your professional competence and personal qualifications. Please list at least three current references to be checked by the appropriate committee using a checklist.
Name:
Position/Relationship
Address
Telephone/E-Mail
Name:
Position/Relationship
Address
Telephone/E-Mail
Name:
Position/Relationship
Address
Telephone/E-Mail
*Please attach a separate sheet if needed
If You Are Offered Employment, When Are You Available To Begin Work?
__________________________________________________
Please Detail Any Other Activities or Experiences Which Qualify You For This Position:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
General Background Information – Please Circle “yes” or “no”
Have you ever been convicted of a criminal offense? Yes No
Are criminal charges currently pending against you? Yes No
Have you ever been discharged or requested to resign from a former position? Yes No
If you answered “Yes” to any of the above questions, please provide a detailed explanation, including dates:
Certification and Release Authorization
I certify that I have made true, correct and complete answers and statements in this application in the knowledge that they will be relied upon in considering my application. I understand that any omission or falsely answered statement in this Application, or any supplement to it, will be sufficient grounds for my termination. I also understand that Virginia is an employment at will state.
I hereby authorize all employers for whom I have worked or others familiar with my abilities to furnish any information which Presbyterian Church of Radford may request concerning my previous employment.
My signature below authorizes Presbyterian Church of Radford to conduct a background investigation to determine my suitability for the position for which I have applied. This investigation may include a review of information such as criminal or civil convictions, driving records, reports from the Department of Social Services relating to the results of investigations of allegations of abuse or neglect, records of previous employers and educational institutions, and personal references. To the extent that any of these sources requires a written release, I agree to provide such a release at the request of the church.
Date: ____________ Signature of Applicant: _______________________________
Additional information is required for Background check: full name, date of birth and Social Security Number -these will be requested if Hiring is Considered.
January 2023