ST. PAUL LUTHERAN CHURCH PRESCHOOL

JOB APPLICATION

Applications must be returned to:

Preschool Hiring Committee

St. Paul Lutheran Church

1450 5^th St., Calhan, CO 80808

(719)347-2798

It is our policy to provide equal employment opportunities to all qualified persons without regard to race, age, color, sex, religion, national origin, disability, or marital status.  Please fill out entire application.  Additional information may be attached (i.e. resume).

Date: _____________________ Position applying for: __________________________________

Name_____________________________________Phone # _______________

Address:________________________City______________State____Zip_____

Are you an U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? YES___  NO__         

Have you ever been convicted of a felony or a crime against children?  YES ____       NO ____

                If yes, explain and give dates: ______________________________________________________
_____________________________________________________________________________________

PERSONAL INFORMATION_________________________________________

YES     NO

                        Can you fulfill all the essential functions listed on the posted job descripton?  If not,

                       please explain:______________________________________________________

YES     NO

                       Do you have a college degree?  If so, school and degree: ____________________

                        _________________________________________________________________

Social Security Number ____________________________

Your last physical examination date___________________

PREVIOUS EMPLOYMENT_____(please list the most recent 3)__________________________

EDUCATION__________________________________________________________________

PROFESSIONAL AND TECHNICAL QUALIFICATIONS________________________________

List licenses or certificates of competence held: _______________________________________
_____________________________________________________________________________

Names of professional associations of which are a member: _____________________________
_____________________________________________________________________________

List business machines you can operate and computer programs you are proficient with: _______

_____________________________________________________________________________
_____________________________________________________________________________

REFERENCES_________________________________________________________________

Give two references who are not your present employer or relative.

I certify that the foregoing statements are true and complete to the best of my knowledge.  I understand that St. Paul Lutheran Church and Preschool reserves the right to discharge an employee if information provided in this application is found to be incorrect, incomplete, or false.  If I am offered a job, it will be conditioned on verification of the information on this application and my references.  I further understand this application and my hiring is subject to my being able to verify employability on INS form I-9, a copy of which I will be provided if offered a job.  I understand that St. Paul Lutheran Church and Preschool is an AT-Will employer.  I understand this means that any employee may be terminated at any time for any reason.  I further understand that employees reserve the same right.  Nothing in this application is intended to create an express or implied contract.

Signature____________________________________________________Date: _____________