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APPLICATION FOR EMPLOYMENT

BETHEL MDO

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

I certify that the information contained in this employment application is true and correct to the best of my knowledge. I understand and agree that misrepresentation or falsification of any part of this application may be cause for withdrawal of any offer of employment or immediate termination of employment.

I understand that this employment application and any other employment-related documents do not constitute a contract of employment and that I or the company may terminate the employment relationship at any time, for any reason, with or without notice, as Bethel is an “at will” employer, in accordance with the guidelines of the State of Tennessee.

In making this application for employment, I understand that an independent investigation may be made whereby job-related information will be obtained regarding my scholastic, employment, credit, and criminal records. I understand that such an investigation will be used to determine work assignment or employment eligibility under the church’s employment policies. I hereby authorize the church to investigate any and all matters contained in this application. I authorize and consent for full release of records (oral or written) to authorized representatives of the church. I acknowledge that, prior to or during my employment, the church may require any legal testing and/or examination, including but not limited to, medical, physical, drug and/or alcohol, psychological, and skill and aptitude. I also authorize my previous employer(s) to release to the church, and the church to receive, any and all information concerning my past work history, including disciplinary records, to be used in connection with consideration of my application for employment. I also waive all statutory rights under any Local, State or Federal law and any private causes of action whatsoever which might otherwise be available to protest the release, receipt and/or consideration of such information including but not limited to any right to notification of release by my previous employer. I hereby release the church, my former employers, and all other persons from any and all claims, demands, or liabilities arising out of, or in any way related to, such disclosure. I further understand that conflict resolution occurs through mediation and, should the need arise, a licensed arbitrator would be selected by Bethel.

Date: November 5, 2026

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Parent or Guardian's Email Address
Email*
Confirm Email*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Participant's Social Secuirty Number *

Employment Experience

1. PRESENT OR MOST RECENT

Present Employer or Most Recent Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

2. PREVIOUS EMPLOYER

Previous Employer
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving

3. PREVIOUS EMPLOYER

PREVIOUS EMPLOYER
Address
Telephone Number
Type of Business
Employment Dates:
From
To
Position Title
Name and Title of Supervisor
Starting Salary
Final Salary
Description of Duties
Reason for Leaving
May we contact the employers listed above?*
No
Yes
If not, please indicate which ones you do not wish us to contact.

Position Objective

Describe the position for which you are applying:
Starting Salary Desired?
When will you be available for employment?
How were you referred to us?*
Employee
Friend
Ad
School
Other
If an employee referred us to you, what is their name?

Have you had any experience working with children, either on a paid or volunteer basis? If yes, please explain (where, when, what your responsibilities were, etc.).

List any other job-related skills, training, experiences, licenses, or certifications that may help qualify you for employment.
Are you a member of a Bethel congregation?*
No
Yes
If yes, which one?

Education

High School (name & whether you graduated) *
College (name, field of study, and degree if any)
Graduate/Business or Seminary (name, field of study, and degree if any)

Other Education or Training

References

List three references, one of which should be a pastoral reference. Please do not list relatives as references.

Name - Address/Phone - Occupation - Years Known

1. Name, Address & Phone, Occupation, Years Known *
2. Name, Address & Phone, Occupation, Years Known *
3. Name, Address & Phone, Occupation, Years Known

Other

Are you applying for
Full Time
Part time
Temporary/Contractual Work
Are you able to perform the essential functions of this job, either with or without reasonable accommodation?*
No
Yes
Are you able to meet the attendance requirements of this job?*
No
Yes
Are you legally authorized for employment in the United States? (Pursuant to relevant law, verification will be required.)*
No
Yes
Have you been convicted of a felony for which you were not pardoned or your record expunged? If yes, please explain. A conviction will not necessarily constitute disqualification, and its nature, age and job-relatedness will be considered.*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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