Church Administrator Application

Current Information

1. Position Title Applied For:

Date:

YYYY

2. When will you be available for employment?

(e.g. immediately, 2 weeks notice)

3. Name:

First Name

Last Name

4. Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

5. Home Phone:

(###)

###

####

Mobile Phone:

(###)

###

####

6. Email:

General Information

If you need to explain any answer, use the space under Explanations near the end of this application.

7. This salaried position has a 32 hour workweek but sometimes has irregular schedule needs. Do you have any schedule constraints that would prevent you from fulfilling the job requirements which include: supervising Wednesday evening activities, some evening and weekend meetings, supervisory responsibilities for some Sunday activities, and being on-call for facility emergencies? If yes, please describe in the Explanations section.

8. Have you ever been employed with Pullen?

If YES, when and in what capacity?

9. Have you applied to Pullen before?

If YES, indicate what position and when:

10. Were you previously a member of Pullen?

If yes, when you were a member:

11. Have you ever been convicted of a felony?

If YES, please explain under Explanations. Note: A conviction record will not necessarily exclude you from employment. Factors such as age at time of offense, rehabilitation efforts, length of time since the offense, and nature of the crime will be taken into consideration.

12. Are you an American citizen or do you currently have authorization to work in the U.S.?

13. Did you receive any of your education or employment experience under another name?

If YES, please explain under Explanations.

Education

Provide your complete history

14. Indicate highest school year completed:

(e.g. 8, 12, 16)

15. Name of High School, City, and State:

16. Have you received a high school diploma or equivalent?

17. College(s), University(ies):

Name and Location:

Attended From:

YYYY

Attended To:

YYYY

Did You Graduate?

Credit Hours:

Degree, Diploma, Certificate Earned or # of Years:

Major / Minor:

18. Graduate or Professional Schools:

Name and Location:

Attended From:

YYYY

Attended to:

YYYY

Did You Graduate?

Credit Hours:

Degree, Diploma, Certificate Earned or # of Years:

Major / Minor:

19. Technical Institutes, Internship, Other:

Name and Location:

Attended From:

YYYY

Attended To:

YYYY

Did You Graduate?

Credit Hours:

Degree, Diploma, Certificate Earned or # of Years:

Major / Minor:

Knowledge, Skills & Abilities

20. Please list any knowledge, skills, or abilities you have that you feel are applicable to the position for which you are applying. Include skills with relevant equipment you can operate, and list computer software and programs which you know or have used, noting familiarity or proficiency.

Registrations, Licenses, Certifications

21. List fields of work for which you have been registered, licensed or certified:

Registration: State: No: Exp. Date:

Other:

22. Please list your valid Driver's License Number and the state in which it was issued. If you do not have a driver's license, please put "NONE" in the blank.

Number

State

23. Have you ever been denied bonding?

Are you eligible to be bonded in the State of North Carolina?

Employment

24. Record your complete work history in the space below. (You may omit including high school, college or summer jobs unless you deem them relevant.) If needed, additional sheets containing the same information and in the same format are acceptable. Begin with your current or most recent position. Include military experience, and you may include related volunteer experience either here or on the supplemental application questions. Be sure to account for gaps in your employment history. All spaces should be completed or marked N/A (not applicable). Note: "See attached resume" is not an acceptable response.

A. Current or Most Recent Employment

(or explain gap in employment)

Job Title:

Employer:

Employer Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone:

(###)

###

####

Supervisor Name:

First Name

Last Name

Starting Salary:

Last Salary:

Date Employed:

YYYY

Date Separated:

YYYY

Full-time for:

(years,months)

Part-time for:

(years,months)

If part-time, number of hours worked per week:

Number of employees supervised by you:

Duties, in order of importance:

Reason for leaving:

B. Next Most Recent Employment

(explain any gaps in employment)

Job Title:

Employer:

Employer address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone:

(###)

###

####

Supervisor Name:

First Name

Last Name

Starting Salary:

Last Salary:

Date Employed:

YYYY

Date Separated:

YYYY

Full-time for:

Part-time for:

If part-time, number of hours worked per week:

Number of employees supervised by you:

Duties, in order of importance:

Reason for leaving:

C. Next Most Recent Employment

(explain any gaps in employment)

Job Title:

Employer:

Employer Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number:

(###)

###

####

Supervisor Name:

First Name

Last Name

Starting Salary:

Last Salary:

Date Employed:

YYYY

Date Separated:

YYYY

Full-time for:

(years,months)

Part-time for:

(years,months)

If part-time, number of hours worked per week:

Number of employees supervised by you:

Duties, in order of importance:

Reason for leaving:

D. Next Most Recent Employment

(explain any gaps in employment)

Job Title:

Employer:

Employer address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone:

(###)

###

####

Supervisor Name:

First Name

Last Name

Starting Salary:

Last Salary:

Date Employed:

YYYY

Date Separated:

YYYY

Full-time for:

(years,months)

Part-time for:

(years,months)

If part-time, number of hours worked per week:

Number of employees supervised by you:

Duties, in order of importance:

Reason for leaving:

Provide any additional employment information at the end of the form.

25. Have you had disciplinary action taken against you in the past 12 months?

If YES, explain under Explanations. (A YES will not automatically disqualify you.)

26. a) Have you ever been dismissed or forced to resign from any job held?

b) Were you dismissed or forced to resign for disciplinary reasons? If YES to "a" or "b", explain under Explanations. (A YES will not automatically disqualify you.)

27. May we contact your present employer for reference prior to an interview (if granted)?

28. If you are not currently employed, please check here:

If so, you may explain under Explanations.

Not currently employed

Explanations

Item #

Certification and Release

(Name and date must be entered below) To the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, I may be disqualified for employment consideration or dismissed from employment with Pullen. I authorize my current and former employers to give to Pullen any information regarding me or my employment, whether or not it is on their records. I also authorize educational institutions which I attended to reveal my scholastic ratings, as well as degrees or certificates earned, to Pullen; and associations, registration and licensing boards and to others to furnish whatever detail is available concerning my qualifications. I also permit Pullen to conduct a Police, Court, Credit and/or Motor Vehicle Records Investigation of my background. I understand that if I apply or have applied for certain jobs, I may be tested for drug and alcohol use to determine if I am currently abusing these substances. I consent to the testing and understand that the results could preclude my employment.

Signature (typed):

First Name

Last Name

Date

YYYY

Saving this form and sending it to the search committee with your name and date entered here authorizes Pullen Memorial Baptist Church to process your application for employment as stated in the Certification and Release.

Continuation Sheet: Additional Employment

(beginning with the next most recent)

E. Next Most Recent Employment

(explain any gaps in employment)

Job Title:

Employer:

Employer address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number:

(###)

###

####

Supervisor Name:

First Name

Last Name

Starting Salary:

Last Salary:

Date Employed:

YYYY

Date Separated:

YYYY

Full-time for:

(years,months)

Part-time for:

(years,months)

If part-time, number of hours worked per week:

Number of employees supervised by you:

Duties, in order of importance:

Reason for leaving:

F. Next Most Recent Employment

(explain any gaps in employment)

Job Title:

Employer:

Employer address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number:

(###)

###

####

Supervisor Name:

First Name

Last Name

Starting Salary:

Last Salary:

Date Employed:

YYYY

Date Separated:

YYYY

Full-time for:

(years,months)

Part-time for:

(years,months)

If part-time, number of hours worked per week:

Number of employees supervised by you:

Duties, in order of importance:

Reason for leaving:

Church Administrator Application

Pullen Memorial Baptist Church

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