St.

Christopher’s Episcopal Church

Personal Information

Name: _______________________________________________ Date: ________________________

Address: _________________________________________________________________________________
(Street) (City) (Zip Code)

Social Security Number: ________________________ Home Phone: _________________________

Best time and number to contact you: _____________________________________________________

E-mail address _______________________________________________________________________

Are you at least 18 years of age? Yes _________ No __________

Are you legally eligible to work in this county? Yes __________ No ____________
Note: If you are chosen for a paid position, you will be required to show documents verifying your employment eligibility
and identity to complete the INS Form I-9 as required by the Immigration Reform and Control Act.

Please list all counties and states where you have lived in the past five years:___________________________

________________________________________________________________________________________

For what type of work are you applying? _______________________________________________________

What has prepared you for this type of work? ___________________________________________________

________________________________________________________________________________________

Education
Are you a high school graduate? Yes ______ No _________

Have you attended any college? Do you have a degree applicable to the type of work for which you are
applying? If yes, please state the degree. _______________________

Have you attended any specialty courses related to the work for which you are applying? If yes, please briefly
describe. _________________________________________________________________________________
Work Experience:
1. Date: From _____________ to ___________________ Position: _________________________________

Employer: ________________________________________________________________________________

Address: _____________________________________________ Telephone: _________________________

Salary: ________________________________ Reason for leaving: _________________________________

_________________________________________________________________________________________

2. Date: From _____________ to ___________________ Position: _________________________________

Employer: ________________________________________________________________________________

Address: _____________________________________________ Telephone: _________________________

Salary: ________________________________ Reason for leaving: _________________________________

_________________________________________________________________________________________

Work Experience:

3. Date: From _____________ to ___________________ Position: _________________________________

Employer: ________________________________________________________________________________

Address: _____________________________________________ Telephone: _________________________

Salary: ________________________________ Reason for leaving: _________________________________

Use and attach additional sheets if necessary.

Computer Experience: (List what programs you may be familiar with) _________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

________________________________________________________________________________________

Volunteer Experience (related to the field in which you are applying)

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________
References: (List three, giving name, address and telephone number. Do NOT list relatives.)

1. _______________________________________________________________________________________
(Name) (Address) (Telephone)

2. _______________________________________________________________________________________
(Name) (Address) (Telephone)

3. _______________________________________________________________________________________
(Name) (Address) (Telephone)

4. _______________________________________________________________________________________
(Name) (Address) (Telephone)

Have you ever been convicted of a crime other than a minor traffic violation? If yes, please provide basic
details. __________________________________________________________________________________

Applicant’s Statement:
I am aware that a criminal and sex offender background check will be done by St. Christopher’s Episcopal
Church.

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in
arriving at an employment decision. I understand that this application is not and is not intended to be a contract
of employment.

In the event of employment, I understand that false or misleading information given in my application or
interview may result in termination. I also understand that I am required to abide by all rules and regulations set
forth by _______________ as my ultimate employer.

I understand that Texas is a Fair Employment state and should it become necessary after the event of
employment, I may be terminated within 90 days of said employment without being given notice or reasons for
termination.

Today’s Date: __________________ Date applicant available to start work: __________________

Signature of applicant: __________________________________