The Life Center Staff Application

By completing this application, you are seeking to join a hardworking team dedicated to The Life Center’s goals and values. The Life Center is a religious 501c3, and as such, reserves the right under Title VII of the Civil Rights Act of 1964 to make employment decisions of all types on the basis of religion. The Life Center reserves the right to exercise a preference for employees who subscribe to The Life Center’s Mission and Vision and are members of The Life Center. All applicants are considered for all positions without regard to race, color, sex, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative.

First Name

Last Name

Phone Number

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Staff Position for which you are applying:

EMPLOYMENT EXPERIENCE

Please list the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give organization name and supply business references.

Workplace #1

Name of Employer:

Job Title:

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Name of Supervisor:

Start Date

End Date

Specific Reason for Leaving:

Please list the jobs you held, duties performed, skills used or learned, and any advancements or promotions while you worked in this position.

May we contact this employer?

Yes

No

Workplace #2

Name of Employer:

Job Title:

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Name of Supervisor:

Start Date

End Date

Specific Reason for Leaving:

Please list the jobs you held, duties performed, skills used or learned, and any advancements or promotions while you worked in this position.

May we contact this employer?

Yes

No

Workplace #3

Name of Employer:

Job Title:

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Name of Supervisor:

Start Date

End Date

Specific Reason for Leaving:

Please list the jobs you held, duties performed, skills used or learned, and any advancements or promotions while you worked in this position.

May we contact this employer?

Yes

No

Have you ever been involuntarily terminated or asked to resign from any job?

Yes

No

Please explain any gaps in your employment history:

Please list any other experience, job related skills, additional languages, or other qualifications that you believe should be considered in evaluating your qualification for employment:

EDUCATION

Please indicate your high school, location, and number of years completed.

If applicable, please indicate your college/university, location, number of years completed, major, and degree.

If applicable, please indicate any specialized training, skills, or extra-curricular activities completed that pertain to the position your are seeking.

If applicable, please indicate your seminary, location, numbers of years completed, area of study, and degree.

PROFESSIONAL REFERENCES

Please list two professional references of individuals who are not related to you.

Professional Reference #1

First Name

Last Name

Title:

Phone Number

Email

Relationship:

Professional Reference #2

First Name

Last Name

Title:

Phone Number

Email

Relationship:

PERSONAL REFERENCES

Please list a person who knows you well.

Personal Reference #1

First Name

Last Name

Relationship:

Years Acquainted:

Phone Number

Email

AGREEMENT

Please read and initial each statement below.

Statement #1

I hereby authorize The Life Center to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to The Life Center any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

Initials:

Statement #2

In the event of my employment with The Life Center, I understand that I am required to comply with all rules and regulations of The Life Center.

Initials:

Statement #3

If hired, I understand and agree that my employment with The Life Center is at-will, and that neither I, nor The Life Center is required to continue the employment relationship for any specific term. I further understand that The Life Center or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.

Initials:

Statement #4

I understand that safety of employees is extremely important to The Life Center and that The Life Center is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to on-the-job safety and health.

Initials:

Statement #5

I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

Initials:

Statement #6

I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.

Initials:

Statement #7

I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed, and the remainder of this Agreement shall be enforceable.

Initials:

SIGNATURE

My signature below attests to the fact that I have read, understand, and agree to all the above terms.

Date Input

The Life Center Staff Application

EMPLOYMENT EXPERIENCE

Workplace #1

Workplace #2

Workplace #3

EDUCATION

PROFESSIONAL REFERENCES

Professional Reference #1

Professional Reference #2

PERSONAL REFERENCES

Personal Reference #1

GENERAL INFORMATION

AGREEMENT

Statement #1

Statement #2

Statement #3

Statement #4

Statement #5

Statement #6

Statement #7

SIGNATURE