Last Name
First Name
Middle Name
Other Names
Dates
Present Address
How long at this location?
Home Telephone Number
Cell Number
Email
Previous Address
How long at this location?
Position Applied for?
Dates you are available to start
How long have you attended Marlbrook Baptist Church?
Address
Senior Pastor
Dates Attended
Reasons for Leaving
Professional organizations, memberships, and licenses (including CDL licensing):
Date Received
License Number
Date Completed
Date Completed
Telephone Number
Address
Supervisor
Title
Responsibilities
Dates of Service
Email
Address
Home Telephone Number
Cell Number
Relationship to Reference
Email
Address
Home Telephone Number
Cell Number
Relationship to Reference
Email
Address
Home Telephone Number
Cell Number
Relationship to Reference
I hereby certify that the information I have provided on this application is true and complete. I authorize the Ministry to verify the information I have provided on this application by contacting the references, churches, and employers I have listed, or by other means, including contacting others whom I have not listed. I authorize the references and employers listed in this application to give the Ministry whatever information they may have regarding my character and fitness for the job for which I have applied. Furthermore, I waive any rights I may have to confidentiality regarding the information that is obtained.
Date
In consideration of my application for employment or volunteer service with Marlbrook Baptist Church, I HEREBY RELEASE the Ministry and its agents as well as any individual, company, law enforcement or records custodian agency, church, youth organization, charity, employer, reference, or any other person or organization, from any and all liability for damages of whatever kind or nature, which may at any time result to me on account of compliance or any attempts to comply with the check of my background, including by means of a criminal background check or reference check.
Signature
Date
I, (name) hereby authorize Marlbrook Baptist Church (the “Ministry”) or its designated agent(s) to conduct both an initial and any future comprehensive reviews of my background for employment and/or volunteer purposes as the Ministry may require or request. I understand the scope of this check may include but is not limited to civil and criminal history records from any criminal justice agency in any federal, state, or local jurisdiction, driving records, or any other public record. I also understand that the Ministry may use the results of the background check to make decisions relating to my potential employment and/or volunteer service.
First Name
Middle Name
Print Maiden Name (if applicable)
Print Other Names Used by Applicant (if applicable)
Date of Birth
Place of Birth
Social Security Number
Driver's License Number
Issuing State
Expiration Date
Address
City
State
Zip Code
Signature of Applicant
Today's Date
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