Concordia Lutheran

Personal Information

First name*

Middle name*

Last name*

Are you at least 21 years of age?*

Yes

No

SSN Last 4*

Current address*

Primary phone*

Secondary phone

Email address*

Referred by*

Employment Desired

Employment type (check all desired)*

Full time

Part time

Seasonal

Substitute

Other

Please specify other employment type*

Position or Title*

Date you can start*

Desired Salary*

/hr or /yr*

Have you worked for Concordia Lutheran before?*

Yes

No

When did you work for Concordia Lutheran previously?*

What was your reason for leaving?*

Do you plan to work for another business while employed by Concordia Lutheran?*

Yes

No

Please indicate business, position and days/hours of the week employed*

Education History

High School

Name*

Location*

Number of years attended*

Did you graduate?*

Yes

No

Check this box if you attended college

College

Name*

Location*

Number of years attended*

Course of Study or Degree Name*

Did you graduate?*

Yes

No

Check this box if you attended trade, business, or correspondence school

Trade, Business, or Correspondence School

Name*

Location*

Number of years attended*

Course of Study, Degree or Diploma Name*

Did you graduate?*

Yes

No

General Information

Please specify any languages that you speak, read and write proficiently:

Any additional comments regarding languages

Please list any subjects of special study / research work

Please list any specialized skills you possess and equipment, including computer programs, which you operate proficiently

Work History

Please complete the following section regarding your last three employers, beginning with the most recent one first

Employer #1

Employer Name*

Employer Location*

Employer Phone

Supervisor Name*

Start Date*

End Date*

Wage*

/hr or /yr*

Position or Title*

Reason for leaving*

Employer #2

Employer Name*

Employer Location*

Employer Phone

Supervisor Name*

Start Date*

End Date*

Wage*

/hr or /yr*

Position or Title*

Reason for leaving*

Employer #3

Employer Name*

Employer Location*

Employer Phone

Supervisor Name*

Start Date*

End Date*

Wage*

/hr or /yr*

Position or Title*

Reason for leaving*

Concordia Lutheran contacts prior employers to obtain references regarding work history, conduct and suitability for employment. May we contact your present employer at this time?*

Yes

No

Have you ever been terminated from employment or asked to resign by any employer?*

Yes

No

Please provide employer, location, dates and describe circumstances*

References

Please list three persons, not related to you, whom you have known at least one year

Reference #1

Name*

Relationship*

Phone*

Number of years known*

Reference #2

Name*

Relationship*

Phone*

Number of years known*

Reference #3

Name*

Relationship*

Phone*

Number of years known*

Criminal History

You must include information on ALL convictions, pleas, and alternative disposition programs that have occurred during your lifetime. Please disclose any criminal offense that may appear on your record, even if you are uncertain of the exact date or how the criminal offense was classified. State the approximate date and your understanding of the criminal classification.

Note: conviction of a crime is not an automatic bar to consideration of employment, except where state law prohibits employment.

Have you at any time (check all that apply)

Pled guilty

Pled nolo contendere (no contest)

Have been convicted of any criminal offenses (misdemeanor or felony) other than parking tickets

Check this box if you have ever been subject to judicial or non-judicial punishment under the Uniform Code of Military Justice

Please provide complete information on all criminal offense(s), date(s), location(s) (city and state) and disposition*

Check this box if NONE of this section pertains to you.

Additional Information

Provide any additional information you believe will assist us in considering your application, including membership in professional or civil organizations, specialized training, apprenticeships or other qualifications.

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Today's date is: May 8, 2024

Applications for employment will be actively considered for the positions listed for 180 days after submission to Concordia Lutheran. Applicants seeking other positions or consideration after this time period has expired must submit another application. Concordia Lutheran may not interview all applicants for a vacancy. Those applications to be interviewed will be contacted by Concordia Lutheran.

Background Check

All applications require a recent background check.

Continue to fill out background check next.*

Yes

No

Select 'No' if you already have a recent background check on file from volunteering with us.

Concordia Lutheran Employment Application Form