Parklawn job application Step 1 of 6 16% Date* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Are there other names under which you have worked or attended school?* Yes No If yes, please list for reference checking purposes.Are you legally authorized to work in the U.S.?*If hired you'll be required to provide proof of work authorization. Yes No Are you at least 18 years old?*If not, your employment will be subject to veriﬁcation that you meet state/federal minimum age requirements for the type of work you are applying for and have obtained a valid work permit. Yes No Have you ever applied at Parklawn Assembly of God before?* Yes No If yes, when?Have you ever worked at Parklawn Assembly of God before?* Yes No If yes, when? Position you are applying for:*Are you seeking full-time or part-time employment?* Select All Full-time Part-time What is your salary preference?*What is your shift preference?*When are you available to start?*How were you referred to PAOG?* PAOG Member PAOG Website Friend / Relative Social Media School Other Referring PAOG Member:Referring Friend / Relative:Other:If relevant, please describe computer proficiency, software knowledge, and ofﬁce equipment experience.If relevant, please list any special skills you may have. EducationHigh School*Name & Location (City, State)Number of Years AttendedDegree / Diploma Received (Yes or No)College*Name & Location (City, State)Number of Years AttendedMajor Subjects / Field of StudyDegree / Diploma Received (Yes or No)GraduateName & Location (City, State)Number of Years AttendedMajor Subjects / Field of StudyDegree / Diploma Received (Yes or No)Other (Please specify.)Name & Location (City, State)Number of Years AttendedMajor Subjects / Field of StudyDegree / Diploma Received (Yes or No)Training CoursesList any relevant programs completed.Course / SeminarOrganizationContentDate(s) Attended Required License(s)If required to drive a motor vehicle for the job applying for, state your:*Driver's License NumberState Issued Are you licensed with any group, association or society relating to the job for which you are applying?* Yes No If yes, please complete.Registration / License NumberState IssuedExpiration Date Employment HistoryPlease start with most recent employment history and add up to four previous places of employment.Employer #1*Name of EmployerTelephoneAddress *Job TitleEmployment Dates (month and year, beginning and ending) Description of Duties*Reason for Leaving*Immediate Supervisor*May we contact as a reference?* Yes No Employer #2*Name of EmployerTelephoneAddress *Job TitleEmployment Dates (month and year, beginning and ending) Description of Duties*Reason for Leaving*Immediate Supervisor*May we contact as a reference?* Yes No Employer #3*Name of EmployerTelephoneAddress *Job TitleEmployment Dates (month and year, beginning and ending) Description of Duties*Reason for Leaving*Immediate Supervisor*May we contact as a reference?* Yes No Employer #4*Name of EmployerTelephoneAddress *Job TitleEmployment Dates (month and year, beginning and ending) Description of Duties*Reason for Leaving*Immediate Supervisor*May we contact as a reference?* Yes No Employment ReferencesList individuals familiar with your job qualiﬁcations (no relatives or personal friends).Reference #1*NamePhoneEmail *RelationshipHow long known? Reference #2*NamePhoneEmail *RelationshipHow long known? Reference #3*NamePhoneEmail *RelationshipHow long known? Electronic Signature* All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize Parklawn Assembly of God Church to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.) Regardless of whether or not I become employed by Parklawn Assembly of God Church, I recognize this application is not and should not be considered a contract of employment. I understand that employment at Parklawn Assembly of God Church is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or Parklawn Assembly of God Church, I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than the Chief Ministry Operations Officer of Parklawn Assembly of God Church, and then only by means of a signed, written document. I have read the following and agree to the terms listed. Employment Opportunities Employment Application Background Check Form For more information, contact firstname.lastname@example.org.