Application For Employment - Diocese Of Venice
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4APPLICATION FOR EMPLOYMENT
I.
PERSONAL INFORMATION
Date
________________________________
Name _______________________________________________
Social Security No.
___________________
Present Address ________________________________________________________________________________________
STREET
CITY
STATE
ZIP
If Less that one year - Previous Address
_________________________________________________________________
STREET
CITY
STATE
ZIP
Phone No.
____________________________
Cell Phone No. ________________________________
Email: __________________________________
Are you at least 18 years of age?
Yes
No
Are you either a U.S. citizen or an alien authorized to work in the U.S.?
Yes
No
Please identify canonical status: Lay
Clergy
Religious
Catholic?
Yes
No
Did your canonical status change
Yes
No
If yes, please give details: _________________________________________________________________________
Have you ever committed or been accused of any offenses involving children or vulnerable adults, or been found guilty of,
regardless of adjudication, or entered a plea of guilty or nolo contendere, or been convicted of a crime? Yes
No
If yes, please explain type of crime, date, place, and penalty imposed:
_________________________________
_____________________________________________________________________________________________________
Are there presently any accusations or criminal charges pending against you?
Yes
No
If yes, please give details: _________________________________________________________________________
_____________________________________________________________________________________________________
Do you agree to disclose any future criminal violations if hired?
Yes
No
Have you ever been a defendant in a civil action for intentional tort?
Yes
No
If yes, please identify the nature of the tort, date and disposition of the action:
__________________________
_____________________________________________________________________________________________________
II.
EMPLOYMENT DESIRED
Diocesan entity ____________________________________________
Position ________________________________
Date you can start __________________________________
Wage/Salary desired ______________________________
Ever applied to the Diocese before? ____________
Where? ___________________________________ When? _________
III. EDUCATION
01/2016
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