Northminster Presbyterian Church Employment Application/criminal History Background Check & Driver'S License Authorization Form (Page 3 of 4) in pdf

Northminster Presbyterian Church Employment Application/criminal History Background Check & Driver'S License Authorization Form Page 3

Previous Position:

Employer: _____________________________________________________ ____

Address:___________________________________________________________

Supervisor: ___________________________________________

Phone: _______________________________

Email: ________________________________

Position Title: _________________________

From: ______________ To: ______________

Responsibilities: ___________________________________________________ __

___________________________________________________________________

Salary: _______________

Reason for Leaving: ____________________________________________ ______

May We Contact Your Present Employer?

Yes _____ No _____

References:

Name/Title Address Phone

___________________________________________________________________

I authorize contact with my references and the verification of any or all information listed above.

I certify that information contained in this application is true and complete. I understand that false information

may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am

hired. I authorize contact with my references and the verification of any or all information listed above.

Signature___________________________________

Date_______________________________________

Northminster Presbyterian Church Employment Application/criminal History Background Check & Driver'S License Authorization Form Page 3