Sample Job Application Form (Page 3 of 3) in pdf

Acknowledgment, Release, and Signature for Inclusion in Application

or with Church Deployment Office Form

To the best of my knowledge, the information contained in this application is complete and

accurate. I understand that providing false information is grounds for not hiring me or choosing

me for a volunteer position or for my discharge if I have already been hired or chosen. I

authorize any person or organization, whether or not identified in this application, to provide any

information concerning my previous employment, education, credit history, driving record,

criminal conviction record, sexual offender registry or other qualifications for my employment or

volunteering. I also authorize ___________________ [Parish or Institution] to request and

receive such information.

If hired or chosen, I agree to be bound by ____________________________ [Parish or

Institution’s] policies and procedures, including but not limited to its Policies for the Prevention

of Sexual Exploitation of Adults and Code of Conduct for Persons Having Pastoral

Relationships.

I understand that these may be changed, withdrawn, added to or interpreted at any time at the

______________________ [Parish or Institution’s] sole discretion and without prior notice to

me.

I also understand that my employment or volunteering may be terminated, or any offer or

acceptance of employment or volunteering withdrawn, at any time, with or without cause, and

with or without prior notice at the option of _____________________ [Parish or Institution] or

myself.

Nothing contained in this application or in any pre-employment or pre-volunteering

communication is intended to or creates a contract between myself and

____________________________ [Parish or Institution] for employment, volunteering or the

providing of any benefit.

I have read and understand the above provisions.

Signature _______________________________________

Date _______________

Print Name _____________________________________

Parish or Institution _________________________________________________________

Sample Job Application Form Page 3