Indiana Ave Baptist Church
Application: Building Staff
This is a PART-TIME position
(806) 797-9704 > 8315 Indiana Avenue > Lubbock, Texas 79423
Name
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Email
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Desired Salary
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Date available to start
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Are you at least 18 years old? Or do you have a work permit?
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Yes
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Referred by
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Education
High School Name & Graduation Date
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College / Vocational School Name & Graduation Date
Experience, Skills and Knowledge
Check your level of knowledge:
Computers: 1 - basic, 2 use frequently, 3 - can teach.
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Skills and previous experience in custodial duties:
Employment History
Starting with most recent, list employment for the past 10 years.
Company Name (most recent)
Job Title (most recent employment)
Employment Dates (most recent employment)
Supervisor Name (most recent employment)
Supervisor Email (most recent employment)
Supervisor Phone Number (most recent employment)
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Duties & Responsibilities (most recent employment)
Reason for leaving (most recent employment)
Do you have a second employer to list?
No
Yes
Company #2
Job Title Company #2
Employment Dates Company #2
Supervisor Name Company #2
Supervisor Email Company #2
Supervisor Phone Number Company #2
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Duties & Responsibilities Company #2
Reason for leaving Company #2
Do you have a third employer to list?
No
Yes
Company #3
Job Title Company #3
Employment Dates Company #3
Supervisor Name Company #3
Supervisor Email Company #3
Supervisor Phone Number Company #3
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Duties & Responsibilities Company #3
Reason for leaving Company #3
Do you have a fourth employer to list?
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Yes
Company #4
Job Title Company #4
Employment Dates Company #4
Supervisor Name Company #4
Supervisor Email Company #4
Supervisor Phone Number Company #4
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Duties & Responsibilities Company #4
Reason for leaving Company #4
Personal Reference
Please list 3 personal references
Name Reference #1
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Phone Number Reference #1
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Name Reference #2
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Name Reference #3
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General
May we contact your current employer for references?
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Yes
No
May we contact your previous employers for references?
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Yes
No
Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?
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Yes
No
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court?
(A yes response does not automatically disqualify your application.)
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Yes
No
If yes, please explain.
I understand that the hiring process includes a criminal history and a driver's record check. An online form will need to be completed at a later date.
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No
Certification & Authorization
By typing my name in the signature field below I acknowledge that I have read and agree to the statements below and have inquired about any information I don't understand.
The information on this form is true and correct. In the event of my employment by Indiana Ave Baptist Church, I shall be subject to immediate dismissal if any information I have given is false or misleading. I acknowledge that I am subject to immediate dismissal for failure to provide information requested, regardless of the time elapsed after discovery of such information.
If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.
My employment is contingent upon satisfactory completion of the required background check.
Signature
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Date
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Indiana Ave Baptist Church is an equal opportunity/affrimative action employer. All qualified applicants will be considered without regard to age, race, color, sex, national origin, marital status, ancestry, citizenship, or veteran status.
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