Employment Application

Contact & Position

Full Name

E-Mail

Address

City / State / Zip

Primary Phone

Secondary Phone

Text #

Desired Position

Desired Location

Regional Office Reynoldswood Site Wesley Woods Site

Can you perform the essential functions of the job with or without reasonable accommodations?

Yes No

Reliable transportation?

Yes No

Education

Highest grade and/or degree completed

Summary

High School

From

To

School

City, State

Extra Curricular

Diploma

Trade School

From

To

School

City, State

Major

Diploma

College 1

From

To

School

City, State

Major

Diploma

College 2

From

To

School

City, State

Major

Diploma

Other

From

To

School / Program

City, State

Major

Diploma

Certifications & Licenses

Certification 1

Expires 1

Certification 2

Expires 2

Certification 3

Expires 3

Certification 4

Expires 4

Work Experience

Start with your present or most recent position.

Employer 1

Firm

Employed From

To

Firm’s Phone Number

Salary

Salary Type

Address

City / State / Zip

Position Title

Supervisor

Type of Work

Why leaving / left

If we may not contact this employer, why not?

May we contact this employer?

Yes No

Employer 2

Firm

Employed From

To

Firm’s Phone Number

Salary

Salary Type

Address

City / State / Zip

Position Title

Supervisor

Type of Work

Why leaving / left

If we may not contact this employer, why not?

May we contact this employer?

Yes No

Employer 3

Firm

Employed From

To

Firm’s Phone Number

Salary

Salary Type

Address

City / State / Zip

Position Title

Supervisor

Type of Work

Why leaving / left

If we may not contact this employer, why not?

May we contact this employer?

Yes No

Camp Experience

Camp Experience 1

Camp

From

To

City, State

Camper, or Position

Describe Your Experience

Camp Experience 2

Camp

From

To

City, State

Camper, or Position

Describe Your Experience

Camp Experience 3

Camp

From

To

City, State

Camper, or Position

Describe Your Experience

Personal Qualifications

List your personal skills, experiences, or qualifications that would help you perform the tasks for which you are applying

Why would you like to work for Outdoor and Retreat Ministries?

Background

Is there any reason that you may be prohibited from working with children?

Yes No

Are there any facts or circumstances involving you or your background that would call into question our entrusting you to supervise, guide or care for children or youth?

Yes No

Explain any “Yes” answers

References

Reference 1

Name

Phone

Address

City / Zip

Reference 2

Name

Phone

Address

City / Zip

Reference 3

Name

Phone

Address

City / Zip

Acknowledgements & Signature

Applicant certification

By my signature and initials placed below, I certify that the information provided in this employment application (and accompanying résumé, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, if discovered at a later date. I agree to immediately notify the Northern Illinois Conference if I should be convicted of any crime while my job application is pending, or during my period of employment, if hired.

Initials

At-will employment statement

I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time. I understand that no person is authorized to change any of the terms mentioned in this employment application form.

Initials

Signature (typed full name)

Date

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