Employment Application Employment Form This field is hidden when viewing the formDate MM slash DD slash YYYY First Name*Last Name*Phone*Email* Location Information* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Position Sought*Were you referred by a current employee? Yes No Name of referring employeeWages Expected*Please state your reason for interest:*Are you legally eligible for employment in the United States?* Yes No Relevant Certifications:Church you are currently involved in:*Have you ever been convicted of a felony?* No Yes Please explain:Employment dates if previously employed with The Centre or LCSDo you have friends or relatives in our employment?* No Yes NameRelationshipAdd another friend or relative ADD NameRelationshipAdd another friend or relative ADD NameRelationshipEducationHigh SchoolCity/StateNumber of Years CompletedPlease enter a number from 0 to 10.Diploma or GED?* Yes No CollegeCity/StateNumber of Years CompletedPlease enter a number from 0 to 20.Degrees Earned:Former EmploymentList below all previous employers starting with the most recent employer. Attach additional paperwork if necessary.Employer 1City/StateSupervisorDates of EmploymentWork PerformedWagesReason for LeavingEmployer 2City/StateSupervisorDates of EmploymentWork PerformedWagesReason for LeavingAdditional Documentation (Cover Letter, Resume, additional documentation) Drop files here or Select files Max. file size: 50 MB. ReferencesPlease provide three personal references. Please include one pastor or church leader.Reference 1 - Name*Relationship*Phone*Email* Reference 2 - Name*Relationship*Phone*Email* Reference 3 - Name*Relationship*Phone*Email* It is the process of the Christian Family Centre not to discriminate on the basis of race, color, national or ethnic origins in the administration of its programs, services, and events, and all other administered programs. Part of the employment process is completion of a background check which may include LIVESCAN fingerprinting. You will receive directions on how to complete the process upon employment. Clicking the Submit button will serve as your electronic signature CAPTCHA