The Executive Committee of the Baptist Convention of the State of Georgia

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1 The Executive Committee of the Baptist Convention of the State of Georgia Employment Application According to its Constitution, the purpose of the Baptist Convention of the State of Georgia is to be a living partnership of churches growing in grace, strengthening one another in faith and working together in obedience to the Great Commandment and the Great Commission of Jesus Christ. It is the policy of the Georgia Baptist Convention to employ only applicants who are members of Southern Baptist churches. Under extraordinary circumstances, the Executive Director can make exceptions to this policy. For all positions, it is the policy of the Convention not to unlawfully discriminate against any employee or applicant for employment on the basis of race, color, age, sex, national origin, ancestry, military service or disability in hiring, training, promotion, salary, benefits, discipline, transfer or termination. Fill in this application in your own handwriting. Write or print legibly. Please answer or acknowledge every question. A résumé may be attached but cannot be used as a substitute for completion of the application. Date of Application: Position Applied For: Salary Desired: Ministry Department: Referral Source: Walk-in Employee: (Name) Call Relative: (Name) Other: (Name) INFORMATION Social Security Number: Drivers License Number: Name: State of License: Last Maiden First Middle Street County: How long at present address? Years: Months: Former Have you ever been known by any other name? If yes, what name(s)? Yes No Telephone No.: ( ) Mobile/Beeper/Other: ( ) If necessary, best time to call you at home is: : a.m. p.m. May we contact you at work? Yes No If yes, work number: ( ) and best time to call: : a.m. p.m. Have you ever filed an application here before? Yes No If yes, give date: Do you have any relatives employed with the Georgia Baptist Convention? Yes No If yes, name and relationship of relative: If referral was made by an employment agency, please give name of agency: Have you ever been employed here before? Yes No If yes, give dates: From: To: Type of employment desired: Full-Time Part-Time Temporary Summer Internship Are you on a lay-off and subject to recall? Yes No Will you relocate if job requires it? Yes No Date available for work: Will you travel if the job requires it? Yes No Will you work overtime if required? Yes No GBC Employee Application Page 1 of 9

2 . It is mandatory that you fill in all this information even if you have a résumé! EMPLOYMENT HISTORY Please start with your present or last position. Include any job-related military service assignments and volunteer activities. You may exclude organizations that would indicate your race, nationality, color, ancestry, sex, age or disability. If you need additional space, please continue on a separate sheet of paper. Present Position: If now employed, why do you wish to make a job change? May we contact for reference? Yes No Later: Last Position: Reason for leaving? Last Position: Reason for leaving? Last Position: Reason for leaving? Last Position: Reason for leaving? Comments (including explanation of any gaps in employment): GBC Employee Application Page 2 of 9

3 RECORD OF EDUCATION School Attended School Name City & State Circle Last Grade Diploma or Type Major Completed Degree Received Last High School Junior College 1 2 College or University Graduate School Trade School/ Continuing Education Professional Certifications/Accreditation/Licenses/Ordinations: Are you currently: Registered Licensed Certified Ordained Church Where Ordained: Date (You may exclude those that would indicate your race, nationality, color, ancestry, sex, age or disability.) List professional, trade, business or civic activities and offices held: Describe any specialized training, apprenticeship, skills and extra-curricular activities: Describe any honors you have received: State any additional information you feel may be helpful to us in considering your application: INDICATE ANY FOREIGN LANGUAGE(S) YOU CAN SPEAK, READ AND/OR WRITE. Speak Read Write Fluent Good Fair Have you ever served as a translator? Yes No If so, where and in what capacity? GBC Employee Application Page 3 of 9

4 JOB RELATED SKILLS Keyboarding: Yes No If yes, Speed Words per minute Filing: Yes No If yes, Method Software (List software programs you have used in the order of your proficiency along with years of experience): Word Processing ( years) Spreadsheets ( years) Databases ( years) Graphics/Desktop Publishing ( years) Operating Systems ( years) Programming ( years) SPECIAL SKILLS AND QUALIFICATIONS Summarize special job-related skills and qualifications acquired from employment or other experience: List any additional information you would like us to consider: PERSONAL If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No Are you legally eligible for employment in this country? Yes No (Proof of U.S. Citizenship or immigration status will be required upon employment.) Have you ever been bonded in a previous job? Don t Know Yes No If yes, has a claim ever been filed against a bond because of your actions? Yes No Is there any reason, including those that are physically, emotionally or mentally related, that might keep you from effectively working with children (age 17 and under) or that might cause a child potential harm? Yes No If yes, please explain: Have you ever been refused participation in any child or youth program? Yes No If yes, please explain: Have you ever been charged with, arrested, indicted for, or plead guilty to a crime?* Yes No If yes, state the nature of the offense, when and disposition: Are you willing to be fingerprinted? Yes No *A conviction record will not necessarily be a bar to employment. This information will be used only for job-related purposes and only to the extent permitted by applicable law. GBC Employee Application Page 4 of 9

5 REFERENCES List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you. Name Relationship Telephone Years Known 1) ( ) 1) ( ) 1) ( ) GOALS Please write a short paragraph explaining your skills/accomplishments that relate to the job for which you are applying. GEORGIA BAPTIST CONVENTION INFORMATION Fill out only if required for position. Name of Southern Baptist Church Where You Are A Current Member: Church Church Telephone No.: ( ) Length of Current Church Membership: [Year(s) & Months] Name of SBC Church Where Previously a Member: Length of Previous Church Membership: [Year(s) & Months] EMPLOYEE SERVICES USE ONLY REFERENCE CHECKS 1) 2) 3) GBC Employee Application Page 5 of 9

6 CONSENT/PERMISSION STATEMENT The information contained in this application is correct to the best of my knowledge. Please initial each statement below. I authorize the Georgia Baptist Convention to obtain information from references, employers and churches herein. I authorize any references, churches or other organizations or employers listed in this application to give you any information, including opinions that they may have regarding my character and fitness as an employee. In consideration of the receipt and evaluation of this application by the Georgia Baptist Convention, I hereby release and agree to hold harmless any individual, church, children s organization, charity, employer, reference, or any other person or organization, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. I understand the Georgia Baptist Convention desires to protect its children; therefore, I give permission for Georgia Baptist Convention leadership to conduct a criminal background check, which may include a review of sex offender registries, child abuse and criminal history records and to maintain my fingerprints and photo ID on file. I understand that the Georgia Baptist Convention has a zero-tolerance policy for sexual misconduct and abuse and any incident will disqualify me from participation in Georgia Baptist Convention activities. I understand that this information will be used only for employment purposes and will not be re-disseminated to other persons or used for any other purpose. I further state that I have carefully read the foregoing release and know the contents thereof, and sign this release as my own free act. I understand that any misrepresentation or omission of a material fact on my application may be justification for refusal of acceptance of my service as an employee. I understand that, if engaged, any misrepresentation made by me in completing this application shall be considered as sufficient cause for removal from service without advance notice. I understand that completion of this application is not a guarantee that any further contact related to employment will be made on behalf of the employer. The applicant understands that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that effect is executed by the employer and employee in writing. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. If applications are being accepted, I understand I will need to fill out a new application in order to apply for a new position. If hired I understand that I am required to abide by all rules and regulations of the employer. If hired I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. Print Name of Applicant: GBC Employee Application Page 6 of 9

7 EMPLOYEE SERVICES USE ONLY Arrange Initial Interview: Yes No Remarks: Arrange Ministry Area Interview: Yes No Remarks: If applicable, Southern Baptist Membership Verified: Degrees/Licenses Verified: Date and Initials Date and Initials Employed: Yes No Date of Employment: Job Title: Hourly Rate/Salary: Department/Ministry Area: By: Name and Title Date NOTES GBC Employee Application Page 7 of 9

8 PARTNERSHIP COMMITMENT STATEMENT I understand that the Georgia Baptist Convention operates in partnership with the Southern Baptist Convention. I have a basic understanding of Baptist doctrine, and agree to work cooperatively in that doctrinal environment. I commit to work in partnership with Georgia Baptists and Southern Baptists. Signature: Print Name: GBC Employee Application Page 8 of 9

9 AUTHORIZATION AND RELEASE OF INFORMATION I hereby authorize the Georgia Baptist Convention and its agent to contact any person or entity named on my application for employment for the purpose of confirming the information contained therein and/or obtaining other information which may be material to my qualifications for employment. I authorize all such persons and entities to release all information they may have which may be material to my qualifications for employment. I also hereby release the agents and any person or entity, which provides information pursuant to this Authorization and Release of Information, from any and all liability based upon the provision of that information. Print Name: Signature: GBC Employee Application Page 9 of 9

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