Page 1 PERSONAL INFORMATION DATE: Name: _ (Last) (First) (Middle) Present address: (Street) (City) (State) (Zip) Length at current address: Birth Date: Telephone: Home Business Cell Email address: Personal website address: If hired, can you present proof of your legal right to live and work in this country? YES NO N/A Citizenship: Number of years lived in the U.S. Marital Status: Married Separated Divorced Widowed Single If Married, Name of Spouse: Occupation: Names and Ages of Children Are you ordained? YES NO Date and Place of Ordination: Denomination: Are you a certified/licensed counselor? YES NO Have you been baptized by immersion, in the name of the Father, the Son, and the Holy Ghost? YES NO If you have not been baptized by immersion, would you submit to baptism by immersion? YES NO HAVE YOU EVER FILED FOR BANKRUPTCY? YES NO If yes, please state the nature and circumstances of the bankruptcy. If there is case number, please provide the number: 1. Have you ever been fired from a position? YES NO 2. Have you ever been convinced of a felony? YES NO 3. Have you ever been convicted of a misdemeanor? YES NO If you answered yes to either of the previous two questions, please state the nature of the crime(s), when and where convicted, and the disposition of the case on attached sheet.
Page 2 TYPE OF SCHOOL College/University EDUCATIONAL BACKGROUND NAME OF LOCATION (Complete SCHOOL mailing address) NO. OF YEARS COMPLETED MAJOR AND DEGREE Vocational or Technical School Seminary Degrees (Required) Honorary Degrees Graduate School Other/Certifications If you answer Yes to any of the questions in the following section, please explain on the attached sheet the nature of the suit, offense, date, court, and disposition or other appropriate explanation. A conviction record will not automatically be a bar to employment. Factors such as your age at the time of the crime, seriousness and nature of the violation, time elapsed since the crime, job relatedness, and subsequent rehabilitation will be considered. 1. Are you presently being investigated or under a procedure to consider your discharge for misconduct by your present employer? YES NO 2. Has any employer ever subjected you to disciplinary action, suspended, terminated, or asked you to leave a job or volunteer position on the grounds of any unlawful sexual behavior, or violation of an employer s sexual misconduct or harassment policy? YES NO 3. Have you ever been charged, found guilty of or found involved in civil or criminal proceedings with improprieties regarding children? YES NO 4. Have you ever entered a plea of guilty, a plea of no contest (nolo contendere), or has any court ever deferred further proceedings without entering a finding of guilt and placed you on probation or in a community service or education program for any crime other than a minor traffic offense? YES NO 5. Have you ever been suspended, discharged, or resigned in lieu of discharge from any position? YES NO
Page 3 MINISTERIAL EXPERIENCE Ministerial Experience: Please list your ministry experience for the past seven years beginning with your most recent position held. Attach additional sheets if necessary. Employer/Church: Job title: Supervisor: Dates Employer/Church: Supervisor: Job title: Dates Employer/Church: Supervisor: Job title: Employer: Dates Dates
Page 4 WORK EXPERIENCE Work Experience: Please list your work experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary. Name of employer: Your last job title: Name of last supervisor: Employment Dates Name of employer: Name of last supervisor: Employment Dates Your last job title: Name of employer: Name of last supervisor: Employment Dates Your last job title: Name of employer: Name of last supervisor: Employment Dates Your last job title: What evidence is there that you are able to operate cross-culturally and be at home in a multicultural community? What experience have you had in a multicultural community?
Page 5 LEADERSHIP ROLES What are your strengths as a leader? What evidence exists to confirm the strengths that you have delineated? What are your weaknesses as a leader? Discuss three goals or objectives you would like to accomplish in your first year as Pastor of Mt. Olive Baptist Church. Do you use social media outlets for communications? YES NO If so, please list the social media networks you use (i.e., Facebook, Twitter), include screen names, hashtags, and affiliations :
Page 6 PROFESSIONAL, PERSONAL, AND SPIRITUAL REFERENCES List references that are qualified to speak of your spiritual experience and Christian service. 1. Name/Complete Address Phone Position 2. Name/Complete Address Phone Position 3. Name/Complete Address Phone Position 4. Name/Complete Address Phone Position 5. Name/Complete Address Phone Position
Page 7 Additional Academic Experience (post-secondary) Please list courses attempted and whether or not completed; part-time or full time; dates, institutions and certificates received. Please briefly describe your general background. Summarize your ministry strengths and weaknesses; ministry preferences and vision; and your special interests in ministry. What evidence is there that you are able to operate cross-culturally and be at home in a multicultural community? What experience have you had in a multicultural community? AGREEMENT (PLEASE READ CAREFULLY PRIOR TO AFFIXING SIGNATURE) Read Carefully, Initial Each Paragraph and Sign Below initials I certify that all the information in this application is accurate and complete to the best of my knowledge and I have not knowingly withheld any information that might adversely affect my chances for employment. I understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment. initials I understand that I consent to submit to a criminal records check and/or background check by the appropriate investigating authorities. Signature of applicant: Date: ***PLEASE USE THE ATTACHED PAGES TO COMPETELY ANSWER THE NUMBERED QUESTIONS THROUGHOUT THE APPLICATION***
Page 8 ADDITIONAL ANSWER PAGES PAGE 1 QUESTIONS 1-3: 1. 2. 3.
Page 9 ADDITIONAL ANSWER PAGES PAGE 2 QUESTIONS 1-5: 1. 2. 3. 4. 5.