Wayne Zion Lutheran Church
15531 Co Rd E17, Monticello, IA 52310
319-465-4834
Wayne Zion Lutheran Church is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.
Please fill out all of the sections below:
Applicant Information
Applicant Name: ____________________________________________________________________
Address: ____________________________________________________________________
City, State, Zip: ____________________________________________________________________
Telephone Number: ____________________________________________________________________
Email Address: ____________________________________________________________________
Date of Application: ____________________________________________________________________
Employment Position
Position Applying for: Youth Director (Part-Time)
How did you hear about this position? _______________________________________________
What days are you available to work? ________________________________________________
What hours are you available for work? ________________________________________________
On what date can you start working if you are hired? ______________________________________
Personal Information
Do you have any friends, relatives, or acquaintances working for Wayne Zion Church? Yes No
If yes, please state name & relationship:
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Do you have any conditions which would require job accommodations? Yes No
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:
__________________________________________________________________________________________
__________________________________________________________________________________________
Job Skills/Qualifications
Please list below the skills and qualifications you possess for the position for which you are applying:
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__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
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(Note: Wayne Zion Lutheran Church complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)
Education and Training
High School
| Name | Location (City, State) | Year Graduated | Degree Earned |
College/University
| Name | Location (City, State) | Year Graduated | Degree Earned |
Vocational School/Specialized Training
| Name | Location (City, State) | Year Graduated | Degree Earned |
Military:
Are you a member of the Armed Services? _______________________________________________
Previous Employment
Employer Name: ____________________________________________________________________
Job Title: ____________________________________________________________________
Employer Address: ____________________________________________________________________
City, State, Zip: ____________________________________________________________________
Dates Employed: ____________________________________________________________________
Reason for leaving: ____________________________________________________________________
Employer Name: ____________________________________________________________________
Job Title: ____________________________________________________________________
Employer Address: ____________________________________________________________________
City, State, Zip: ____________________________________________________________________
Dates Employed: ____________________________________________________________________
Reason for leaving: ____________________________________________________________________
Employer Name: ____________________________________________________________________
Job Title: ____________________________________________________________________
Employer Address: ____________________________________________________________________
City, State, Zip: ____________________________________________________________________
Dates Employed: ____________________________________________________________________
Reason for leaving: ____________________________________________________________________
References:
Please provide 3 personal and professional reference(s) below:
| Reference | Contact Information |
AT-WILL EMPLOYMENT
The relationship between you and the Wayne Zion Lutheran Church is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Wayn Zion Lutheran Church. No representative of Wayne Zion Lutheran Church has authority to enter into any agreement contrary to the foregoing “employment at will” relationship. You understand that your employment is ‘at will”, and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement agreed to by a Congregational vote and signed by you and a member of the Executive Committee of the church Council.
Criminal Background Check
By signing this application, you acknowledge that a criminal background check will be conducted due to the nature of this position involving work with children. Any conviction for a crime against children will disqualify you from consideration for this role.
Applicant Signature: _____________________________________ Dated: ________________________
Please return this application along with your resume to:
Waynezionlutheranchurch@gmail.com
Or
Wayne Zion Lutheran Church, 15531 County Road E17, Monticello, IA 52310
Questions? Contact us via email or319-465-4834.