Spreadsheet: 10655353-ffc0-430b-ab59-5ee97246a90e
Sheet: Sheet1

UNITED METHODIST COMMUNICATIONS EMPLOYMENT APPLICATION
(PLEASE PRINT OR TYPE IN BLACK INK)
LAST NAME |  |  |  |  |  | FIRST NAME |  |  |  | MIDDLE NAME |  |  |  |  | POSITION APPLIED FOR OR TYPE OF WORK DESIRED:
STREET ADDRESS |  |  |  |  |  |  |  | CITY |  | STATE |  | ZIP CODE |  |  | [   ] | APPLYING FOR FULL-TIME |  |  | [   ] | PART-TIME/TEMP
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] EXPECTED: $
SOCIAL SECURITY NUMBER |  |  |  |  |  | IF NOT U.S. CITIZEN, DO YOU HAVE AUTHORIZATION |  |  |  |  |  | HM PH: |  |  | WK PH: |  | WHO REFERRED YOU?
 |  |  |  |  |  | TO ACCEPT EMPLOYMENT IN U.S.? |  |  |  | Y   /   N |  | CELL PHONE:
DO YOU HAVE ANY PHYSICAL CONDITION THAT WOULD LIMIT YOUR ABILITY TO PERFORM THE JOB APPLIED FOR? |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NAMES OF RELATIVES WORKING AT UMCOM
COMMENT: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (INDICATE RELATIONSHIP)
EVER WORK HERE BEFORE? |  |  |  |  | APPLY? |  | WHEN? |  |  | DATE AVAILABLE FOR WORK: |  |  |  |  |  |  | WOULD YOU RELOCATE WITHIN U.S.?
I HAVE HAD EXPERIENCE OR TRAINING AS CHECKED BELOW:
 | [   ] | WRITING / EDITING |  |  |  |  | [   ] | ART & DESIGN |  | [   ] | SUPERVISION |  |  | [   ] | BOOKKEEPING / ACCOUNTING |  |  |  | [   ] | PRINTING
 | [   ] | PRODUCING & DIRECTING |  |  |  |  | [   ] | MARKETING |  | [   ] | MANAGEMENT |  |  | [   ] | SECRETARIAL |  |  |  | [   ] | PHOTOGRAPHY
 | [   ] | MEDIA PRODUCTION TECHNICAL |  |  |  |  | [   ] | COMPUTER |  | [   ] | CLERICAL |  |  | [   ] | DATA ENTRY |  |  |  | [   ] | TYPING / SPEED
 | [   ] | OTHER |  |  |  |  | LANGUAGES YOU READ, SPEAK OR WRITE FLUENTLY:
EDUCATION |  |  |  |  |  |  |  |  |  |  |  | YEAR  COMPLETED |  | CIRCLE YEAR COMPLETED |  | INDICATE DIPLOMA OR TYPE OF DEGREE |  |  |  |  | AVERAGE GRADE
 |  |  | NAME OF SCHOOL |  |  |  |  | CITY AND STATE |  |  |  |  |  |  |  |  |  | MAJOR(S) |  | MINOR(S)
ELEM. AND |  |  |  |  |  |  |  |  |  |  |  |  |  | 6    7    8    9    10   11   12   GED
HIGH SCHOOL
COLLEGE |  |  |  |  |  |  |  |  |  |  |  |  |  | 13    14    15    16
OTHER
OTHER
SCHOOL HONORS AND AWARDS: |  |  |  |  |  |  |  |  |  |  | SCHOOL ACTIVITIES PARTICIPATED IN AND OFFICES HELD:
U.S. MILITARY |  |  | BRANCH |  |  | DATES (FROM-TO) |  |  | OCCUPATIONAL SPECIALTY |  |  |  | RANK |  |  | Have you been convicted of a felony?
SERVICE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | {    } Yes       or      {   } No
LIST PRESENT AND PAST EMPLOYMENT BEGINNING WITH YOUR LAST POSITION HELD (WRITE ON THE BACK OF THIS SHEET IF MORE SPACE IS NEEDED.)
 | FROM |  | TO
 | MO   /   YR |  | MO   /   YR |  | NAME OF COMPANY AND ADDRESS |  |  |  |  | NAME OF SUPERVISOR |  |  | [NAME] |  | PER | WHAT DID YOU DO? |  |  | WHY DID YOU LEAVE
1
 |  |  |  |  |  |  |  |  |  | PHONE:
2
 |  |  |  |  |  |  |  |  |  | PHONE:
3
 |  |  |  |  |  |  |  |  |  | PHONE:
PERSONAL |  |  | 1 | NAME, OCCUPATION |  |  |  |  |  |  |  |  | The answers given herein are true and correct to the best of my knowledge.  I hereby authorize this company to contact my schools and previous employers for reference information to be held in strict confidence and hereby release the individuals connected therewith from all liability.  My present employer        [   ]  may                     or      [   ]  may not  be contacted.
REFERENCES |  |  |  | ADDRESS |  |  |  |  |  | PHONE
 |  |  | 2 | NAME, OCCUPATION
 |  |  |  | ADDRESS |  |  |  |  |  | PHONE |  |  | DATE: |  |  |  | SIGNED:
Federal and State Civil Rights Acts prohibits discrimination on the basis of race, color, religion, sex, age, national origin or handicapping condition.
Form A/6
6/01