Indiana Ave Baptist Church
Staff App: Office Intern
PART - TIME Position (15 - 20 hours)
(806) 797-9704 | 9507 Indiana Ave, Lubbock, Texas 79423
Hours: Mon-Thurs. 1-5 pm, Fri. 9am - 12pm (if possible), and an occasional Sunday morning.
Name
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First
Last
Phone Number w/ area code
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Email
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Desired Salary
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Date available to start
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MM
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DD
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YYYY
Are you at least 18 years old? Or do you have a work permit?
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Yes
No
Referred by or heard about opening from
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Education
High School Name
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College / Vocational School Name
Computer Proficiency & Skills
Knowledge level: 0 - no experience, 1 - familiar, 2 - proficient, & 3 - expert (could teach others).
Microsoft Word
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0
1
2
3
Microsoft Excel
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0
1
2
3
Microsoft Publisher
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0
1
2
3
Microsoft Powerpoint
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0
1
2
3
Briefly Share Your Office Experience and Skills
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Employment History
Starting with most recent, list employment for the past 10 years.
Company Name (most recent)
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Job Title (most recent employment)
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Employment Dates (most recent employment)
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Supervisor Name (most recent employment)
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Supervisor Email (most recent employment)
Supervisor Phone Number (most recent employment)
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-
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-
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Duties & Responsibilities (most recent employment)
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Reason for leaving (most recent employment)
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Do you have a second employer to list?
No
Yes
Company #2
Job Title Company #2
Employment Dates Company #2
Supervisor Name Company #2
Supervisor Email Company #2
Supervisor Phone Number Company #2
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-
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-
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Duties & Responsibilities Company #2
Reason for Leaving Company #2
Do you have a third employer to list?
No
Yes
Company #3
Job Title Company #3
Employment Dates Company #3
Supervisor Name Company #3
Supervisor Email Company #3
Supervisor Phone Number Company #3
###
-
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-
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Full-time
Part-time
Duties & Responsibilities Company #3
Reason for leaving Company #3
Do you have a fourth employer to list?
No
Yes
Company #4
Job Title Company #4
Employment Dates Company #4
Supervisor Name Company #4
Supervisor Email Company #4
Supervisor Phone Number Company #4
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-
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-
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Duties & Responsibilities Company #4
Reason for leaving Company #4
Brag on yourself
Share anything that you think would make you a good candidate for this position.
References: it is good to have one co-worker, if possible.
Reference #1 Name
First
Last
Reference #1 is/was:
Supervisor
Co-Worker
Personal Friend
Reference #1 Phone Number
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-
###
-
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Reference #2 Name
First
Last
Reference #2 is/was:
Supervisor
Co-Worker
Personal Friend
Reference #2 Phone Number
###
-
###
-
####
Reference #3 Name
First
Last
Reference #3 is/was:
Supervisor
Co-Worker
Personal Friend
Reference #3 Phone Number
###
-
###
-
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General
I understand that should I be offered a posiiton ORIGINAL documents for the I-9 are required. Copies / photos are NOT allowed by the US Citizenship and Immigration Services.
*
Yes
No
I understand this is a part-time position (less than 25 hours per week)
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Yes
No
May we contact your current employer for references?
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Yes
No
N/A
May we contact your previous employers for references?
*
Yes
No
N/A
Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?
*
Yes
No
I understand that the hiring process includes a criminal history and a driver's record check. An online form will need to be completed at a later date.
*
Yes
No
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court?
(A yes response does not automatically disqualify your application.)
*
Yes
No
If yes, please explain.
Certification & Authorization
By typing my name in the signature field below I acknowledge that I have read and agree to the statements below and have inquired about any information I don't understand.
The information on this form is true and correct. In the event of my employment by Indiana Ave Baptist Church, I shall be subject to immediate dismissal if any information I have given is false or misleading. I acknowledge that I am subject to immediate dismissal for failure to provide information requested, regardless of the time elapsed after discovery of such information.
If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.
My employment is contingent upon satisfactory completion of the required background check.
Signature
*
First
Last
Date
*
MM
/
DD
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YYYY
Indiana Ave Baptist Church is an equal opportunity/affrimative action employer. All qualified applicants will be considered without regard to age, race, color, sex, national origin, marital status, ancestry, citizenship, or veteran status.
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