Personal Information s2

Black Rock Congregational Church Date ______3685 Black Rock Turnpike Fairfield, CT 06825

Application for Employment

PERSONAL INFORMATION Name (First) (Middle) (Last)

Address (Street) (City) (State) (Zip) Day phone DOB (optional) Evening Cell SSN E-mail: Driver’s License # ______State ______

May we inquire of your present employer? Please list names, addresses and telephone numbers for three references to whom you are not related:

Have you ever been convicted of a felony? yes ___ no ___

Please attach a resume detailing education and complete employment history, or complete below: FAMILY INFORMATION Marital status: married ___ single ___ divorced ___ widowed ___ remarried ___

Brief statement, if desired:

Name of spouse:

Has your spouse been married before? yes ___ no ___

Names and birthdates of children:

EDUCATION College Location Major Degree

Graduate/Seminary Location Major Degree

Other education which may be relevant to your qualifications for this position:

EMPLOYMENT HISTORY (Begin with most recent employer) Name and Address of Employer Position Dates

Brief description of duties:

Name and Address of Employer Position Dates

List other positions held, including employer, title or position, and dates:

MINISTRY ACTIVITIES Please describe any participation you have had with ministry activities related to position to which you are applying:

CHURCH BACKGROUND With what church and denomination are you presently affiliated?

Church name:

Address:

Pastor: Denomination:

How long have you been a member? Have you been ordained?

Ordained as: Date: By: List any other church positions or responsibilities:

Are you in agreement with principles stated in the Black Rock Statement of Faith? Yes ___ No ______Yes, with the following reservations: