<p> Black Rock Congregational Church Date ______3685 Black Rock Turnpike Fairfield, CT 06825</p><p>Application for Employment</p><p>PERSONAL INFORMATION Name (First) (Middle) (Last)</p><p>Address (Street) (City) (State) (Zip) Day phone DOB (optional) Evening Cell SSN E-mail: Driver’s License # ______State ______</p><p>May we inquire of your present employer? Please list names, addresses and telephone numbers for three references to whom you are not related:</p><p>1. 2.</p><p>3.</p><p>Have you ever been convicted of a felony? yes ___ no ___</p><p>Please attach a resume detailing education and complete employment history, or complete below: FAMILY INFORMATION Marital status: married ___ single ___ divorced ___ widowed ___ remarried ___</p><p>Brief statement, if desired:</p><p>Name of spouse:</p><p>Has your spouse been married before? yes ___ no ___ </p><p>Names and birthdates of children:</p><p>EDUCATION College Location Major Degree</p><p>Graduate/Seminary Location Major Degree</p><p>Other education which may be relevant to your qualifications for this position:</p><p>EMPLOYMENT HISTORY (Begin with most recent employer) Name and Address of Employer Position Dates</p><p>Brief description of duties:</p><p>Name and Address of Employer Position Dates</p><p>Brief description of duties:</p><p>Name and Address of Employer Position Dates</p><p>Brief description of duties:</p><p>List other positions held, including employer, title or position, and dates:</p><p>MINISTRY ACTIVITIES Please describe any participation you have had with ministry activities related to position to which you are applying:</p><p>CHURCH BACKGROUND With what church and denomination are you presently affiliated?</p><p>Church name:</p><p>Address:</p><p>Pastor: Denomination:</p><p>How long have you been a member? Have you been ordained?</p><p>Ordained as: Date: By: List any other church positions or responsibilities:</p><p>Are you in agreement with principles stated in the Black Rock Statement of Faith? Yes ___ No ______Yes, with the following reservations:</p>