CONTACT INFORMATION

Name

First Name

Last Name

Home phone

(###)

###

####

Business phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

EMPLOYMENT DESIRED

Position applying for

Please indicate the type of employment you are seeking by checking any of the following which apply

Regular full-time work

Regular part-time work

Temporary work

Days and hours available

If hired, on what date can you start work

PERSONAL INFORMATION

Have you ever applied to or worked for SFBFS before?

Yes

If yes, when and where?

Do you have any relatives working for SFBFS

Yes

If yes, state name(s) and relationship

Why are you applying for work at SFBFS?

Are you at least 18 years old?

If under 18, hire is subject to verification that you are of minimum legal age and have been granted a student work permit, if applicable)

Yes

If hired, can you present proof of your legal right to live and work in the United States

Yes

Are you able to perform the essential functions of the position for which you are applying, either with or without reasonable accommodations?

Yes

Have you ever been convicted of a crime other than a traffic violation?

Notes: when responding to this question, please do not include any of the following types of convictions: (1) misdemeanor convictions for marijuana-related offenses more than two years old; (2) convictions that have been sealed, expunged, or legally eradicated; and (3) misdemeanor convictions for which probation was successfully completed or otherwise discharged and the matter was judicially dismissed. A conviction is not an automatic bar to employment — each case will be considered on its own specific merits.)

Yes

If you answered yes, please identify / explain the charge, the court, the date of conviction, and the final disposition of the case

EDUCATION, TRAINING AND EXPERIENCE

Please indicate which of the following you have attended, including name and address, number of years attended, did you graduate, and did you receive a degree or diploma.

HIGH SCHOOL (name and address)

Number of years

Did you graduate?

Yes

Degree or Diploma

COLLEGE UNIVERSITY (name and address)

Number of years

Did you graduate?

Yes

Degree or Diploma

VOCATIONAL/BUSINESS (name and address)

Number of years

Did you graduate?

Yes

Degree or Diploma

OTHER (name and address)

Number of years

Did you graduate?

Yes

Degree or Diploma

Many of our services are provided to persons who do not speak English. Do you speak and/or write any foreign language?

Yes

If yes, which language(s) do you speak?

If yes, which language(s) do you write?

Do you have any other experience, training, qualifications or skills which you believe make you especially suited for work at SFBFS? Is so, please explain:

EMPLOYMENT HISTORY

Are you currently employed?

Yes

If yes, may we contact your current employer?

Yes

Please indicate your 3 most recent jobs.

NAME OF EMPLOYER

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of business

Phone

(###)

###

####

Your supervisor's name

First Name

Last Name

Your position and duties

Dates of employment

Please list start and end dates. If still employed here, write "present" for end date.

Work schedule

Please list how many hours per day, days per week, and months per year you worked here.

Reason for leaving

NAME OF EMPLOYER

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of business

Phone

(###)

###

####

Your supervisor's name

First Name

Last Name

Your position and duties

Dates of employment

Please list start and end dates. If still employed here, write "present" for end date.

Work schedule

Please list how many hours per day, days per week, and months per year you worked here.

Reason for leaving

NAME OF EMPLOYER

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of business

Phone

(###)

###

####

Your supervisor's name

First Name

Last Name

Your position and duties

Dates of employment

Please list start and end dates. If still employed here, write "present" for end date.

Work schedule

Please list how many hours per day, days per week, and months per year you worked here.

Reason for leaving

REFERENCES

Please list 3 persons not related to you who have knowledge of your work performance within the last three years.

NAME OF REFERENCE

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Daytime phone

(###)

###

####

Number of years acquainted

NAME OF REFERENCE

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Daytime phone

(###)

###

####

Number of years acquainted

NAME OF REFERENCE

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Daytime phone

(###)

###

####

Number of years acquainted

I hereby certify that the information in this application form is true and correct to the best of my knowledge, and I agree to having these statements checked by SFBFS and the Diocese. I authorize my personal references and supervisors to provide information about my previous employment, education, and other matters related to my suitability for employment, and I further authorize those individuals to discoles to SFBFS and the Diocese that information without prior notice to me of such disclosure. I hereby release SFBFS and the Diocese and all other paties from any and all liabiility for any damages that may result from furnishing such information to SFBFS and the Diocese or any of its agents, employees, or representatives. I understand that if I have submitted any false or misleading information, or made any material omission from this application, it may result in my failure to receive an offer or, if I am hired, in my dismissal. I also understand and agree that my employment can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of SFBFS and the Diocese. No representative of SFBFS and the Diocese other than the Bishop of Sacramento (or his specific designee) has any authority to agree to the contrary. Further, no represnetative of the SFBFS and the Diocese may alter the at-will nature of the employment unless it is done specifically in a written agreement signed by both of us. In consideration of my employment, if I become employed by SFBFS and the Diocese I agree to conform to all the rules, policies, and standards of conduct of the Diocese. I understand that any offer of employment is conditioned on: (1) My providing satisfactory proof of my identity and legal authority to work in the United States; (2) Obtaining background fingerprint clearance through the California Department of Justice if I am applying for a position in which I will have any contact with minors (children under the age of 18), or if I am later transferred or promoted to such a position within SFBFS and the Diocese; and (3) Obtaining tuberculosis testing clearance, in a manner prescribed by law, if I am applying for a position in which I will have any contact with minors, or if I am later transferred or promoted to such a position within SFBFS and the Diocese.

I have read and agree to the above terms.

Employment Application

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