People's City Mission Employment Application

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People's City Mission Employment Application

110 Q Street, Lincoln, NE 68508 (402)-475-1303

Separate applications and job specific supplemental questionnaires are required for each position. Resumes may be helpful and can be included with this application, but cannot be used as a substitute for an application or supplemental questionnaire.

Instructions to Applicant: All required fields must be filled in. Please digitally sign last page. The application and any attachments become the property of the People's City Mission of Lincoln. Please submit resumes to asnavely@pcmlincoln.org

Date *

Department Applying for: *

First Name *

Middle Name

Last Name *

Home Phone: *

Cell phone:

Address 1

Apartment #

Zip *

State/Province *

Social Security Number

Employment Desired:

Full-time

Part-time

On-Call

Date Available to start:

Are you under the age of 18? *

Yes

Are you a United States Citizen? *

Yes

If you are not a citizen, give the number of your permanent resident card or work permit:

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Criminal History

Have you ever been convicted of any violations of law other than a minor traffic violation? *

Yes

If yes, please explain below: List ALL convictions for any law violations such as DUI, shoplifting, minor in possession, reckless driving, etc., including convictions that have been set aside, pardoned, or expunged. Minor traffic violations, i.e., parking ticket, speeding tickets, do not need to be listed.

Date and charge 1:

Date and charge 2:

Date and charge 3:

Date and charge 4:

Date and charge 5:

Date and charge 6:

Explanation: A conviction will not automatically disqualify you from consideration. We will consider the nature of the offense in relation to the job for which you are applying. We will also consider your record since the offense was committed.

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People's City Mission Employment Application

Do any of your relatives work in a supervisory position? *

Yes

If yes, give names and departments:

Have you ever worked for People's City Mission of Lincoln? *

Yes

If yes, what are the dates and departments you worked for?

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Employment/Volunteer/Military Record (most recent) 1 of 3

1 Title

1 Address

City, State and Zipcode

Supervisor Name:

Supervisors Phone Number:

Date Started (mnth and year)

Date Left (mnth and year)

Pay at Start::

Pay at End::

What were your responsibilities?

Reason for leaving:

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Employment/Volunteer/Military Record - 2 of 3

Title

Address

City and Zip

State

Name of Supervisor:

Supervisor Phone Number:

Date Started (month and year)

Date Left (month and year)

Pay at Start:

Pay at End:

What were your duties?

Reason for leaving?

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Employment/Volunteer/Military Record - 3 of 3

- Title

- City and Zip

- State

- Name of Supervisor:

- Supervisor Phone Number:

- Date Started (month and year)

- Date Left (month and year)

- Pay at Start:

- Pay at End:

- What were your duties?

- Reason for leaving?

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Please Read Before Signing

I understand that:

Any Material omissions and/or false information I record on the application will be sufficient reason for rejection of this application or termination of my employment. In addition, I authorize and request now or in the future each and every former employer, school, individual, agency, organization, or law enforcement agency to answer any and all questions that may be asked and herewith hold such persons harmless for giving any information with their knowledge or record.

As a CONDITION OF EMPLOYMENT, I agree to submit documents relating to my identity and employment authorization within prescribed time limits in accordance with the Immigration Reform and Control Act of 1986.

If I am applying for a safety sensitive position covered by the Federal Department of Transportation regulations, applicants and employees are subject to mandatory drug and alcohol testing policies as a CONDITION OF EMPLOYMENT.

All People's City Mission employees, regardless of status, are subject to Reasonable Suspicion, Return to Duty, and unannounced Follow-up Drug and Alcohol testing. Employees who test positive are subject to discipline up to and including termination.

If hired, probationary, temporary and unclassified employees have no right to regular status employment or appeal rights, if terminated.

THIS FORM IS FOR APPLICATION PURPOSES ONLY AND IS NOT A CONTRACT FOR EMPLOYMENT.

This application must be signed and dated for consideration of employment.

DIGITAL SIGNATURE: *

DATE: *

People's City Mission is incorporated as a privately funded non-profit Christian ministry. Please share some thoughts regarding your philosophy of ministry/faith and how that would relate to employment at People's City Mission. Please use another sheet, if needed, for additional comments.

comments: *

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People's City Mission Employment Application

Criminal History

People's City Mission Employment Application

Employment/Volunteer/Military Record (most recent) 1 of 3

Employment/Volunteer/Military Record - 2 of 3

Employment/Volunteer/Military Record - 3 of 3

Educational Record

Vocational Education (Business School, Trade School, Service School, etc)

College and University

Please Read Before Signing

THIS FORM IS FOR APPLICATION PURPOSES ONLY AND IS NOT A CONTRACT FOR EMPLOYMENT.