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Job Application

FACULTY & STAFF APPLICATION
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  Applicant General Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Are you related to anyone employed by Sts. Joan of Arc & Patrick School, St. Joan or Arc Parish or St. Patrick Parish? REQUIRED Please fill out this field.
  
  If yes, please state their name and position or department Please enter valid data.
  
  Employment Desired
  
  Position REQUIRED Please fill out this field. Please enter valid data.
  
  Desired Salary Amount Please enter valid data.
  
  Have you applied to or worked for the Diocese of Lafayette-in-Indiana before? REQUIRED Please fill out this field.
  
  If yes, please provide details Please enter valid data.
  
  Educational Background
  
  Highschool
  
  Name of Highschool REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Year Completed or Graduated REQUIRED Please fill out this field. Please enter valid data.
  
  College
  
  Name of College REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Year Completed or Graduated REQUIRED Please fill out this field. Please enter valid data.
  
  Major / Minor REQUIRED Please fill out this field. Please enter valid data.
  
  Graduate School
  
  Name of College Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Year Completed or Graduated Please enter valid data.
  
  Major Please enter valid data.
  
  Areas of Special Study or Research Work Please enter valid data.
  
  Certifications/Licenses & Expiration Dates: Please enter valid data.
  
  Prior Employment
  
  Name & Address of Employer
  
  Name of Prior Employer REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Position REQUIRED Please fill out this field. Please enter valid data.
  
  Dates From/To REQUIRED Please fill out this field. Please enter valid data.
  
  Reason for Leaving REQUIRED Please fill out this field.
  
  Salary: Begin/End REQUIRED Please fill out this field. Please enter valid data.
  
  Name & Address of Employer
  
  Name of Prior Employer Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Position Please enter valid data.
  
  Dates From/To Please enter valid data.
  
  Reason for Leaving
  
  Salary: Begin/End Please enter valid data.
  
  Name & Address of Employer
  
  Name of Prior Employer Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Position Please enter valid data.
  
  Dates From/To Please enter valid data.
  
  Reason for Leaving
  
  Salary: Begin/End Please enter valid data.
  
  Criminal History
  
  Have you ever been convicted of a criminal offense? REQUIRED Please fill out this field.
  
  If yes, please provide details Please enter valid data.
  
  *All job applications are subject to passing a criminal background conducted via a third-party reporting company
  
  References
  
  Professional Reference
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  How do you know this person? REQUIRED Please fill out this field. Please enter valid data.
  
  Reference
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  How do you know this person? REQUIRED Please fill out this field. Please enter valid data.
  
  Reference
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  How do you know this person? REQUIRED Please fill out this field. Please enter valid data.
  
  APPLICANT'S STATEMENT
  
  I hereby authorize Sts. Joan of Arc & Patrick School / Diocese of Lafayette-in-Indiana to contact, obtain and verify the accuracy of information contained in this application from all previous employers, educational institutions and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.
  
  I understand that certain positions may require the knowledge of or the practice of the Catholic faith. If this is a requirement, I will be told prior to employment.
  
  I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation for this application or immediate termination of employment if I am employed, whenever it may be discovered.
  
  If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause at any time, so as there is no violation of applicable federal or state law.
  
  I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA.
  
  I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment.
  
  I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
  
  My typed name below represents my signature REQUIRED Please fill out this field. Please enter valid data.
  
  I Agree Please select this field.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Submit
  
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