Rocketown · Employment Application

Position applying for:

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Full Time Staff

Part Time Staff

Position Desired:

Contact Information

Name

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Prefix

First Name

Last Name

Suffix

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email

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Verify Email

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Cell Phone

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Education

High School

Name, City, Dates Attended, Diploma/Degree

Undergraduate/College

Name, City, Dates Attended, Diploma/Degree

Graduate/Professional

Name, City, Dates Attended, Diploma/Degree

Other (Specify)

Name, City, Dates Attended, Diploma/Degree

Employment Experience

Start with your present or last job. Include any job related military service assignments and volunteer activities.

Employer

Name | Address | Supervisor's Name | Phone Number

Job Description

Job title ! Pay Rate ! Dates Employed | Work performed

Reason for Leaving

Add 2nd Employer

Add Another Employer

Employer

Name | Address | Supervisor's Name | Phone Number

Job Description

Job title ! Pay Rate ! Dates Employed | Work performed

Reason for Leaving

Add 3rd Employer

Add Another Employer

Employer

Name | Address | Supervisor's Name | Phone Number

Job Description

Job title ! Pay Rate ! Dates Employed | Work performed

Reason for Leaving

Professional References

First Reference

Name | Company | Phone Number

Second Reference

Name | Company | Phone Number

Third Reference

Name | Relationship | Phone Number(s)

Proficiencies | Activities

Computer Software Proficiencies:

Language Proficiencies:

Current Hobbies and Recreational Activities:

Additional Information

Have you previously worked or volunteered at Rocketown

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Yes

No

If yes, when and in what capacity?

Do you have the legal right to work permanently in the U.S.?

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Yes

No

If no, explain:

Have you ever been convicted of an offense against the law (including any conviction for driving under the influence) other than a minor traffic violation?

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Do not disclose any conviction for wich the records have been sealed, expunged or subject to deferred adjudication.

Yes

No

If yes, please explain:

Include dates, charges, resolution, etc.

Are you currently a member of a church?

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Yes

No

If yes, what church and what activities are you involved in at your church?

What experience do you have working with Middle School and/or High School students?

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Write "None" if you have no experience

Please describe your Christian journey, including your current relationship with Jesus Christ.

Who is the main person to impact your life for Christ?

Describe how he/she has impacted you?

What do you feel is the best way to guide someone into a personal relationship with Jesus Christ?

What creates the most anxiety or fear for you about working with teenagers?

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Personal & Pastoral References

Please let your references know a Rocketown staff member will be calling them.

Personal Reference

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Name | Relationship | Phone Number(s)

Pastoral Reference

Name | Relationship | Phone Number(s)

By signing this application, I certify that this application is complete and accurate to the best of my knowledge, that I have not made any attempt to conceal information, and that falsification could be cause for dismissal. Furthermore, Rocketown or its agents may request employment information from my previous employers and persons or corporations who provide information related to my pprevious employment and will be released from any liability or damage.

I understand that employment will be subject to:

Passing any and all backgroud checks and drug screenings deemed necessary by Rocketown's HR Dept.
Receiving satisfactory reference reports.
Receiving favorable reports from any outside agency on verification of information supplied.

Signature (type your name):

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First Name

Last Name