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Employment Application Form
Rev. Justin Wiese"
1300 W Benjamin Avenue"
Norfolk NE 68701"
[email protected]"
Phone: 402-371-1985, x. 7
Name:
Todays Date:
First
Middle
Last
Address:
Street
Contact: (
City
State
Home Phone
ZIP
)
Mobile Phone
High School Attended:
Email
Other College Attended (if applicable):
Home Church (if applicable):
Name/City, State
Churchs Pastor/Leader Name:
Contact Phone/Email:
Position(s) Desired (check all interested): Peer Minister
Martinflatable Mascot/Handler
Helpful Hygiene Hut
Inventory Specialist
Beginning Date You Are Available:
Are you currently employed?: Yes No
Will you be seeking other employment while at college? Yes No
Previous Employment
Company 1:
Job Title:
Address
Company 2:
Dates of Employment:
Job Title:
Address
Company 3:
Phone:
Phone:
Dates of Employment:
Job Title:
Address
Phone:
Dates of Employment:
Which companies may we check for a reference?
Company 1
Company 2 Company 3 None
Additional References
Name:
Relationship to You:
Phone:
Name:
Relationship to You:
Phone:
Name:
Relationship to You:
Phone:
See Back Page for Additional Information Requested
What excites you about the position(s) for which you are applying with NeLCM-Norfolk?
What gifts & skills do you bring to the positions for which you are applying?
NeLCM-Norfolk is a faith-based non-profit organization. What can you tell us about your life of faith?
Your Signature_________________________________________________________________________________