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Employment Application

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Diocese of Palm Beach Employment Application

Please answer all questions as fully and accurately as possible. Please attach a separate sheet if necessary to fully answer. If any questions are not applicable, please type “NA” rather than leaving blank. Please do not type “see resume.” Your answers shall be treated with the greatest respect and confidence. Your cooperation in filling out this questionnaire is greatly appreciated.

Applicant Information
First Name *
Middle
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Are you authorized to work in the U.S.?
Education
Country
Address Line 1
City
State/Province
Postal Code
Did you graduate?
Country
Address Line 1
City
State/Province
Postal Code
Did you graduate?
Country
Address Line 1
City
State/Province
Postal Code
Did you graduate?
Licenses and Certifications
Please list all licenses and certifications that you currently hold, including the license and/or certification numbers, as well as the name of the issuing authority and expiration date:
Software Proficiency

Please rate your proficiency in the following Microsoft programs on a scale of 1-10, 10 being excellent

References

Please list three professional references. Please include Full Name, Relationship, Company Name, Phone & Address.

Previous Employment

Please include Comany Name, Phone Number, Address & Supervisor's Name

May we contact your previous supervisor for a reference?
May we contact your previous supervisor for a reference?
May we contact your previous supervisor for a reference?
Military Service
Background Questions
Have you ever been convicted of a crime or felony (other than a minor traffic violation)?
If yes, please explain.
Has a criminal, civil or internal complaint to management or supervisors at places of employment ever been filed against you which alleged sexual misconduct, harassment or child abuse by you, or your participation in or facilitation of such activities?
If yes, please explain.
Do you presently serve, or have you ever served, as a volunteer for any organization, entity or group in which you had significant contact with children or other vulnerable populations (i.e., elderly, mentally or emotionally challenged, etc.)?
If yes, please provide the name, address and telephone number of the organization; period of volunteer service, supervisor’s name; and briefly describe your activities and/or your duties.
Have you ever terminated any employment or volunteer service or chosen not to renew or continue any employment or volunteer service, or have you ever had employment/volunteer service terminated, or been subject to any disciplinary action against you for reasons relating to allegations of sexual misconduct or child abuse by you?
If yes, please explain. Please include in your explanation the date, nature and place of the occurrence(s) or allegation(s); and the disposition of the matter(s). Also identify your employer and supervisor at the time by name, address and telephone number.
Have you ever been reprimanded, investigated, or dismissed from a position for grounds that include or involve immoral conduct, unprofessional conduct, unethical conduct, harassment, including sexual harassment, unfitness for service, etc.?
If yes, please explain incident, and provide name of supervisor, telephone numbers, dates, etc.
Have you ever been a defendant in a civil action for an intentional tort, including but not limited to, assault, battery, false imprisonment, rape, etc.?
If yes, please explain.
Do you have any relative(s) employed by the Diocese of Palm Beach or any of its entities?
If yes, please indicate the name(s) or relative(s) and the entity at which he/she is employed:
If you are hired for the position for which you have applied, would you be in a supervisory relationship with any member of your family, household, or relative?
If yes, please indicate the name(s) and relationship.
Annual or Hourly Salary Desired (Please do not write "Negotiable")
Do you prefer to work Full Time or Part Time?
Have you ever worked for this company?
No file selected
No file selected

EQUAL EMPLOYMENT
The Diocese of Palm Beach is committed to equal employment opportunity for all qualified persons, without regard to race, color, ancestry, national origin, sex, marital status, physical handicap, medical condition, or age, to the extent required by law. This applies to all employment practices, including hiring, promotion, training, disciplinary action, termination or benefits.

EMPLOYMENT AT WILL
Employment is with the mutual consent of the employee and the Diocese of Palm Beach. Consequently, both the employee and the Diocese have the right to terminate the employment relationship at any time, with or without cause or advance notice. This employment at will relationship will remain in effect throughout one’s employment with the Diocese unless it is specifically modified by an express written agreement signed by the employee and the Diocese of Palm Beach.

CONSENT
The information I have provided on this questionnaire is complete and accurate to the best of my knowledge and may be verified by the Catholic Diocese of Palm Beach. I understand that if hired, any misleading statement and/or misrepresentation and/or inaccurate statement on this application may be cause for discipline, up to and including dismissal.
I understand that, as part of their hiring process, the Diocese of Palm Beach will conduct employment verification, education verification, driving record check, criminal background check, reference check and/or other inquiries regarding my background, including information as to my personal character, general reputation and other qualities pertinent to my prospective service.
I hereby consent and authorize the Diocese of Palm Beach and/or their designated agents to make such inquiries, and I authorize without reservation, the release of such information to the Diocese of Palm Beach and/or their designated agents, and release the Diocese of Palm Beach and the provider of such information from any and all liability for damages arising from the investigation and disclosure of the requested information. I understand that this information will be kept confidential. I will allow a photocopy of this authorization to be as valid as the original.

I acknowledge that employees must witness by their public behavior, actions and words a life consistent with the teachings of the Catholic Church.

SIGNATURE & DATE LEFT BLANK UNTIL OFFICE VISIT.
Applicant Signature
Date
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