Employment Application - Diocese of Altoona-Johnstown

Diocese of Altoona-Johnstown - General Employment Application

Employment Application

GENERAL INFORMATION
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Parish In Which You Are A Member/Attend*
List all previous experiences involving youth (employment/volunteer):
Location/Address Phone Contact Person Type of Work Dates
Position(s) Applied For*
Please check all that apply:
- Accounting Assistant - Diocesan Finance Office
- Maintenance/General Laborer - Divine Mercy Catholic Academy, Johnstown
- Principal - Butler Catholic School, Butler (Diocese of Pittsburgh)
- School Principal - Lock Haven Catholic School
- Teacher (3rd Grade) - Saint Francis School, Clearfield (Diocese of Erie)
- Teacher (4th Grade) - All Saints Catholic School, Cresson
- Teacher (4th/5th Grade) - Saint Matthew School, Tyrone
- Teacher (Math, Grades 9-12) - Bishop McCort Catholic High School, Johnstown
- Teacher (Music) - Saint Nicholas Catholic School, Nicktown
- Teacher (Physical Education) - Saint Francis School, Clearfield (Diocese of Erie)
- Other/General Consideration
If "Other/General Consideration", please specify position applied for:
Have you previously applied within the diocese? If so, please list positions applied for below.
Have you previously worked within the diocese? If so, please list position and location below.
Education Institution #1*
Graduation Achieved #1*
- Yes
- No
Degree #1*
Education Institution #2
Graduation Achieved #2
- Yes
- No
Degree #2
EMPLOYMENT HISTORY RELATED TO POSITION
Employer #1*
Job Title #1*
Workplace Address #1*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Workplace Phone #1*
Employment Start Date #1*
MM slash DD slash YYYY
Employment End Date #1*
MM slash DD slash YYYY
Reason for Leaving (#1)*
May we contact this employer? (#1)*
- Yes
- No
Employer #2
Job Title #2
Workplace Address #2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Workplace Phone #2
Employment Start Date #2
MM slash DD slash YYYY
Employment End Date #2
MM slash DD slash YYYY
Reason for Leaving (#2)
May we contact this employer? (#2)
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
Have you ever had your driver's license revoked or suspended?*
- Yes
- No
Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor?*
- Yes
- No
If you answered "Yes" to any of the questions above, please explain below.
Reference #1 - Name*
First Last
Reference #1 - Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #1 - Phone Number*
Reference #1 - Relationship*
Reference #2 - Name*
First Last
Reference #2 - Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2 - Phone Number*
Reference #2 - Relationship*
How soon will you be available?*
FOR EDUCATOR POSITIONS ONLY
Do you currently possess a valid Pennsylvania Teaching Certification?
- Yes
- No
Pennsylvania Certification Number
Pennsylvania Certification Type
Issue Date
MM slash DD slash YYYY
Do you currently possess certifications from other states?
- Yes
- No
Certification Type
State Of Certification
Issue Date
MM slash DD slash YYYY
Have you completed a state induction program?
- Yes
- No
PPID Number (Act 48)
Scholastic Record
Type of School School Name/Address Dates Attended Degree Earned Date Degree Granted
College Major (24+ Credits)
College Minor (15+ Credits)
Graduate Degree Major (if applicable)
SIGNATURE
I certify that the information I have provided within this application is correct, and that I have not omitted any of consequence. I agree not to hold the Diocese of Altoona-Johnstown or its employees liable if not hired, or if my employment is terminated because I have given incorrect answers or statements, or omitted important information, within this application. I authorize the companies, schools, and people named within this application to give the Diocese of Altoona-Johnstown the requested information about my employment or education, and release them from liability for damages for giving this information. I further authorize any law enforcement agencies, courts of law or other government offices to give the Diocese of Altoona-Johnstown any requested information concerning any criminal conviction of myself, and I release any such agency from liability for damages for giving this information. I understand that if I am employed by the Altoona-Johnstown Diocese, my employment will not be for any specified term and may be terminated by me or by the company at any time for any reason. I understand that employment is conditioned upon my ability to verify eligibility for employment in the United States. Falsification or omission in this application will disqualify you for employment. If falsification or omission is discovered after you are employed, it may be grounds for termination. The Diocese of Altoona-Johnstown is an Equal Opportunity Employer - All qualified applicants will receive consideration for employment without regard to any characteristic protected by law. My signature indicates that I have read and understood the above statement and am signing below of my own free will. I also understand that the Diocese of Altoona-Johnstown will conduct a background check every five years for the duration of my employment/volunteerism.*
I certify that the information I have provided within this application is correct, and that I have not omitted any of consequence. I agree not to hold the Diocese of Altoona-Johnstown or its employees liable if not hired, or if my employment is terminated because I have given incorrect answers or statements, or omitted important information, within this application. I authorize the companies, schools, and people named within this application to give the Diocese of Altoona-Johnstown the requested information about my employment or education, and release them from liability for damages for giving this information. I further authorize any law enforcement agencies, courts of law or other government offices to give the Diocese of Altoona-Johnstown any requested information concerning any criminal conviction of myself, and I release any such agency from liability for damages for giving this information. I understand that if I am employed by the Altoona-Johnstown Diocese, my employment will not be for any specified term and may be terminated by me or by the company at any time for any reason. I understand that employment is conditioned upon my ability to verify eligibility for employment in the United States. Falsification or omission in this application will disqualify you for employment. If falsification or omission is discovered after you are employed, it may be grounds for termination.

The Diocese of Altoona-Johnstown is an Equal Opportunity Employer - All qualified applicants will receive consideration for employment without regard to any characteristic protected by law.

My signature indicates that I have read and understood the above statement and am signing below of my own free will. I also understand that the Diocese of Altoona-Johnstown will conduct a background check every five years for the duration of my employment/volunteerism.
I Understand
Signature*
Date of Signature*
MM slash DD slash YYYY