This application must be completely filled out to be considered.


Full Name (required)

Did you serve with St. Luke's Episcopal Church in previous years? (required)

Social Security Number (required)

Current Address (required)

Address Line 2(required)

City (required)

State (required)

ZIP (required)

How long have you lived at this address?

List previous addresses in the last 5 years

Home Phone

Cell Phone

Your Email (required)

Date of Birth


Emergency Contact (required)


Emergency Contact Phone Numbers:



What position are you applying for?

If you are applying for a paid position: You will be required to show documents verifying your employment eligibility and identity to complete the INS Form I-9 as required by the Immigration Reform and Control Act.

Are you legally eligible to work in this country?

Can you perform the essential functions of the job for which you have applied, with or without reasonable accommodations?


Personal Statement: Please write a personal statement and answer the following questions.

What interests you about the position or which you are currently applying?

What has prepared you for the position for which you are currently applying?

References from persons who know you well and are willing to supply data regarding your qualifications are an important part of your application. These persons might be teachers, employers or an adult friend, none of whom are related to you.

Enter Name of Reference, Company, Relationship, Years Known, Address, and Day-Time Phone for each reference, separated by a comma.

Volunteer Experience: Enter you volunteer experience as Dates, Organization, Director/Contact, Address, Phone, and Duties, separated by commas.

Edicational History: Enter Years, School, Major Subjects, and Degree Granted, separated by a comma.

Employment History: Enter Dates, Address, Phone, Nature of Work, Supervisor, and Reason for Leaving, separated by a comma.

St. Luke’s Episcopal Church reserves the right to request a background check which could include criminal records and/or motor vehicle checks on prospective Church Personnel.

Have you ever been convicted of a crime, including any drug or alcohol offense other than a minor traffic offense?

If YES, please describe:

Under penalty of perjury, I swear or affirm that all the information on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected, and, if I am selected, my service may be terminated at any time.

I authorize St. Luke’s Episcopal Church to investigate the statements I have made in this application, and specifically authorize any parties listed in this application or reference sheet to release information they have about me to St. Luke’s Episcopal Church.

I agree to comply with St. Luke’s Episcopal Church’s rules, regulations and policies. I agree that my selection may be evaluated and can be terminated at any time either by St. Luke’s Episcopal Church or me. I understand that the terms and conditions of my service may be changed at any time by St. Luke’s Episcopal Church.

I agree to and accept all that is contained in this applications:

Background Check Form

Last Name (required)

First Name (required)

Middle Initial

Race (required)

Gender (required)

Birthdate (required)

Former Legal Names

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