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Employment Application Form

Rev. Justin Wiese"

1300 W Benjamin Avenue"
Norfolk NE 68701"
norfolk@nelcm.com"
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_________________________________________________________________________________