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Application For Employment

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Application for Employment

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URL
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Position Applied for:*
Date*
MM slash DD slash YYYY
First name*
Last name*
Home Phone*
Work Phone
Cell Phone
Email
Are you legally eligible to work in the US?*
Note: All prospective employees must submit proof of identity and eligibility for employment in the US prior to employment
- Yes
- No
If you are not a US citizen, are there any restrictions on your eligibility for employment?
Have you ever worked for the Broome County Council of Churches?
- Yes
- No
When?
On what date would you be available to begin work?
MM slash DD slash YYYY
What days and hours are you available to work?
What salary and benefits expectation do you have?
EDUCATION
Select the highest grade you completed
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
Name of High School
Address of High School
Street Address City State / Province / Region ZIP / Postal Code
Did you graduate?
- Yes
- No
If not, have you passed a G.E.D. test?
- Yes
- No
Select the number of years of post high school education completed
- 1
- 2
- 3
- 4
- 5
- 6
College
Degree
Major Area of Study
Date Graduated
MM slash DD slash YYYY
College Address
Street Address City State / Province / Region ZIP / Postal Code
College
Degree
Major Area of Study
Date Graduated
MM slash DD slash YYYY
College Address
Street Address City State / Province / Region ZIP / Postal Code

SKILLS AND TRAINING:
Please describe other skills, training, honors or extra-curricular activities you feel might be relevant to the position for which you are applying. (A separate page may be attached)
Do you have a driver’s license?
- Yes
- No
Commercial Driver’s License?
- Yes
- No
Have you ever been convicted of any offense against the law?
Omit juvenile offenses and minor traffic violations. Include convictions by general court martial while in the military service.
- Yes
- No
If yes give date, place, charge, court and fine or sentence.
A conviction does not automatically mean that you cannot be employed. What you were convicted of and how long ago are important. Give all facts so that a decision can be made
Have you ever been fired or asked to resign from a job?
- Yes
- No
If yes, give the name and address of employer and describe the reason
EXPERIENCE
The selection process for the position involves an evaluation of relevant education and experience. It is important, therefore, that you provide enough details so that your qualifications can be properly evaluated. Start with your present job and work back. Include military service and volunteer experience. Additional experience should be listed by attaching separate sheets of paper. Be sure to include all requested information.
Present Employer
Start Date
MM slash DD slash YYYY
Final Date
MM slash DD slash YYYY
Work Address
Street Address City State / Province / Region ZIP / Postal Code
Job Title
Phone
Average Hours Per Week
Starting Salary
Ending Salary
Describe your work
EXPERIENCE
Present Employer
Start Date
MM slash DD slash YYYY
Final Date
MM slash DD slash YYYY
Work Address
Street Address City State / Province / Region ZIP / Postal Code
Job Title
Phone
Average Hours Per Week
Starting Salary
Ending Salary
Describe your work
EXPERIENCE
Present Employer
Start Date
MM slash DD slash YYYY
Final Date
MM slash DD slash YYYY
Work Address
Street Address City State / Province / Region ZIP / Postal Code
Job Title
Phone
Average Hours Per Week
Starting Salary
Ending Salary
Describe your work
May we conduct a background check of your qualifications, character and record of employment?
- Yes
- No
If No, please explain
for example: “I do not wish to make known this application to my current employer.”
Signature
First Last
SPECIAL QUALIFICATIONS AND SKILLS
Please list religious, professional, trade, business or civic activities, foreign languages, special services, volunteer roles, awards and offices, licenses or certificates you hold. (You may exclude memberships which would reveal sex, race, national orign, ancestry, disability or other protected status.)
List Skills and Qualifications

REFERENCES
Please provide three or more professional work related references we can contact to discuss your experience, qualifications and suitability for the position for which you are applying. Ordained clergy applicants are asked to include their Judicatory Executive or Bishop. References may be listed on a separate sheet and attached.
References Name
First Last
References Address
Street Address City State / Province / Region ZIP / Postal Code
References Phone
What is relationship?
How Long?
References Name
First Last
References Address
Street Address City State / Province / Region ZIP / Postal Code
References Phone
What is relationship?
How Long?
References Name
First Last
References Address
Street Address City State / Province / Region ZIP / Postal Code
References Phone
What is relationship?
How Long?
I authorize Broome County Council of Churches to consult references, verify information and seek other data as may be necessary to arrive at an employment decision
Please identify any exceptions and a brief explanation such as “present employee/do not wish to jeopardize continued employment
Signature of applicant
First Last
By typing my name above I am providing my electronic signature which represents and is equal to my physically written signature

CERTIFICATION
I certify that all of the statements made in this application are true and complete to the best of my knowledge. I understand that a false or incomplete answer may be grounds for not employing me, or for dismissing me after I have begun work. I understand that Broome County Council of Churches is an at-will employer. I waive all rights I might have against a previous employer who provides references and/or records concerning my employment history. I waive all rights I might have against a reference or referral who provides information to Broome County Council of Churches in consideration of my employment suitability. I certify below that no civil, criminal, or ecclesiastical complaint has ever been sustained or is pending against me for sexual misconduct; and have never resigned or been terminated from a position for reasons related to sexual misconduct.
Signature*
First Last
I agree that I will hold harmless the employing or any other entity from any and all claims, liabilities, and causes of action for the legitimate release of any information related to sexual misconduct or job performance related misconduct.
Date
MM slash DD slash YYYY

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Special Thanks to Our Community Partners

3 Otseningo Street
Binghamton, NY 13903

Phone: (607) 724-9130
Email: mail@broomecouncil.net

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Faith In Action
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Position Details

Position Title: Program Coordinator

Position Status: Part-Time, Non-Exempt (20 hours/week)

Program: FIA

Supervisor: FIA Program Director

Purpose of Position: To support the smooth operation of Faith in Action by coordinating programming in the office and the community

Job Responsibilities:

Act as a liaison between Faith in Action and clients, volunteers and the general public
Assist in the recruitment of volunteers to assist with programming
Maintain program records (volunteer hours, attendance, survey responses, finances, etc) using Excel spreadsheets or Google sheets
Obtain and organize materials necessary for programs
Facilitate program sessions in the community
Assist in the scheduling office when necessary
Provide help in program outreach and fundraising when necessary
Other duties as they arise

Qualifications:

High School diploma, GED, or higher.
Basic understanding of computers including Microsoft Office and Google Drive
Good communication skills (written and spoken) with attention to detail
Ability to work in a team environment with a variety of personalities
Demonstrate flexibility in roles when necessary
Adaptability to new and changing circumstances
Utilize problem solving skills when necessary
Ability to interact with clients, volunteers and the public in a caring and pleasant manner
Meet deadlines with efficiency and a high quality of work
Valid NYS driver’s license and background check

Work Setting:

Office setting with significant amounts of time on a computer and/or telephone, when necessary
In the community when providing programs and services

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