Diocese of Altoona-Johnstown - Employment Application Employment Application GENERAL INFORMATIONName* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Parish In Which You Are A Member/Attend*Non-CatholicNon-ReligiousPracticing Outside of Altoona-Johnstown DioceseAll SaintsBasilica of Saint Michael the ArchangelCathedral of the Blessed SacramentChurch of the TransfigurationGood ShepherdHoly Family (Colver)Holy Family (Hooversville)Holy Family (Portage)Holy NameHoly RosaryHoly SpiritImmaculate Conception (Dudley)Immaculate Conception (New Germany)Most Holy Trinity (Huntingdon)Most Holy Trinity (South Fork)Our Lady of FatimaOur Lady of LourdesOur Lady of Mount CarmelOur Lady of the AllegheniesOur Lady of VictoryOur Lady Queen of AngelsOur Mother of SorrowsPenn State Catholic Campus MinistryPrince of PeaceQueen of Archangels (Clarence)Queen of Archangels (Snow Shoe)Queen of PeaceResurrectionSacred HeartSaints Cyril & MethodiusSaint GregorySaint BarnabasSaints Peter & PaulSaints Philip & JamesSaint AloysiusSaint AndrewSaint Anne (Davidsville)Saint Anne (Johnstown)Saint Anthony of PaduaSaint AugustineSaint BartholomewSaint Benedict (Carrolltown)Saint Benedict (Johnstown)Saint BernardSaint Catherine of Siena (Duncansville)Saint Catherine of Siena (Mount Union)Saint Clare of AssisiSaint ClementSaint DemetriusSaint Elizabeth Ann SetonSaint Francis of AssisiSaint Francis XavierSaint Joan of ArcSaint John the Baptist (New Baltimore)Saint John the Baptist (Summerhill)Saint John the Evangelist (Altoona)Saint John the Evangelist (Bellefonte)Saint John the Evangelist (Everett)Saint John GualbertSaint John VianneySaint Joseph (Bellwood)Saint Joseph (Renovo)Saint Joseph (Williamsburg)Saint Kateri TekakwithaSaint MarkSaint Mary (Altoona)Saint Mary (Hollidaysburg)Saint Mary (Nanty Glo)Saint Mary (Meyersdale)Saint Mary (Orbisonia)Saint MatthewSaint Michael (Hollidaysburg)Saint Michael (Johnstown)Saint Michael (Salisbury)Saint Michael (St. Michael)Saint MonicaSaint NicholasSaint Patrick (Johnstown)Saint Patrick (Newry)Saint PeterSaint Rose of LimaSaint StephenSaint Therese of the Child Jesus (Altoona)Saint Therese of the Child Jesus (Johnstown)Saint Thomas the ApostleSaint Thomas AquinasSaint Thomas MoreSeven Dolors of the Blessed Virgin MaryVisitation of the Blessed Virgin MaryList all previous experiences involving youth (employment/volunteer):Location/AddressPhoneContact PersonType of WorkDates Position(s) Applied For* Administrative Assistant - Church of the Transfiguration, Conemaugh Administrative Assistant - Resurrection Parish, Johnstown Maintenance/General Laborer - Divine Mercy Catholic Academy, Johnstown Regional Director of Faith Formation and Discipleship (Diocese of Greensburg) Regional Director of Youth Formation and Discipleship (Diocese of Greensburg) 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 (Math/Technology) - Our Lady of Victory School, State College Teacher (Music) - Saint Nicholas Catholic School, Nicktown 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 POSITIONEmployer #1* Job Title #1* Workplace Address #1* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Reference #2 - Phone Number*Reference #2 - Relationship* How soon will you be available?* FOR EDUCATOR POSITIONS ONLYDo 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 CertificationAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificIssue Date MM slash DD slash YYYY Have you completed a state induction program? Yes No PPID Number (Act 48) Scholasitc RecordType of SchoolSchool Name/AddressDates AttendedDegree EarnedDate Degree Granted College Major (24+ Credits) College Minor (15+ Credits) Graduate Degree Major (if applicable) SIGNATUREI 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 understandSignature* * MM slash DD slash YYYY