Name:
Address, City, State, Zip:
Cell Phone:
Home Phone (optional):
Work Phone (optional):
Email (personal or work):
Best time of day to call: MorningAfternoonEvening
Current employer and position:
Can you receive calls at work?: YesNo
Previous Employer and Position:
Dates employed:
Have you ever been convicted of a crime?: YesNo
If yes, please explain:
Is there any other information we should know?:
Please write a brief statement about your Christian faith:
High School:
Did you graduate?: YesNo
College/Trade School:
Certifications related to early childhood development:
What volunteer or career experiences with children/youth have you had in the church or community?:
List any concerns or needs you have in working with children and youth:
Name 1:
Phone:
Address:
Name 2:
I understand that a condition of my employment will be to read, agree and to follow our Safe Sanctuaries policy and to attend training as it is made available. I understand that this position requires child abuse clearances, FBI fingerprinting and background checks as mandated by the law of PA.
Applicant's Statement
The information contained in this application is true and correct to the best of my knowledge. I authorize any of the above references, employers, or churches to give you any information they may have regarding my character and fitness to work with children and/or youth.
Type Name:
Date:
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