Children's Ministry Application

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Basic Information

Name: *

Phone *

Address: *

Employment Information (only for those applying for a paid childcare position)

Are you a student? If so, where? (only for those applying for a paid childcare position)

Emergency Contact (Name and phone number) *

In which program(s) do you want to become involved? *

Nursery

Godly Play

Godly Explorers

Required

What previous children's and youth worker experience do you have? *

Legal Disclosure

Have you at any time been arrested for any reason? *

Have you at any time been convicted of or pleaded guilty or no contest to any crime? *

Yes

Have you at any time engaged in or been accused of, or plead guilty or no contest to any child molestation, exploitation, abuse or sexual misconduct? *

Yes

Are you aware of having any traits or tendencies that could pose any threat to children, youth, or others? *

Are you aware of any reason why you should not work with children, youth, or others? *

Have you completed The Mission Cincinnati Pathways? *

Yes

Please provide two references with each of the reference's name, phone number, email address and title as well as your relationship to the reference. *

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This form was created inside of The Mission Cincinnati.