Childcare Application - CPC
It is the goal of Covenant Presbyterian Church - Lander to create a safe and secure environment for all children and workers who are involved in church activities. To facilitate this, it is necessary to gather pertinent information from those who desire employment or offer volunteer services to our children. This information will be used for the sole purpose of helping the church provide a safe and secure environment for children and workers. All information is kept completely confidential.

By completing and submitting this form you agree to a national background check (at CPC’s expense) using the information you provide below.

Sign in to Google to save your progress. Learn more
Email *
Your Full Name [First, Middle, Last] *
In which Childcare positions are you interested in serving? *
Address [including address, city, state, and zip code] *
Years you have lived at this address *
Preferred Phone Number *
Cell Phone Number
Social Security Number *
Date of Birth *
Gender *
Ethnicity *
Is there any reason you should NOT work with or around children or youth? *
Have you ever been the subject of a child abuse investigation? Has anyone ever reported your behavior with children to authorities such as church leaders or law enforcement? *
If yes, please provide details:
Have you ever been convicted of or pleaded guilty to a criminal offense? *
If yes, please provide details:
What is the highest level of education you have completed? *
Are you currently attending college/university? *
From where did you receive college degree(s) and in what was the degree?
What, if any, church affiliation do you have? *
How long have you attended that church?
Are you a member of that church? *
List any other churches with which you have been affiliated:  
Have you ever worked with children? *
List where you have worked with children (babysitting, daycare, church nursery, etc):
Please list two (2) references (preferably those who have witnessed your work with children). Please provide their name, telephone number, email address, and number of years you have known them: *
By checking the box below, I hereby give permission to make a thorough investigation of my background, and release from liability all persons, companies, or corporations supplying such information. I also release Covenant Presbyterian Church from any liability that might result from making such an investigation. I understand that any false statements or implications made by me on this application or other required documentation shall be considered sufficient cause for denial of employment or discharge. *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy