Chapelstreet Job Application - Coordinator of Shepherd's Heart and Benevolence

Employment Application: Paid Childcare Worker
Please fill in all fields. Be sure to sign (see end of form) and date. You must complete this application all at once.
Name*

First NameMiddle NameLast Name
Maiden name, if any
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
E-mail*
How do you prefer for us to reach you?*

Home PhoneCell PhoneEmail
Are you eligible to work in the United States?*

YesNo
Availability
How many hours per week are you available?*
What days can you work?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Date you can start work*

MonthDayYear
Qualifications
Summary of qualifications for this position (skills, training, experience, Licenses, etc)*
Church Information/Experience
Do you attend worship services at Chapelstreet Church?*

YesNo
How long have you attended Chapelstreet Church?*

Less than 6 months6 months to 2 years3 - 5 years5 - 10 yearsMore than 10 years
How frequently do you attend?*

WeeklyTwice a monthOnce a month or less
Do you currently serve or have you previously served in any other ministries at Chapelstreet Church?*
Please identify: name of ministry, length of service & ministry leader
What was your previous church affiliation in the last 2 years (If not Chapelstreet Church)?*
Please identify: name of church, location, phone number, pastor's name, dates attending this church & reason for leaving.
Please list any ministry/ volunteer experience you have had with children.*
Please identify: where you were involved, length of service, your position/role, and a contact name with email and phone number.
References
Please provide 3 references (no family members please):

#1 - A personal reference. The person should have known you for at least two years

#2 - An occupational reference (or another personal reference if you are not employed)

#3 - A ministry person whom you have served with and can identify your character weaknesses and strengths.
#1 - Personal reference
Name/Title*
Phone*
Email*
Length of relationship*
Nature of relationship:*
#2 Occupational Reference (or an additional personal reference)
Name/Title*
Phone*
Email*
Length of relationship*
Nature of relationship:*
#3 Ministry Reference (Pastor, Director, Coordinator, Group Leader, etc)
Name/Title*
Phone*
Email*
Church/Service Organization/Other*
Describe nature of relationship & length of service:*
Statement of Faith
Please share your spiritual journey, including how you began your relationship with Jesus Christ, what you are doing to grow spiritually, and how you live out your faith in daily life.*
Chapelstreet Church Statement of Faith (click link)
I agree with the above Statement of Faith*

YesNo
Child Sexual Abuse Information and Chapelstreet Church Protection Policy (click link and scroll down the page)
I have read and understand the above information and policy:*

YesNo
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination at any point in the future if I am hired. I authorize the verification of any or all information listed above, including having references provide you with information or opinions they may have about my fitness for employment. I hereby release all such references from any liability for furnishing information or opinions to you.
Signature*
Date*

MonthDayYear
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