Childcare Worker for Special Events

Must be completed by anyone watching children 18 or under at Wooster Nazarene.

Your name *

Email address *

Marital status *

Household members

Birthday *

Prefer to be contacted by: *

Call

Text

Gender *

EMPLOYMENT

Current Employer

MY HISTORY WITH WOOSTER NAZARENE

Do you attend Wooster Nazarene? *

Yes

Are you presently involved in any other ministry?

Yes

Area in which I am applying to serve. *

REFERENCES

Please provide two references that we will be contacting. Please provide full name and a current phone number. Please do not use family members as references.

Reference #1 Name *

Reference #1 Phone *

Reference #2 Name *

Reference #2 Phone: *

Authorization for background check *

I, (applicant complete name listed above), hereby authorize Wooster Nazarene and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal, or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information, which may be material to my qualifications as a volunteer or for employment now, and if applicable, during the tenure of my volunteering or employment with Wooster Nazarene. I release Wooster Nazarene and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.

I consent

I do NOT consent

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