Lakeshore Vineyard Church / Ministries / Childcare Job Application

This application is to be completed by all those desiring a position involving the care of minors at Lakeshore Vineyard Church or offsite at a church sponsored activity. It is being used to help the church provide a safe and secure environment for children to be cared for while their parents participate in midweek activities. I understand that all personal information will be held confidential by the church staff & leadership.

Basic Information

Name:

Date of birth:

Primary Phone Number:

Secondary Phone Number:

Best time to call:

Email:

Best way to contact you:

Phone

Text

Address

Street:

City:

State:

Zip Code:

Have you been at this address less than one year?

Yes

If you answered yes, please fill out your previous address information below.

Street:

City:

State:

Zip Code:

Dates lived there (MM/YYYY):

Have you lived in a different state within the past ten years?

Yes

If yes, please list the states below:

Marital Information (optional)

Marital Status:

Emergency Contact:

Emergency Number:

Application Information

Are you a member of Lakeshore Vineyard?

Yes

If not, what church do you attend/have previously attended?

Please describe your faith:

Please list any LVC small groups you are a part of (if none, please list N/A):

Please list any other service you perform at LVC (if none, please list N/A):

Please list any previous childcare experience, both paid and volunteer (if none, please list N/A):

Please list what skills, training, or education that you feel would advance your work in childcare (if none, please list N/A):

Do you have any medical training, or are you CPR certified?

Yes

Explain:

Personal References

Must be over 18 years of age

Must be unrelated

Preferred one local

Reference 1

Reference 2

Reference 3 (optional)

The questions below are part of the interview process in order to provide a safe and secure environment for our children. All information is held strictly confidential by our staff. Answering yes to any of these questions may not necessarily preclude your consideration as a childcare provider at Lakeshore Vineyard. (If you respond “yes” to any of the questions below, please offer an explanation.) Thank you for understanding.

Have you ever been convicted of a criminal offense (excluding a minor traffic violation)?

Have you ever been accused, arrested, or convicted for any sex-related crimes?

Have you ever been accused, arrested, or convicted for any abuse-related crimes?

Have you ever been reported to Social Services?

Have you ever been hospitalized or treated for substance abuse?

Do you have any drug-related conviction, whether violent or non-violent?

If you answered yes to any of the questions above, please use this space to explain the situation:

Applicant's Statement

The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, or other organizations listed in this application to give you any information they may have regarding my character and fitness for working with children. I release all such references from liability for any damage that may result from furnishing such evaluations to you. I give Lakeshore Vineyard Church permission to conduct any background checks that are necessary, and I understand that all childcare work is contingent on meeting all the requirements of Lakeshore Vineyard Church.

Vineyard’s Statement

I understand that in the event of any accusation of child abuse or molestation made against me, Lakeshore Vineyard will notify the proper authorities in such an investigation, and will, if deemed necessary, publicly publish or announce the results of such an investigation.

Should my application be accepted, I agree to follow the policies of Lakeshore Vineyard and to refrain from unscriptural conduct in the performance of my service on behalf of the church.

I understand that the personal information will be held in confidence by the church staff and leadership.

By filling out the information below, I hereby agree to the above statement.

Full legal name:

Date (MM/DD/YYYY):

Vineyard Childcare Application