Childcare Worker Application

Application for paid childcare workers who provide care for Southbridge events.

Your name *

Email address *

Phone number

Birthdate

Gender

What is your availability for paid childcare work? *

What days and hours can you work?

I understand I must complete a W-9 tax form before the church can issue a pay check. *

I understand that the church issues pay checks the Thursday AFTER the event and they will be mailed to you. *

Reference Information

Please provide your reference information. The reference should not be related to you.

Reference Name *

Phone Number *

Email Address *

Your Background

Child safety is important to us. Please answer a couple of questions about your background.

Do you have any prior convictions *

Have you been convicted of: a traffic offense, crime, child molestation, child abuse, possession, use or sale of illegal drugs, driving under the influence, or any other incident that could affect your ability to be entrusted with the supervision, guidance, and care of children?

Disclaimer

I certify that the information provided on this application is accurate to the best of my knowledge. I authorize the listed references to share any information or opinions regarding my character and suitability for working with children. I release any individual or organization from liability for any damages that may result from providing this information. I have read and fully understand this release, and I sign it of my own free will. This is a legally binding agreement.

I have read, agreed, and understand the previous disclaimer statement *

Date of Completion *

By filling the date below, you are signing that the information provided is to the best of your knowledge.

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