Nursery Worker Application

Name: *

Are you 21 years or older? *

Yes No

Address: *

City *

State: *

Zip *

Home Telephone *

Other Phone

Occupation, current employer, and business address

Time at above employment:

Years: (0)

Months: (0)

Why are you interested in this position? *

Describe your background working with infants and toddlers. (Include information about church-related, volunteer, and paid experience you may have.) *

While everyone has the occasional need to be absent, we will need as much notice as possible so we could schedule someone else to work. Do you feel that you are reliable and can be counted on? *

Please pick your answer to the following questions:

Have you ever been convicted of any criminal offense? *

Yes No

Have you ever been charged with or convicted of child neglect or abuse? *

Yes No

Have any complaints of misconduct involving children ever been made against you? *

Yes No

Have you been convicted of the possession, use, or sale of drugs? *

Yes No

Please explain fully any YES answers to the above questions. In addition to the above, is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance, and care of young people?

The information that I have provided may be verified by contacting persons or organizations that may have information concerning me, including a background check. I hereby release and agree to hold harmless from any liability any person or organization that provides information, and this release may be sent to any reference. I also agree to hold harmless Crossville First United Methodist and the officers, employees, and volunteers thereof from any use of this application or information. I waive any right that I may have to inspect references provided on my behalf. I certify that the information I have provided is true and correct; if it is found that the answers given are untrue, I understand it may be cause for dismissal.

Name: *

Date: *

Please list three people (non-family members) we may contact as a reference:

Name: *

Phone: *

Name: *

Phone: *

Name: *

Phone: *

If You Would Like to Attach Your Resume, Please Upload it Here

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Stewardship 2019-2020