Child Protection Application

Name

Middle Name

Please list other names used:

Address

SSN

Drivers License / State ID # (N/A if under 18)

State Issued (N/A if under 18)

Phone

This address will receive a confirmation email

Date of Birth

EXPERIENCE WITH CHILDREN

Why do you want to serve with children?

Have you ever worked with children before? Where, when and in what capacity?

Do you have any physical conditions that might limit you from performing certain types of activities in the position for which you are applying? If so, please explain:

Have you ever been convicted of, or are you presently charged with any crimes involving domestic violence, child pornography, child abuse, neglect or molestation, or any crime related to persons?

Yes No

If yes, please explain. (If you prefer, you may discuss your answer in confidence with a church staff member.)

CHURCH EXPERIENCE

All volunteers working with kids are required to attend Christ Church Madison. Paid childcare workers may attend elsewhere, as long as they affirm the Nicene Creed and agree to follow our Child Protection Policy.

When did you begin regularly attending Christ Church Madison?

If you have been a regular attender of a church other than Christ Church Madison in the past three years, please fill out this section.

Previous Church Name

Previous Church Phone Number

Previous Church Ministry Involvement

REFERENCES

Please list the names, phone numbers and email addresses of two references, including: at least one person who has known you well for two or more years and at least one current or former supervisor. (Applicants under 18 may provide a second personal reference, instead of a professional reference.)

We ask that you not use Christ Church Madison staff as references. References that have observed you interacting with children are preferred.

We will mainly communicate via email, however, if your reference does not have an email address, please write "n/a" in the form.

For this process to go quickly and smoothly, it is helpful if you notify your references that we will be contacting them.

Personal Reference #1

Name and relationship to you

Phone

Personal Reference #2

Name and relationship to you

Phone

Professional Reference #1

Required for applicants 18 and older

Name and relationship to you

Phone

The Nicene Creed

We believe in one God,
the Father, the Almighty,
maker of heaven and earth,
of all that is, seen and unseen.

We believe in one Lord, Jesus Christ,
the only Son of God,
eternally begotten of the Father,
God from God, Light from Light,
true God from true God,
begotten, not made,
of one Being with the Father.
Through him all things were made.

For us and for our salvation
he came down from heaven:
by the power of the Holy Spirit
he became incarnate from the Virgin Mary,
and was made man.

For our sake he was crucified under Pontius Pilate;
he suffered death and was buried.
On the third day he rose again
in accordance with the Scriptures;
he ascended into heaven
and is seated at the right hand of the Father.

He will come again in glory to judge the living and the dead,
and his kingdom will have no end.

We believe in the Holy Spirit, the Lord, the giver of life,
who proceeds from the Father and the Son.
With the Father and the Son he is worshiped and glorified.
He has spoken through the Prophets.
We believe in one holy catholic and apostolic Church.
We acknowledge one baptism for the forgiveness of sins.
We look for the resurrection of the dead,
and the life of the world to come.

Amen.

I have read the Nicene Creed and am in harmony with it.

Yes No

Safeguarding Policy

Download or view our Safeguarding Policy.

If you would like a printed copy, please reach out to nicole@christchurchmadison.com

Please review the Safeguarding Policy, linked above.

I have read and agree to abide by Christ Church Madison's Safeguarding Policy.

I am giving my authorization to the Christ Church Madison (or its representatives) to verify the information on this form.

The church may contact my references. I release Christ Church Madison and its representatives from liability which may result from such actions.

Description

In order to serve in children's ministry at Christ Church Madison, volunteers must go through a child protection training and background check process.
Please fill out this form to provide your personal information for the background check.
Once you submit this, you will receive a confirmation email with a link to an authorization form for the background check. Please submit that asap!

Child Protection Application

Description

Please Fix the Following