First Name
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Middle Name
Last Name
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Today's Date
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Email Address
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Primary Phone Number
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Birth Date
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Marital Status
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Spouse's Name (if applicable)
Number of Children (if applicable)
Ages of Children (if applicable)
Emergeny Contact Name
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Emergency Contact Phone
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Do you have any medical training or are you CPR certified?
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In which areas would you like to serve? Select all that apply.
Have you accepted Christ as your Lord & Savior?
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Please describe how you came to faith in Jesus Christ:
How long have you been attending Cross of Grace?
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Are you a member of Cross of Grace Santa Ana?
List any skills, training, or education that have prepared you to work with children or youth:
Please list any other CGSA ministries in which you are involved.
Why do you want to work with children or youth at CGSA?
Name
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Last Name
How long have you known the reference?
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Relationship
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Email
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Phone
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1) Have you ever been convicted of a crime?
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2) Have you ever been accused, arrested, or convicted of child abuse, neglect, or a crime involving actual or attempted sexual molestation of a minor or other sexually related crime?
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3) Do you use illegal drugs?
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4) Have you ever been convicted of or plead guilty to the use or sale of drugs?
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5) Have you ever been hospitalized or treated for alcohol or substance abuse?
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6) Is there any health related reason that would keep you from effectively working with children/minors or cause any potential harm to our children?
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7) Are there any circumstances involving your lifestyle or background that would call into question your ability to work with children or youth?
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8) Have you ever had sexual relations with any minor after you became an adult?
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9) Have you ever struggled with any sin involving a child or youth?
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10) Have you ever been charged with a crime or misconduct at your workplace?
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11) Have you ever been accused of improper conduct by an employer or as a volunteer for any reason?
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12) Is there any other information that will be revealed through a background check?
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13) Do you presently have any communicable diseases?
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14) Have you ever been a victim of any form of child abuse?
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If you answered "Yes" to any of the questions above, please provide a written explanation here.
Please be prepared to discuss your answers with a pastor or ministry leader. By clicking below you agree to immediately inform Cross of Grace Santa Ana of any subsequent information, including any accusations, convictions, or other occurrences that relate to the areas of inquiry set forth above.
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Acknowledgement
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