Weekday Childcare Provider Application

Thank you for your interest in working at Blackhawk Church! As a next step, please complete the following application form.

*Address Line 1
Address Line 2
*Zip/Postal Code
*Citizenship Status:
*Marital Status:
If you have children, please list their names and ages:
Describe how you came to faith in God, and how you are growing in your relationship with Him.
Parent/Guardian's Name (if applicant is under 18):
Parent/Guardian's Email (if applicant is under 18):
Why do you want to work as a child care provider at Blackhawk Church?
If there are any disabilities you have that you think may prevent you from working in a classroom with children, please indicate them here:
If applicable, please share experience you have working with children, and with what organization.
If applicable, list the churches you have attended regularly in the past 10 years and, if any, the church ministries you volunteered in. Please include dates when possible (can be approximate).

Are there any past or present issues (spiritual, physical, emotional/mental, social) which would hinder your ability to work appropriately with children?
Have you ever been accused, charged or convicted of a criminal offense (felony or misdemeanor) other than a parking violation?
Do you have any past or present struggles with addiction (alcohol, drug, pornography, etc.)?
If you answered Yes to any of the Security questions, please explain below.

Please provide complete contact information for three references who have acquired accurate knowledge of your character and meet the following criteria:
  • Known for more than one year,
  • At least 18 years old, 
  • Not related to you,
  • Not your significant other,
  • Not a member of Blackhawk staff. 
Reference #1
*Reference #1 Name:
*Reference #1 Relationship to You:
*Reference #1 Email Address:
*Reference #1 Mailing Address:

Reference #2
*Reference #2 Name:
*Reference #2 Relationship to You:
*Reference #2 Email Address:
*Reference #2 Mailing Address:

Reference #3
*Reference #3 Name:
*Reference #3 Relationship to You:
*Reference #3 Email Address:
*Reference #3 Mailing Address:


By signing below I agree that the information provided in this application is true, and I authorize the Church (Blackhawk Evangelical Free Church and/or its representative) to verify the information on this form. I authorize any organizations, institutions, churches or references listed in this application to give the church any information (including opinions) that they may have regarding my character and suitability for volunteer work. I hereby release any individual, organization, employer, church or reference from any and all liability for any damages that may at any time result to me, my heirs, or family, on account of compliance or any attempt to comply with this authorization. Should my application be accepted I agree to adhere to all policies of Blackhawk Church.

In the interest of safety and security I, the undersigned applicant, authorize Blackhawk Evangelical Free Church to procure background information about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request. Also, I understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.
*Applicant's Signature: