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P E R S O N A L   I N F O
Gender
Shirt Size
Month
/
Day
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Year
Are you authorized to work in the U.S.?
P E R S O N A L   H I S T O R Y
Are there any limitations to your physical ability that we need to be made aware?
Do you have any prior experience related to abuse, neglect, or abandonment?
Do you have any training working with children who have been abused, neglected, and or abandoned?
Have you ever been denied the opportunity to work with children in any capacity?
Have you ever been arrested for or charged with any criminal offense including but not limited to sexual crimes, violent crimes, or a drug and alcohol related crimes?
Which of the following have you obtained?
Month
/
Day
/
Year
Start Date
End Date
E M P L O Y M E N T
Start Date
End Date
C H R I S T I A N   F O R M A T I O N

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Is Jesus Christ your Lord and Savior?
E X P E R I E N C E
R E F E R E N C E S
Pastoral Reference:
Employer, Supervisor, or Teacher Reference:
I N T E R E S T E D   P O S I T I O N S
Summer begins on May 17, 2025, and summer ends on August 3, 2025.
Start Date
End Date
Commitment of Honesty