What to Expect
Our Staff & Leadership
Become A Member
Forms & Requests
Fill out the form below with your information.
Questions? Call the office at (541) 899-1287
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How long have you attended Jacksonville Presbyterian Church?
Are you a member of JPC?
If yes, for how long?
Occupation & Education
Occupation (if employed)
Highest year of education, or degree granted:
Indicate current certifications with expiration dates and any registration numbers.
Nurse, EMT, CPR, Teaching, etc.
Do you have a valid driver's license?
Number & State
Please provide a brief explanation of why you want to become a part of the children's ministry.
The spiritual gifts that I have been given include, but are not restricted to:
My past experiences with children in any capacity include the following:
References & Background
Please list three persons not related to you who have a definite knowledge of your qualifications for the position for which you are applying.
Must have complete addresses & contact info
Have you ever been convicted in any judicial or administrative proceeding of having sexually assaulted or exploited any minor, or to have physically abused any minor?
If yes, please know that while you are unable to serve in the children's ministry, we will discuss other areas that you may be able to serve.
Have you ever been convicted of a criminal offense in the last seven years?
If yes, please give date, nature of offense, and disposition.
Please note: A criminal record will not necessarily bar an applicant. A criminal record will be considered as it relates to specifics of the position for which you have applied.
Are you available and willing to participate in periodic volunteer training?
I authorize contact of references both primary and secondary. I understand that misrepresentation or omission of facts requested is cause for non-appointment as a volunteer. By signing below I grant permission to Jacksonville Presbyterian Church to seek validation of the above information with a police records check, as they may deem appropriate.
By typing your name above, you consent to electronic signature.
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PO Box 297
425 Middle Street
Jacksonville, Oregon 97530