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CEF Northern Kentucky

Worker’s Compliance Agreement

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First Name*

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Last Name*

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How do you want your name to be printed on your name tag?*

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YOUR ADDRESS

Street Address*

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City*

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Zip Code*

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State*

Phone

Email Address

Today's Date*

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Name of your Good News Club (school) *

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Name of the Church you attend *

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Please explain briefly your salvation experience.

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Have you ever been convicted of a crime?*

YES

Have you ever been accused of child abuse?*

YES

I am in agreement with CEF's statement of faith.*

YES

I will abide by the Workers Compliance Agreement.*

YES

I have reviewed the Protecting Todays Child presentation (866-878-4182 or www.cefonline.com/childprotection) in the last 12 months. *

YES

Provide 3 References (non-related; at least 1 Pastor or Church Leader)

First Reference Full Name

Type Full Street Address

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Phone

Email Address

Church Member of

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Provide 3 References (non-related; at least 1 Pastor or Church Leader)

Second Reference Full Name

Type Full Street Address

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Email Address

Church Member of

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Provide 3 References (non-related; at least 1 Pastor or Church Leader)

Third Reference Full Name

Type Full Street Address

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Email Address

Church Member of

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Your Signature

8 plus 1 equals?*

Prove you are a human

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