Application For Service Forms

Thank you for your desire to serve the children of Calvary Church!  Our desire is to provide a safe environment for the protection of our children. All individuals involved in ministry to minors (less than 18 years of age) will be asked to fill out the “Application for Service” forms before they begin serving in order to abide by the PA child abuse reporting law signed in October, 2014. Every 5 years thereafter, all volunteers are asked to update this application for service.


  1. Download Forms: All forms in one PDF can be found here.
  2. Fill them out completely
  3. Have 2 references complete the reference forms
  4. Place your finished forms in an envelope, seal it, and address it to:
    Tamara Brubaker, Children's Ministries/Guest Services Assistant

You may hand it in at the West Connection Center in the lobby, or to the church office.  Thank you!

» For those individuals who will have regular ongoing contact with children, the following must be completed prior to serving:

  • Application for Service
  • Pennsylvania Child Abuse History Clearance (there is no fee for volunteers)
    • This form may be completed on-line.  Please contact Tamara Brubaker at the West Connection Center for instructions and to receive a fee-waived code.
    • Hard Copy- please print out and complete the form at the link above, and sign the consent form for the PA Child Abuse History Clearance found here. This allows the Clearance Certificate to be mailed to Calvary Church. Once it has been received, you may request the original or a copy of the certificate from Tamara Brubaker.
  • Request for State Criminal Record Check (this form will be completed by Calvary)
  • Signed Doctrinal Basis (fill out online or print out a copy)
  • Signed Children's Ministry Covenant (fill out online or print out a copy)
  • (2) Adult References (It is your responsibility to send out the reference forms, references can either fill out the forms online or print out a copy)
  • FBI Criminal History Clearance Certificate (only if you have not lived in PA for at least the past 10 consecutive years).  If this applies to you, you will be contacted after you submit this application.

» If you are a teen worker, age 12-17, you only need to complete the Application for Service (pages 2-4) and References (at the link above).

» If you are an educator or employed by a school district, and have already completed  PA Background Checks, Child Abuse Checks, and/or FBI Criminal History Clearance/Fingerprints, you need to provide copies of these to Calvary Church at time of application.

» Child abuse clearances and PA background checks can be obtained for free for volunteers once every 57 months.  If you obtained clearances free of charge in the last 5 years, and dated after July 25, 2015, please provide copies of these to Calvary Church.


References cannot be relatives. They must fall into one of these categories listed:

  1. Employer
  2. Organization in which you have volunteered i.e. former church, PTA, sports team, etc.
  3. An individual you have worked with for three years or more
  4. A family you have babysat for more than five times
  5. A church leader who has known you for more than three years


Application for Service is presented to you in the strictest of confidence.  Return all requested forms (Application, Doctrinal Basis, Covenant, consent form, PA Abuse History Clearance, and references) to Tamara Brubaker, Children's Ministries/Guest Services Assistant. You can place them in her mailbox in the administrative area mailroom or bring them to the West Connection Center.

Your care to completely fill out every part of this form will speed along your application process. Therefore, do not leave any question unanswered. If requested information is not applicable to you, please write "N/A" on the line.

Thank you again for your faithful service to the next generation here at Calvary Church. Your ministry to children is appreciated very much. This is a crucial ministry as we model God's love, grace, and truth to them. May God grant you much eternal fruit through your ministry.

If you have any questions, please contact Tamara Brubaker, at (717) 560-2341.