New Worker Form

To assist us in keeping our workers' records for all District Workers up to date and accurate, please complete this form online or print it out and return it to the District Office. Only licensed workers on staff at a church or currently receiving credentials from the Alliance are required to complete this form.

Title: *

Legal First Name: *

Preferred First Name:

Last Name: *

Birthdate: *

Place of Birth: *

Social Insurance #: *

Marital Status: *

Date of Marriage:

Spouse's Name:

Please include maiden name if female

Spouse's Birthdate:

Children:

Please provide the full names and birthdates of each child. Include wheter they live at home or are married, and whether or not they are attending college.

Home Address: *

City: *

Postal Code: *

Home Phone Number: *

Church / Employer Name: *

Church Phone: *

Position: *

Job Title

Starting Date: *

Personal Email Address:

Work Email Address: *

Previous Experience:

Please list past experience by listing the church/position and then the dates you served there.

Education:

Post Secondary Education - Name of school and degree or program completed

Date of Ordination:

Place of Ordination:

Ordaining Body:

Home Church:

Date Service began with the C&MA:

Canadian Pacific District

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New Worker Form

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Church… Movement…