Confidentail Application for Work with Minors

Confidential Application for Work with Minors

This application is to be completed by all applicants, volunteer or compensated, for any position involving the supervision of minors. The information on this form will be held in strict confidence.
Date of Application
Name

First Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long at current address?
Previous Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Date of Birth
Social Security #
Which Ministry are you volunteering for?
Other names you have been known by
E-mail
Home Number

Area Code Phone Number
Cellular Number

Area Code Phone Number
Work Number

Area Code Phone Number
Marital Status
Occupation
Do you have a current driver's license?
If yes, please provide your driver's license number
Please provide the state of your driver's license issue and the expiration date
Have you ever been charged with, indicted for, or pled guilty or no contest to an offense involving a minor? If yes, please describe all incidences that have occured in the past 5 years.
Were you the victim of abuse or molestation while a minor? If you prefer, you may refuse to answer this question. You may discuss your answer in confidence with a staff minister rather than answering on this form. Answering yes does not automatically disqualify you from working with minors.
Please put a check mark in the box for each statement

The information contained in this application is correct to the best of my knowledge I understand that the church will conduct a criminal history check and I give my permission for this check. I understand that this information will be kept on file. Should my application be accepted, I agree to be bound by the bylaws and policies of this church and to refrain from unscriptural conduct in the performance of my services on behalf of the church. I understand that workers, compensated and volunteer, are subject to termination at the discretion of the church. In the event that I choose to voluntarily terminate my services, I am free to do so at any time. I further state that I have carefully read the foregoing release and know the content thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand.
Signature
Signature date
Should be Empty:

Confidential Application for Work with Minors