EmailMe Form - Fellowship In The Pass Church Ministry Application

PRIMARY SCREENING FOR WORKING WITH MINORS AND DISABLED

This application is to be completed by all applicants for any position (voluntary or compensated) involving supervision or custody of minors. Persons seeking a position in the church as a paid employee will be required to complete an employment application in addition to this screening form. It is being used to help the church provide a safe and secure environment for those children and youth who participate in our programs and use our facilities.

Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Email *

Date of Birth *

MM / DD / YYYY

Please list the area of ministry you desire to work.

YOUTH

CHILDREN

DISABLED

Message *

Date Available to begin. *

MM / DD / YYYY

What is the minimum length of commitment you can make? *

Have you ever plead guilty to a crime?

NO

YES

If you prefer, you may refuse to answer the following two questions, or you may discuss your answer in confidence with the pastor rather than answering it on this form. Answering yes, or leaving the question unanswered, will not automatically disqualify an applicant for children, youth or working with the disabled.

Were you a victim of abuse or molestation as a minor?

NO

YES

Do you have a current California driver’s license? *

YES

NO

Previous addresses for the past 5 years: *

Church History and Prior Youth / Children Work

List (names and addresses) of other churches you have attended regularly during the past 5 years: *

List all previous church work involving youth and children (list each church’s name and address, type of work performed and dates): *

As a church volunteer, do you agree to observe all church policies regarding working with youth or children? *

YES

NO

Have you ever been convicted of or plead guilty to a crime? *

YES

NO

Were you a victim of abuse or molestation while a minor?

YES

NO

List all previous non-church work involving youth. List each organization’s name and address, type of work performed, and dates:

List any gifts, callings, training, education, or other factors that have prepared you for children or youth work:

Personal references

NOT former employers, current pastors, child/teen, or relatives:

Name (REFERENCE #1)

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Name(REFERENCE #2)

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Applicant’s Statement *

I have read the church’s abuse policy.

I have read the church’s Statement of Faith and Conduct.

I hereby state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.