MinistrySafe Volunteer Application

This application should be completed by all applicants for any position involving the supervision of children or students. This is not an employment application. The purpose of this form is to assist in the creation of a safe environment for children or students who participate in the programs of Foundation or use Foundation facilities.

Applicant *

First Name Last Name

Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

How long have you lived at your current address? *

Phone Number *

Area Code Phone Number

Email *

example@example.com

Drivers License # *

Social Security # *

Sex *

Date of Birth: *

Date

Marital Status *

Previous Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

List all other cities and states where you have lived as an adult: *

Please list all previous volunteer work or employment involving children or students. List each organization's name and address, type of work, dates, and a contact person familiar with your work there. *

List any talents, training, or other experiences that have equipped you to work with children or students: *

Because we care for children and desire to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy in every possible context. It is the position of Foundation that suspicions or allegations of child abuse or neglect will be reported to relevant state authorities.

Why do you want to work with children or students at Foundation? *

Do you have a preference concerning the age or sex of children or students with whom you would like to work? If so, what is the basis for this preference? *

What is your philosophy concerning redirection or discipline of children? *

When you are unhappy, angry, or emotional about a person or circumstance, what do you do? *

Have you experienced any significant physical or emotional stressors within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain. *

Have you ever physically or sexually abused a child? *

Has someone ever accused you of physically or sexually abusing a child, or molesting a child? *

Do you consider yourself to have been physically or sexually abused as a child? *

If you answered yes, would you consider counseling or accept resources to address any resulting emotional or spiritual harm or damage?

Each applicant must submit the names and phone numbers of at least one professional reference, one personal reference, and one family member. The professional references should be familiar with the quality of the individual’s work. If applicant has never held outside employment, a volunteer supervisor will suffice. One of these references should be a person of the opposite sex. Please contact these references and inform them an authorized Foundation staff person will be contacting them.

Reference #1 *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reference #2 *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reference #3 *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please click each box to signify your acceptance of the following statements: *

I declare that all statements contained in this Safety Application are true to the best of my knowledge. I understand that any misrepresentation or omission is cause for dismissal from any ministry involvement. I understand that my references and contacts from my prior church or secular work with children, students, or disabled adults will be contacted and that an appropriate criminal background check will be conducted. I authorize investigations of all statements contained in this application. I specifically authorize the church to undertake a criminal background check of my past. I understand that I must be interviewed and recommended by a member of Foundation's Safety Screening Committee before I begin service as a volunteer in Foundation Church ministries. I understand that I can withdraw from the application process at any time. I understand that Foundation Church has a policy of ZERO TOLERANCE FOR ABUSE and takes all allegations of abuse seriously. I further understand that Foundation Church cooperates fully with the authorities to investigate all cases of alleged abuse. Abuse of any kind is grounds for immediate dismissal from my volunteer position and possible criminal charges. I declare that I am not a pedophile or child molester. I have no perpetrated physical abuse, sexual abuse, emotional abuse, or neglect against a child, student, or disabled adult, and I have never been accused of these acts. I understand and agree that false statements regarding past conduct and/or present situations may be grounds for denial of this application to provide volunteer services, and that refusal to inform Foundation Church of the contents of a sealed criminal record will result in the automatic denial of the application. If accepted as a volunteer, I agree to read and abide by all Policies and Procedures provided to me by Foundation Church.

I authorize Foundation to contact all individuals, organizations and references listed on this Safety Application Form in order to verify the information I have provided. I agree to release from liability any person or organization providing information related to me, including those persons I have listed as references, as well as contact persons from my previous volunteer work or employment with children.

I specifically authorize Foundation to undertake a criminal background check concerning my past.

I understand and agree that any information received from the background check and application verification will not be disclosed to me except as required by law, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form.

By signing this form, I certify and affirm that the information I have given on this form is true, complete and correct in all respects.

Signature: *

Clear

Date: *

Date

Safety Application Form for Volunteers

REFERENCES

Volunteer Statements and Agreed Code of Conduct

RELEASE