• Background Check Authorization

  • Today's Date*
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  • Birthdate*
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  • Confidential Information

    Answering "YES" to any of these will require an explanation
  • Have you ever been convicted on any crime against children or other persons?*
  • Have you ever been convicted of crime relating to financial exploitation if the victim was a vulnerable adult?*
  • Have you ever been convicted of crimes related to drugs as defined in RCW 43.43.830?*
  • Have you ever been found in any dependency action under RCW 13.34.040 to have sexually or physically abused any minor?*
  • Have you ever been found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult?*
  • Have you ever been found by a court in a protection proceeding under chapter 74.34 RCW, to have abused or financially exploited any vulnerable adult?*

  • To ensure both your safety and the safety of the children in your care, please speak with a Ministry Staff Member if you have concerns or special meeds related to HIV/AIDS, blood disorders or hepatitis. Thank you.

  • Applicant's Statement

    The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, or other organizations listed in this application to give you any information they may have regarding my character and fitness for children's/minor's services, and I release all such references from liability for any damage which may result from furnishing such evaluations to you. I understand the personal information will be held confidentially by the professional church staff. I also understand that there will be a background check conducted.
  • Today's Date*
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  • Should be Empty: