Worthy Redeemer Kids Worker Application

Worthy Redeemer Kids Worker Application
This form is to be completed for any position involved in the supervision or care of minors. This is being used to help provide a safe and secure environment for the minors, volunteers and the church.
Basic Information
Name

First NameMiddle NameLast Name
Maiden, if applicable
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If less than one year, previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
Occupation
Cell or Home Phone
Best way to contact you

EmailPhone CallText
I have attended Worthy Redeemer Church since
approximate month/year
What age group do you most enjoy working with?

Toddler Class (ages 1-4)Elementary Age Class (ages K-3)
Please list any previous experience, paid or volunteer, involving children or youth
Please describe what motivates you to become involved in ministry to children or youth.
Confidential Information
The following questions are designed to help us provide a safe, loving, and secure environment for the volunteers and children/youth who attend our church. Your answers will not necessarily disqualify; however, an elder may talk with you in private, to see whether you need any assistance regarding the matter and to learn whether the findings have bearing on your ability to work with children/youth If you prefer not to answer any of the questions in writing, you may leave them blank and an appropriate leader will talk with you personally and privately.
1.Do you have any legal charges pending against you and/or have you ever been arrested for, charged with, under probation for, convicted of or pleaded guilty to either sexual or physical abuse?

NoYesI would like to discuss
2. Have you committed any act of neglecting, abusing or molesting any child?

NoYesI would like to discuss
3. Is there any evidence that you may have an addiction to drugs, alcohol, pornography or any other destructive behavior?

NoYesI would like to discuss
4. Is there any circumstance or pattern in your life that would make it inappropriate for you to serve with minors or would compromise the integrity of Worthy Redeemer Church?

NoYesI would like to discuss
Reference Information
Please list all churches you have regularly attended during the past five years.
Church name City State Years attended Phone number
Church name City State Years attended Type a label
Church name City State Years attended Type a label
Please provide personal references for each of the following:
Gospel Community Host

First NameLast Name
Email
example@example.com
Phone
Person, other than a family member, who knows you well (employer, coworker, etc.)

First NameLast Name
Email
example@example.com
Phone
Person, other than a family member, who has observed you interacting with minors

First NameLast Name
Email
example@example.com
Phone
By completing this application, I give Worthy Redeemer Church full approval to discuss with the references I've provided any interactions I've had, positive or negative, with children in the past.
Background Screening Information
Worthy Redeemer Church desires to protect its children by requiring anyone with regular access to minors, including but not limited to Worthy Redeemer Kids adult volunteers, to submit to a background check. We have engaged Checkr, Inc., a third party consumer reporting agency as defined by the Fair Credit Reporting Act, to obtain a consumer report, which will provide a background investigation as a pre-condition of your engagement with Worthy Redeemer Kids and in compliance with applicable law. You can expect to receive an email from the church office administrator with a link to a form from Checkr to begin the screening process.
Should be Empty:

Worthy Redeemer Kids Worker Application

Basic Information

Confidential Information

Reference Information

Please list all churches you have regularly attended during the past five years.

Please provide personal references for each of the following:

Background Screening Information