-
-
-
- Bearing in mind that your proposed service may involve access to minor children, is there anything in your personal history or experience that indicates you have any problem whatsoever involving sexual attraction to children or any related tendencies that could pose a risk of harm to any children you may encounter during your service?*
-
- Have you ever been the subject of a complaint of child abuse or any other type of mistreatment of children?*
-
- Has anyone ever complained to you, the organization you were serving with, or to the government concerning your care of children?*
-
- Certain types of behavior may reflect negatively on your fitness to serve in this ministry. Have you ever been charged with or convicted of any crime or misdemeanor involving (1) a minor child, (2) stalking or harassment, (3) sex or lewd behavior (e.g., rape, sexual assault, prostitution, public indecency) or (4) violence against another person?*
-
- Have you engaged in any illegal drug use within the past 10 years?*
-
-
- Date*
-
-
-
-
-
-
-
-
- Current Address Since:*
-
- Previous Address 1 Since:
-
- Previous Address 2 Since:
-
- Date of Birth*
-
Format: (000) 000-0000.
-
-
-
-
- Date*
-
- Should be Empty: