Connect Kidz Application
CONFIDENTIAL : This application is to be completed by all volunteers 18 years and older who are involved in the supervision or custody of minors. This is not an employment application form. The purpose of this form is to protect those children who participate in our programs from incidents of misconduct or inappropriate behavior while also protecting our staff and volunteer (workers) from false accusations.
General Information
Today's Date :
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Month
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Day
Year
Date
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Employment History
Employer Name, Title
First Name
Last Name, Title
Employer Phone Number
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Please enter a valid phone number.
Employer Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Position
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Time at Job
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References
Before an applicant is permitted to work with children, at least two of the applicants’ references will be checked. These references should be of an institutional nature as opposed to personal or family references, preferably from organizations where the applicant has worked with children in the past. Documentation of the reference checks will be maintained in confidence on file at The Experience Vineyard Church.
Ref. 1
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First Name
Last Name, Title
Phone Number
Please enter a valid phone number.
Ref. 1 Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ref. 2 Name, Title
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First Name
Last Name, Title
Ref. 2 Phone Number
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Please enter a valid phone number.
Ref. 2 Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ref. 3 Name, Title
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First Name
Last Name, Title
Ref. 3 Phone Number
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Please enter a valid phone number.
Ref. 3 Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ministry Specific
Which services are you available to serve? Click all that apply.
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9:30am
Connect time (in between services)
11:30am
Family Night Out/Events
VBS (during the summer)
Most Needed
Which areas of ministry are you interested in serving? Click all that apply.
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The Artists (0-3 age)
The Zookeepers (4-5 age)
The Astronauts (6-11 age)
Buddy - Special Needs
Events
1. Why are you considering working with the children at our church?
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2. Have you had any formalized education in teaching or working with young children?
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3. How long have you attended our church?
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2. In what are(s) of ministry are you currently involved? How long?
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Criminal Background Information
A national criminal background check is required for all employees and children/youth volunteers. If your application is accepted, you will be sent a link via email authorizing The Experience Vineyard Church to run a criminal and national sex offender background check. * If the answer to any of the questions below is yes, please write a full explanation in the space provided.
1. Have you ever been arrested, convicted or pleaded guilty to a crime? yes/no
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2. Are you presently using illegal drugs? yes/no
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3. Have you ever been involved romantically or sexually with any minor as an adult? yes/no
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4. Have you ever been suspected, accused, charged, or alleged to have or have you ever committed an act of neglecting, abusing, or molesting a child? yes/no
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5. Have you ever been treated for a psychiatric disorder? yes/no
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6. Is there any circumstance or pattern in your life that may make it inappropriate for you to work with children? yes/no
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Applicant's Statement
The information contained in this application is correct to the best of my knowledge. I authorize The Experience Vineyard Church representatives- hereafter referred to as the church- to verify the information on this form. The church may contact any appropriate government agencies as deemed necessary to verify my suitability as a Church Youth/Children’s Ministry worker (volunteer or compensated). In consideration of the receipt and evaluation of this application by the church, I hereby release any individual, church, children’s organization, charity, employer, reference, or any other person or organization, including records custodian, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me my heirs, or family, on the account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to refrain from unscriptural conduct in the performance of my services on behalf of the church. I agree to be bound by the constitution, statement of faith and policies of the Church. If I violate these guidelines, I understand that my volunteer status may be terminated. I state that all of the information given about myself is true. I further state that I HAVE CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF AND SIGN THIS RELEASE OF MY OWN FREE ACT. This is a legally building agreement I have read and understand.
Applicant's Signature
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Today's Date
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Month
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Day
Year
Date
Please verify that you are human
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Submit
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