Children, Youth, Vulnerable Adults Worker Application (Appendix A)
Information supplied in this confidential application is to be used for the sole purpose of Safe Sanctuaries, and will be kept in a confidential file at Kingswood United Methodist Church. It is to be completed by all applicants for any position (volunteer or compensated) involving the supervision or custody of children, youth and vulnerable adults. Safe Sanctuaries is required to help the church provide a safe and secure environment for children, youth and vulnerable adults who participate in our programs and use our facilities. ***Kingswood United Methodist Church does not discriminate due to age, ethnicity, sex or ability levels.***
Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Please list any allergies, dietary needs/restrictions, and/or medical conditions we should know about.
*
Emergency Contact Name and Cell Number
*
First and Last Name
Cell phone number
Are you CPR and/or First Aid certified? If so, list last date of certification.
*
Each applicant is required to go through Safe Gatherings training every three years.
As part of this training, two electronic reference checks will be done, as well as (for applicants age 18 or older), a National Criminal Background Check, a 7-year County of Residence Background Check, and a National and State-of-Residence Sex Offender Registry Check.
Have you ever participated in, or been accused, charged or convicted of any criminal offense, especially improper conduct involving children, youth and vulnerable adults?
*
Hover here to read additional details.
Education Background (please include name of school, what you studied, year graduated, and degree)
*
Work Experience of the last FIVE years (please include company name, what you did there, and how long you worked there)
*
Volunteer Experience (please include the organization's name, what you did there, and how long you volunteered there)
*
What type of volunteering do you prefer? (Nursery, elementary-aged children, youth 6th-12th grade, vulnerable adults)
*
When can you begin volunteering?
*
Is there any other information that should be known that was not covered in the information described above?
*
The information contained in this application is correct to the best of my knowledge. In consideration of the receipt and evaluation of this application by Kingswood United Methodist Church, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization.
Should my application be accepted, I agree to be bound by the Bylaws and policies of Kingswood United Methodist Church, and to conduct my services on behalf of the church in an ethical and Christian manner. (Please check the following items.)
*
I understand that I will be required to go through the Safe Gatherings online training, reference checks, and background checks (applicants 18 years old and older) and will give permission through that organization for these items to complete the Safe Sanctuaries process which will then complete my application.
I have received the Kingswood Safe Sanctuaries Plan information.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
*
Parent/Guardian Signature if volunteer is under 18 years old
Date signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: