1. Personal Information
Full Name
Preferred Name (if different)
Phone
Format: (000) 000-0000.
Email
example@example.com
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
2. Affiliation with Rooted Resource Center
Are you currently connected with Rooted Resource Center (RRC)?
Yes
No
Not yet, but interested
If yes, please describe your involvement:
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3. Church & Faith Community
Rooted Resource Center is a faith-based organization that values Christian community and discipleship.
Do you currently attend a church?
Yes
No
Occasionally
Church Name
City / State
Pastor or ministry leader (optional)
4. Experience Working with Children or Students
Please list any professional, volunteer, ministry, or educational experience working with children, youth, or families.
Organization / Program
Role or Responsibilities
Dates of Involvement
5. Skills & Areas of Interest
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Which age groups are you most comfortable working with?
Age Groups
Preschool (3-5)
Elementary (6-10)
Middle School (11-13)
High School (14-18)
What subjects, activities, or skills would you be interested in teaching or assisting with?
Subjects, activities, or skills
Core Academics
Art/Creative
STEM
Vocational / Trades
Outdoor Education
Faith & Discipleship
Tutoring
Other
Please describe any training, education, certifications, or relevant experience:
6. Teaching & Mentorship Philosophy
Why are you interested in serving at Rooted Resource Center?
How would you describe your approach to guiding, mentoring, or disciplining children?
7. Character & Personal Readiness
At Rooted Resource Center, we believe adults who serve students should model integrity, humility, patience, and a heart for mentorship. These questions help us understand your character, motivations, and readiness to work with children and families.
What motivates you to serve children and students in an educational or mentoring environment?
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What are you most passionate about sharing with the next generation?
Describe a moment when you positively impacted a child or student. What happened and what did you learn from the experience?
How would you describe your personal strengths when working with children or youth?
Patience
Encouragement
Teaching ability
Leadership
Creativity
Organization
Mentorship
Other
Please explain or give an example:
Children sometimes struggle with behavior, emotions, or learning challenges. How do you typically respond when a child becomes frustrated, disruptive, or uncooperative?
Describe a time when you had to resolve conflict with a student, parent, or colleague. What did you do?
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Healthy emotional boundaries are essential when working with minors. How do you maintain appropriate boundaries with students while still being supportive and encouraging?
Serving students can require patience, flexibility, and teamwork. How do you handle stressful or emotionally challenging situations?
What qualities do you believe are most important for adults who mentor or teach children?
Is there anything about your personal calling, interests, or life experiences that you believe would uniquely benefit the students at Rooted Resource Center?
8. Background & Safety Screening
Because Rooted Resource Center (RRC) is committed to the safety and well-being of children, all individuals serving with minors must complete this safety screening.
Your honesty is critical. Disclosure does not automatically disqualify you, but failure to disclose relevant information may result in disqualification from serving.
Legal & Criminal Background
Have you ever been convicted of, pled guilty to, or pled no contest to a criminal offense (excluding minor traffic violations)?
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Yes
No
If yes, please explain:
Have you ever been charged with, investigated for, or accused of a crime involving violence, abuse, misconduct, or harm toward another person?
Yes
No
If yes, please explain:
Have you ever been convicted of, investigated for, or accused of abuse, neglect, or misconduct involving a minor?
Yes
No
If yes, please explain:
Have you ever been subject to a child abuse investigation by a government agency (such as Child Protective Services)?
Yes
No
If yes, please explain:
Have you ever been asked to resign, step down, or been dismissed from a position involving children or youth?
Yes
No
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If yes, please explain:
Have you ever been the subject of a restraining order, protective order, or court order involving safety concerns?
Yes
No
If yes, please explain:
Safety & Conduct
Do you agree to follow all Rooted Resource Center child protection policies, including supervision guidelines and safety procedures?
Yes
No
Do you agree to avoid situations where you are alone with a minor in a private setting unless permitted by RRC safety policies?
Yes
No
Do you agree to use appropriate language, behavior, and physical boundaries with students at all times?
Yes
No
Do you agree to report any suspected abuse, misconduct, or safety concerns involving a child immediately to leadership?
Yes
No
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Background Check Authorization
Rooted Resource Center requires background checks for individuals serving with minors.
Do you consent to the following screening processes?
Screening Processes
Criminal background check
Sex offender registry check
Reference verification
Policy agreement review
Consent
Yes, I consent
No
Additional Safety Acknowledgement
I understand that serving with Rooted Resource Center requires maintaining the highest standards of conduct with children and families. I agree to uphold the organization's policies, maintain appropriate boundaries, and support a safe learning environment.
I agree
9. References
Please provide three references who can speak to your character and experience working with children. They may not be of family relation.
Reference #1 Name
Reference #1 Relationship
Reference #1 Phone
Format: (000) 000-0000.
Reference #1 Email
example@example.com
Reference #2 Name
Reference #2 Relationship
Reference #2 Phone
Format: (000) 000-0000.
Reference #2 Email
example@example.com
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Reference #1
Name
First Name
Last Name
Relationship
Phone
Email
example@example.com
10. Agreement & Authorization
I certify that the information provided in this application is accurate and complete to the best of my knowledge.
I authorize Rooted Resource Center (RRC) to contact references and organizations listed in this application for verification purposes.
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