Volunteer Application

Please note - this form is being submitted over an https secure connection to ensure the privacy of your data.

Last Name*

First Name, Middle Name or Initial*

Street Address*

City*

State*

ZIP*

Phone (Home/Cell)*

Phone (Work)

Birth Date*

MonthDayYear

Place of Birth (City, State, Country if not USA)*

Driver's License Number*

Driver's License State*

Social Security Number*

Race

Gender*

E-mail address*

Emergency Contact (Name and Phone)*

1st Character Reference - Please enter the person's full name. Do not list immediate family.*

1st reference email*

2nd Character Reference - Please enter the person's full name. Do not list immediate family.*

2nd reference email*

3rd Character Reference - Please enter the person's full name. Do not list immediate family.*

3rd reference email*

Chapelwood program(s) for which you are volunteering*

Special trainings that might aid in volunteer work

Please list any health issues which might limit your ability to serve.

Are you a member of Chapelwood?*

YesNo

For how many years?

Please list the names and cities of churches you have attended regularly during the last five years.

Please list prior volunteer opportunities in which you have been involved (i.e., Boy Scouts, Girl Scouts, children or youth sports, etc.).

Please list any gifts, callings, training, education, or other factors that have prepared you to work with children, youth, or vulnerable adults.

Have you ever been convicted or pled guilty before a court for any federal, state, or municipal criminal offense? (Exclude minor traffic misdemeanors.)*

YesNo

State

County

Date of offense

MonthDayYear

Details of conviction

Have you ever received deferred adjudication or similar disposition for any federal, state, or municipal offense?*

YesNo

State

County

Date of offense

MonthDayYear

Details of offense

Have you ever received probation or community supervision for any federal, state, or municipal offense?*

YesNo

State

County

Date of offense

MonthDayYear

Details of supervision

Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?*

YesNo

Country

City

Date of offense

MonthDayYear

Details of conviction

As of the date of this consent form, do you have any pending charges against you?*

YesNo

State

County

Date of arrest

MonthDayYear

Details of pending charges

Please list all cities, counties, and states of residence since high school graduation or age 18.*

This is a consent form that allows Chapelwood United Methodist Church to perform a criminal history/background check every three years in compliance with the FCRA (Fair Credit Reporting Act). Please read it carefully, and acknowledge your acceptance by checking the box below.

I am an applicant to volunteer with Chapelwood United Methodist Church and have been advised that as a part of the application process, the church conducts a criminal history background check. I do hereby consent to Chapelwood United Methodist Church's use of any information provided during the application process in performing the criminal history check. Chapelwood United Methodist Church has informed me that I have the right to review and challenge any negative information that would adversely impact a decision to offer volunteer work. In addition, I have been informed that I will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established within the sole discretion of the church/division. Under the Fair Credit Reporting Act, I have been advised that upon request I will be provided the name, address, and telephone number of the reporting agency as well as the nature, substance, and source of all information.

Additionally, I authorize any references or churches listed in this application to give you any information, including opinions, which they have have regarding my character and fitness for working with children, youth, or vulnerable adults. In consideration of the receipt and evaluation of this application by Chapelwood United Methodist Church, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, their heirs and assigns, from any and all liability for damages of whatever kind of 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. 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.

I hereby certify that all information provided in this consent form is true, conrrect, and complete. All offers of volunteer opportunities are contingent upon applicant's successful completion, as determined in the church's sole discretion, of this criminal history/background check. Should my application be accepted, I have read and agree to be bound by the attached Child, Youth, and Adult Safety Policy for Chapelwood United Methodist Church and to refrain from conduct in violation of the attached policies in the performance of my services on behalf of the church.

The Safe Sanctuary Policy of Chapelwood United Methodist Church

I have read and understand the above information, and by checking the following box, signify my acceptance of its terms. I understand that checking this box is as binding as my signature.*

I agree.

My name*

First NameLast Name

Today's date*

MonthDayYear

Chapelwood HR - label

HR email

Volunteer Application - Chapelwood U.M.C.