Volunteer Form

Adult Volunteer Application for Children's & Youth Ministry
Name:*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Best Day(s) to serve:*

MondayFridayTuesdaySaturdayWednesdaySundayThursday
Best day of the week and time of day to be contacted
Position applying for
Present church member?*

YesNoIn membership process
Church positions held in the past
Current Ocupation*
Where employed*
What skills, spiritual gifts, or talents do you have which might be useful in this position?
Have you been convicted of a criminal offense? If yes, explain below.*

YesNo
If yes, please explain.
Have you been convicted of child abuse or sexual abuse or been involved in any activities related to molesting or abusing children/youth?*

YesNo
If yes, please explain.
What moving violations are on your driving record? Please list and explain.*
References

Please list two (2) references (not related to you) , including a former supervisor.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration, and may result in my removal if discovered at a later date.

Further, I agree to observe the constitution and policies of Jenison Christian Church and to strive for New Testament conduct in the performance of my service on behalf of the church.
Signature*
Additional Information for Background Check
Other Names Used (alias, maiden, nickname)*
Former Address (last 5 years)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Former Address (last 5 years)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Social Security Number*
Driver's License Number & Date of Issuance*
Gender*

FemaleMale
Permission to Obtain a Background Check
In the interest of safety and security I, the undersigned applicant, authorize Jenison Christian Church through its independent contractor to procure background information about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/record; and sex offender records.

I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Jenison Christian Church if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.
Signature
Should be Empty:

Adult Volunteer Application for Children's & Youth Ministry

References

Reference 1

Reference 2