Background Check

Background Check

All information provided within this form is held as confidential among the individual, the leader of the ministry they are applying to, and the staff member who processes the background check.

This application is to be completed by all applicants for any position (volunteer or compensated) involving the supervision or custody of minors (under 18 years of age). This is not an employment application form. It is being used to help the church provide a safe and secure environment for children and students who participate in our programs and use our facilities.

General Information
Which ministry are you filling this form out for?
Full Name:*

First NameMiddle NameLast Name
Date:*

MonthDayYear
Gender*

MaleFemale
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
E-mail:*

Background Information
Have you personally accepted Jesus Christ as your Lord and Savior?

YESNO
Other areas you have been involved in at HCC:*
Last Church:*
Dates Attended:*
Youth and Child-related Work:*

References

List two (2) people you know, other than family, who have knowledge of your character and ability to work with children or students.
Reference #1
Full Name:*

First NameLast Name
Length of time known:*
Do they attend Hillside?*

YesNo
Contact Phone Number:*

Area CodePhone Number
E-mail:*

Reference #2
Full Name:*

First NameLast Name
Length of time known:*
Do they attend Hillside?*

YesNo
Contact Phone Number:*

Area CodePhone Number
E-mail:*

DRIVER POLICY

The following guidelines are to be followed when transporting minors for a ministry event.
- All drivers must be at least 25 years old.
- All drivers must be carry liability insurance.
- All Vehicles must have two adults (18 and older) in the vehicle.
- All drivers must complete a HCC Event Driver form.
- Any incidents of traffic violation while transporting of students must be reported to the ministry leader of that event.
- Riders of this vehicle are limited to the number of available seat belts in vehicle. All passengers must use appropriate safety equipment while travelling in vehicle.
APPLICANT'S STATEMENT

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or student work. I authorize the release of the information contained in this application to any ministry at Hillside Community Church in which I seek a position (volunteer or compensated). In consideration of the receipt and evaluation of this application by Hillside Community 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, 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 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 will be mindful of my attitudes, actions and speech so as to conduct myself in a manner consistent with the goals, values and teachings of this church. I have read the driver policy and agree to follow the guidelines listed.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF, AND SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
I understand that checking yes and entering my name below constitutes a legal signature.*

Yes
Full Name:*

First NameMiddle NameLast Name

Confidential Confidential

REQUEST FOR CRIMINAL RECORDS CHECK AND AUTHORIZATION

Thank you for your cooperation with this process. Due to the sensitivity surrounding this type of personal information, we agree to delete this portion of your application once your background check has been cleared.

I hereby request and authorize the release of any information which pertains to any record of convictions contained in law enforcement files or in any criminal file maintained on me whether local, state, or national. I hereby release local, state and national law enforcement agencies from any and all liability resulting from such disclosure.
Full Name:*

First NameMiddle NameLast Name
I understand that checking yes and entering my name below constitutes a legal signature.*

Yes
Date:*

MonthDayYear

In order to complete a background check we will need the following:
Full Name:*

First NameMiddle NameLast Name
Maiden Name:*
Print all Aliases (if applicable):*
Gender:*

FemaleMale
Date of Birth:*

MonthDayYear
Place of Birth:*
Social Security No:*
Please use dashes (ex. 123-45-6789)
_________ Trak-1

_________ Report

_________ References Approved By

_________ Signature

_________ DB Update
Should be Empty:

General Information

Background Information

Personal Information