• 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

  • Date:*
     - -
  • Gender*
  •  -

  • Background Information

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

  • 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

  • Do they attend Hillside?*
  •  -

  • Reference #2

  • Do they attend Hillside?*
  •  -

  • Personal Information

  • Are you:*
  • Has there ever been a concern of alcohol abuse, drug abuse, and/or physical or sexual abuse in your family of origin or your current family situation?*
  • Have you ever been arrested, convicted or plead guilty to a crime?*
  • Have you ever been accused of, charged with, alleged to have, or actually committed any act of neglect, abuse, or molestation of any child?*
  • Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography; any other addiction, or has anyone ever suggested that you may have a problem with any of the above?*
  • Have you ever been diagnosed and treated for a psychiatric disorder? *
  • Is there any circumstance or pattern in your life which would make it inappropriate for you to serve with minors or would compromise the integrity of Hillside Community Church?*
  • We are a part of the Transformation Ministries association of Churches and we align with their Core Values. Is there any circumstance or pattern in your life which would be in opposition to these Core Values? Please see the Transformation Ministries Website.
  • I need to discuss my responses with the appropriate staff person.*

  • 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.

  •  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.

  • Date:*
     - -

  • In order to complete a background check we will need the following:

  • Gender:*
  • Date of Birth:*
     - -

  • _________ Trak-1

    _________ Report

    _________ References Approved By

    _________ Signature

    _________ DB Update

  • Should be Empty: