2025 Chandler T.R.A.C. Volunteer Application

New Staff Member Information
Have you ever been abused, neglected, or abandoned?*

YesNo
Please Explain*
Leave blank if you prefer to discuss in person.
Have you committed your life to Jesus Christ?*

YesNoSearching
Do you feel you could lead a 15 minute devotion with your campers with material we provide?*

YesNoMaybe

Motivation and Experience
Highest Level of Education*

Some High SchoolHigh SchoolSome CollegeAssociates DegreeBachelors DegreeMasters DegreePhD
Describe any previous experience working with children or teens.
Describe previous training or background in dealing with abused, neglected, or abandoned teens?
Why do you wish to be a volunteer at T.R.A.C.?*

Personal References

One professional, one ministry, one personal (no immediate relatives). Please list either an email address or phone number for each reference, preferably both.
Professional Reference Name*

First NameLast Name
Professional Reference Email*
example@example.com
Professional Reference Phone
Ministry Reference Name*

First NameLast Name
Ministry Reference Email*
example@example.com
Ministry Reference Phone
Personal Reference Name*

First NameLast Name
Personal Reference Email*
example@example.com
Personal Reference Phone

Read the embedded PDF above or click here to download a copy.
I have read, agree with, and will comply with the Teen Reach Statement of Faith, Volunteer Standards, Position Statement, and Code of Conduct.*

YesNo

Returning Staff Update
Why do you wish to continue volunteering at T.R.A.C.?*
Since your original application, have you been accused or convicted of any sexual misconduct?*

YesNo
In the past year, have you taken drugs other than prescription drugs prescribed to you?*

YesNo
If you answered yes to either question above, please explain.*
How has God been growing you over the past year?*

Medical History
Medical Conditions
Please explain any medical conditions you may have.
Medications
Please list all medications (including medical marijuana), the reason and possible side effects.
Can you hike at least 2 miles?*

YesNo
List any allergies
Dietary restrictions:

Gluten FreeVegetarianNut Allergies
Additional Comments
Please list anything at all that you would like to add or anything from above that you would like to clarify.
Signature*

Clear

Liability Waiver and Consent to Procurement of an Investigative Background Report

I understand that, as a condition of consideration for employment and/or volunteer work with Crossroads Nazarene Church, or as a condition of continued employment and/or volunteer work with Crossroads Nazarene Church, Crossroads Nazarene Church may obtain a background report that includes, but is not limited to, employment and education verification, social security number verification, criminal and civil court history, personal interviews, driving records, and any other public records or any other information bearing on my character, general reputation, personal characteristics, and trustworthiness.

I hereby authorize and consent to Crossroads Nazarene Church’s procurement of such a report and acknowledge that such report may be prepared by a third party to be selected by Crossroads Nazarene Church. I understand that, pursuant to the federal Fair Credit Reporting Act, Crossroads Nazarene Church will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making an adverse decision regarding my fitness for employment or volunteer work with Crossroads Nazarene Church. I further understand that such report will be made available to me prior to such decision being made, along with the source of the information contained in the report.

I agree to release from liability and damages Crossroads Nazarene Church and its agents who conduct and participate in any such review and those individuals, organizations, and their agents who provide information about me during this review, only to the extent that such information is released without malicious intent. I authorize all such persons to treat a photocopy of this Consent as though it were an original, executed consent. All materials pertaining to the background report shall be the property of Crossroads Nazarene Church.

I attest and affirm that all of the information I have provided is true, complete, and correct. I agree to abide by the policies and procedures of Crossroads Church of the Nazarene and to protect the health and safety of the children or youth at all times.

I agree to submit this form by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. I understand that I am not required to sign this form electronically and can request to sign a paper copy if I so choose.
Signature*

Clear
Please verify that you are human*
Should be Empty:

New Staff Member Information

Criminal History

Motivation and Experience

Personal Profile

Strengths

Weaknesses

Personal References

Returning Staff Update

Medical History