NM NazSafe Children and Youth Worker Application

Please read the District Nazarene Safe Policy Document.

I have read the District Nazarene Safe Policy

Full Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone*

Area CodePhone Number

E-mail*

YouthChildren

In which children/youth programs do you want to be come involved?*

What skills would you bring to the children/youth program?*

What other children/youth work experience do you have? (Please list)*

Please give organization(s), program, dates and contact name

YesNo

Please explain why:

YesNo

Please explain in detail:*

YesNo

Please explain in detail:*

YesNo

Please explain in detail:*

YesNo

Please explain in detail:*

Church Activity - What church or churches have you attended in the past five years:*

Provide Church Name, Pastor's Name and Years Attended

Pastoral Approval

Please provide information on your Pastor (who will be asked to approve of your serving with children and/or youth).

We will email him/her, and you, a link where:
- he/she may fill out an online approval form
- or download a printable form which may scanned and emailed.

NOTE: It is YOUR responsibility to check with your Pastor to make sure the approval form is filled out, submitted and received.

Pastor's Name*

First NameLast Name

Pastor's Phone*

Area CodePhone Number

Pastor's Email*

Personal References

Please provide at least one (1) Personal Reference (other than your Pastor and someone not related to you) who know you well and can testify to your walk with Christ, your character and your willingness to serve.

We will email them, and you, a link where:
- they may fill out an online reference form
- or download a printable form which may be scanned and emailed.

NOTE: It is YOUR reponsibility to check with your Personal References to make sure the reference forms are filled out, submitted and received.

Personal Reference Full Name*

First NameLast Name

Personal Reference E-mail*

Relationship*

Personal Reference Phone Number*

Area CodePhone Number

2nd Personal Reference Full Name

First NameLast Name

2nd Personal Reference E-mail

Relationship

2nd Personal Reference Phone Number

Area CodePhone Number

Verification and Release

I recognize that the NM District Church of the Nazarene is relying on the accuracy of the information I provide on the Children’s / Youth Work Application Form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the Children’s / Youth Work Application Form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organization and any such person or entity listed on the Children’s / Youth Work Application Form from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary.

I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth assigned to my care or supervision at all times.

YesNo

We are sorry, but unless you verify that you have read and consented to the above terms and conditions, we can not accept your application.

Sign below using your computer mouse or (if using a touch screen) your finger/stylus.

Applicant Signature*