Life Connection Baptist Church Volunteer & Employee Application Form

Name*

First NameLast Name

Please list your maiden name and/or an alias

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Drivers License #

Social Security #*

Gender

MaleFemale

Date of Birth*

Date

What is your current marital status (single, married, separated, divorced, widowed, etc.)?

Are you affiliated with LCBC?*

If so, for how long?

How long have you lived at your current address?*

Please list your previous addresses for the past 10 years.*

Please list all previous church work involving children, and students. (List each institution's name and address, type of work carried out, dates, and a contact person familiar with your work there. If none please state that.*

Please list the name, address, city and state of other churches you have attended regularly during past 10 years*

Please list all previous non church work involving children, students or vulnerable populations. (List each organization's name and address, type of work carried out, dates and a contact person familiar with your work there.) If none please state that.*

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, youth*

Please provide three references ideally one professional reference (if applicable), one personal reference, and one family member. References must include one non family member and one member of the opposite sex. Please contact these references and inform them an authorized LCBC staff person will be contacting them. Please provide their name, email address, and telephone number.*

Because LCBC cares for our members and our children, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy.

Why do you want to work with children at LCBC?*

Do you have a preference concerning the age group or sex of children or students with whom you would like to work? Why?*

What is your philosophy concerning re direction or discipline of children?*

When you are unhappy, angry or emotional about a person or circumstance, what do you do?*

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain. (Use back of page if necessary.)*

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)*

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?*

Have you ever physically or sexually abused a child?*

Has someone ever accused you of abusing a child?*

I authorize Life Connection Baptist Church to contact all individuals, organizations and references listed on this Safety Application Form in order to verify the information I have provided to the school. I agree to release from liability any person or organization that provides information concerning me, including those persons I have listed as references, as well as contact persons from my previous school and non-school work, listed on this application.

I specifically authorize the church to undertake a criminal background check concerning my past.

I understand and agree that any information received from the background check and application verification will not be disclosed to me, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form.

By signing this form, I certify and affirm that the information I have given on this form is true, complete and correct in all respects.

Signature*

Date*

Date