Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long have you attended Faith Church?

I have completed the Connect Class process.

Yes

Have you worked in children’s ministry in another church? If so, for how long?

Date of Birth

YYYY

I would like to work with Faith Kids or Youth because...

I'm interested in working with:

Nursery

3yr. - 3rd Grade

4th - 6th Grade

Youth Ministry

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Emergency Contact Email

Confidential Background Screening

The following section is used to conduct confidential background checks on all Faith Church volunteers. All information provided is strictly confidential and will only be used to meet the requirements of the screening process. REFERENCES: It's required for all applicants to list 3 references who are not family members. These references must have known you for at least a year and have a sincere knowledge of your character & work with children. References are not required to be connected to Faith Church.

Character Reference #1 (application cannot be processed if this is left incomplete)

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of Relationship

Length of Time Known

Character Reference #2 (application cannot be processed if this is left incomplete)

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of Relationship

Length of Time Known

Character Reference #3 (application cannot be processed if this is left incomplete)

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of Relationship

Length of Time Known

The following questions are part of a process to help provide a safe and secure environment. All information is confidential. (Answering YES to any of the following questions does not automatically disqualify someone for church service.)

I prefer to discuss the following questions confidentially with one of our Pastors.

Yes

We conduct a police background check on all adult applicants. Do you have any objections?

Yes

Are you presently facing charges for any criminal offense?

Yes

Have you ever been charged with a misdemeanor or felony?

Yes

Have you ever been accused of or charged with any offense involving children?

Yes

Have you ever been dismissed from a volunteer position for any reason?

Yes

Criminal Records Check and Authorization

(All applicants must complete this section; only those 18 and older are subject to check.) I hereby request a criminal background check and the release of any information, which pertains to any record of convictions in its files or in any criminal file maintained on me whether local, state, or national. I hereby release any criminal law enforcement agency from any and all liability resulting from such disclosure. Any person or entity relying on this request may rely on a photocopy or facsimile as if it were an original.

Social Security Number

Applicant 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 working with or around minors. In consideration of this evaluation by Faith 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 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 agree to be bound by the Bylaws and policies of North Central and to refrain from unscripted conduct in the performance of my services on behalf of the church. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.

I hereby authorize a confidential background screening

Decline

Thank you for submitting the background check form! We will be contacting your references, and we will let you know when the background check process is complete (usually 2 weeks).

Application and Background Check to Serve with Minors.