Ministry Volunteer Application

This application is to be completed by those volunteering in a ministry in which they will interface in some capacity with children under the age of 18. This includes chaperones for on or off-sight activities and any activity that takes place on our campus whether or not a ministry of Church of the Resurrection. Thank you for helping to make Resurrection a safe and secure environemt for our children and volunteers!

Personal Information

Name

Other names used (nicknames, maiden name, previous legal names)

Date of Birth

Place of birth (City, State)

Gender Male Female

Marital Status Single Married Divorce

Spouse

Address

Date moved into current address

Phone

Background Information

Previous addresses (needs to cover the past five years)

Dates resided at address above

Previous addresses (needs to cover the past five years)

Dates resided at address above

Previous addresses (needs to cover the past five years)

Dates resided at address above

Are you a member of Church of the Resurrection?

Yes No

Names and addresses (City, State) of churches you have attended regularly during the past five years. Please also include the name of who was Pastor/Rector while you attended, for each of the churches listed.

Please describe all your previous church work involving children or youth. Identify the church, its location, the dates of your work there, and the type of work you performed.

Please describe any callings, gifts, training, education, or other factors that have prepared you to work with youth or children.

Have you ever been arrested for, or convicted of any crime or misdemeanor involving actual or attempted child abuse, neglect or molestation, or had any such conviction expunged?

Yes No

If yes, please provide details:

Have you ever been charge with child sexual abuse in a civil proceeding?

Yes No

If yes, please provide details:

Have you ever committed an act of child sexual abuse?

Yes No

Have you ever been diagnosed with any paraphiliac psychological condition, as defined by the American Psychiatric Association, including, but not limited to, pedophilia, voyeurism, or exhibtionism (except where such injury is prohibited or limited by applicable laws or regulations?)

Yes No

Have you ever been charged with a sexual offense or crime of violence?

Yes No

If yes, please provide details:

Have you ever been convicted of, pled guilty to, or have charges pending concerning any other crime?

Yes No

If yes, please provide details:

Have you ever been the subject of a civil lawsuit involving, or an investigation or allegation of, sexual misconduct, sexual harassment or other immoral behavior or conduct involving adults or children?

Yes No

If yes, please provide details:

Do you have any investigation, review or disciplinary action pending by an employer, organization in which you volunteered, or professional association for sexual misconduct, violence or misconduct involving children?

Yes No

If yes, please provide details:

Have you at any time during the past five years used illegal drugs or other illegal controlled substances?

Yes No

Have you ever participated in the creation, dissemination, or transmission of pornography or pornographic materials of any type?

Yes No

Is there any fact or circumstance about you or your background that would call into question the advisability of entrusting you with the supervision, guidance and care of children?

Have any members of your household ever been arrested for, or convicted of, any crime involving child abuse and/or neglect, or had any such conviction expunged?

Yes No

Have any members of your household ever been charged with child sexual abuse?

Yes No

Have any members of your household ever committed an act of child sexual abuse?

Yes No

Has any other member of your household ever been diagnosed with any paraphiliac psychological condition, as defined by the American Psychiatric Association, including, but not limited to, pedophilia, voyeurism, or exhibtionism (except where such injury is prohibited or limited by applicable laws or regulations?)

Yes No

Personal Reference

Please do not list family members as references.

Name

Address

Phone Number

Is this person a regular attender of Church of the Resurrection?

Yes No

Personal Reference

Please do not list family members as references.
Please include one reference from a ministry leader at your prior church, if applicable.

Name

Address

Phone Number

Is this person a regular attender of Church of the Resurrection?

Yes No

Personal Reference

Please do not list family members as references.

Name

Address

Phone Number

Is this person a regular attender of Church of the Resurrection?

Yes No

Applicant's Statement:
The information contained is correct to the best of my knowledge. I authorize any references, churches, or organizations listed in this application to give you informtion they may have regrding my chracter and fitness for working with children. I release all such references from my liability for any damages that may result from furnishing such evaluations to Church of the Resurrection. I understand that I will be asked to complete the necessary paperwork for a criminal background check. I release Church of the Resurrection from all liability and damages that may occur from the results of this information. I understand that personal information will beheld confidential by the professional church staff.

Applicant's Electronic Signature

Statement of Faith

Please share with us a brief statement of faith, or history of your faith, in Christ Jesus as you Savior.

Ministry Volunteer Application

Description

Please Fix the Following