This application is to be completed in full by all church paid staff and all volunteers for any position involving the supervision, teaching, or custody of minors. Information will be treated as confidential and is needed to help us provide a safe environment for children and youth who participate in our programs and use our facilities. Name (First, Middle, Last):______________________________ Date:___________________ (List any other names that have been used, including maiden or previous married name) Address:___________________________________________________ Home Phone: ( )_________________ Work Phone: ( )________________________ Best time to call: ___________________________________________________________ SS# _____-____-_____ Birth date: ____________________ Marital Status:_______________ Emergency Contact:_________________________________ Number of Children:_________ Ages:_____________________________________________ Do you have any medical training or are you CPR certified?_________________________
Positions
Background
Are you a member of this church? Yes No In Process Do you have a personal relationship with Jesus Christ? Yes No Since when?_________________ List your top three spiritual gifts (if you are not aware of your gifts, please ask for a Spiritual Gifts Inventory): List any gifts, talents, training, skills or education that have prepared you to work with children: Do you have any physical disabilities or conditions preventing you from performing certain types of activities? Have you ever been convicted of a crime? Have you ever been accused, arrested or convicted of child abuse, neglect, or a crime involving actual or attempted sexual molestation of a minor or other sexually related crime? Do you use illegal drugs? Have you ever been hospitalized or treated for alcohol or substance abuse? Are there any circumstances involving your lifestyle or your background that would call into question your ability to work with children?
Yes No Please explain: Have you had any painful experiences in your life that have better equipped you or that may hinder you from a productive ministry with children? If so, would you like to talk to a pastor regarding this circumstance?    Ministry to Refugees and ImmigrantsLearn about reaching your cross-cultural neighbors.  Shepherd Children with Special NeedsBe prepared to respond with love and care when children with special needs walk through the door. A Case for Serving Special-Needs Children and Their Families Recognize the value of all the parts of the body. Spiritual Pathways These nine paths show the variety of ways that we worship God.
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