Good Shepherd Form | Hope Presbyterian Church

Good Shepherd Volunteer Form

Form for adults who wish to work with children or youth at Hope Presbyterian Church

Step 1 of 8

Children's and Youth Ministry Application
Note: This form is to be completed by all applicants (volunteer and employee) for any position involving supervision or custody of minors. This application is used by HOPE PRESBYTERIAN CHURCH to help promote a safe environment for the children and youth who participate in our programs or use our facilities. Any applicant who has ever been convicted of child sexual abuse, physical abuse, or domestic violence should not volunteer service in any church sponsored activity or program for children or youth. Applicants with criminal records of other types will be evaluated at the discretion of church leaders. Any applicant who is a survivor of childhood sexual or physical abuse needs the love and acceptance of the HOPE PRESBYTERIAN CHURCH family. Applicants who have such a history should discuss their desire to work with youth with the Associate Pastor or Senior Pastor prior to any participation as a youth worker. All applicants must study and agree to obey the guidelines that are provided for their program and position within the church's children's and youth ministry.

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Applicant Identification
Consistent with relevant law, the information on this application will not be disclosed to unauthorized persons. You may use the back of the paper for explanations or you may attach extra pages for the children and youth who participate in our programs or use our facilities.
Name*
First Middle Last
Have you used any other names?*
Is there another name you have used recently, such as a maiden name?
- Yes
- No
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone*
Work Phone
License #*

Put "None" if you do not have a Driver's License.
What age of children/youth work do you prefer?*

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Church Activity
List other churches you have attended over the past five years.
Church Name:
Church Telephone:
Church Contact:
Current Member?
- Yes
- No
Church Name (2)
Church Telephone (2)
Church Contact (2)
Current Member (2)
- Yes
- No
Church Name (3)
Church Telephone (3)
Church Contact (3)
Current Member (3)
- Yes
- No
If a member of this church, how long have you been attending Hope Presbyterian Church?

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Previous Youth Work
List previous work (church and non-church) involving children or youth.
Organization Name:
Telephone:
Email:
Contact Name:
Type of Work:
List gifts, callings, training, education, or other factors that may have prepared you for work with children and youth.

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Employment History
Identify all employers for whom you have worked within the last 5 years. Include part-time and temporary employers. Start with your most recent employer. (Please fill out to the best of your ability.)
Employer Name:
Supervisor's Name:
Telephone:
Email:
Title:
Duties
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Reason For Leaving:
Would you like to add a 2nd employer?
- Yes
- No
Employer Name:
Supervisor's Name:
Telephone:
Email:
Title:
Duties
Reason For Leaving:
Would you like to add a 3rd employer?
- Yes
- No
Employer Name:
Supervisor's Name:
Telephone:
Email:
Title:
Duties
Reason For Leaving:
Please describe your activities during any gaps in employment in excess of three months. Do not include leave or time off due to illness or medical treatment.*

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References
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Years Known:*
Relationship:*
Would you like to add a 2nd reference?
- Yes
- No
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Years Known:*
Relationship:*
Would you like to add a 3rd reference?
- Yes
- No
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Years Known:*
Relationship:*

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Consent and Signature
Consent*
I agree to the following statement.
I hereby authorize all employers, organizations, churches, and other entities and persons identified in this form to release any information contained in their files or records concerning me.

In consideration of the receipt and evaluation of this application by HOPE PRESBYTERIAN CHURCH I hereby release HOPE PRESBYTERIAN CHURCH and 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 this 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. I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF, AND I SIGN THIS RELEASE AS MY OWN FREE ACT.

I understand and agree that it is critical to the mission and ministry of HOPE PRESBYTERIAN CHURCH that all employees and volunteers conform to the highest standards of safety, interpersonal conduct, and sexual morality. I affirm that I will strictly comply with HOPE PRESBYTERIAN CHURCH youth ministry policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal, or disciplinary action, all at the discretion of the church.

My responses above are truthful and accurate. I understand and agree that if they are not truthful and accurate, HOPE PRESBYTERIAN CHURCH may determine that I am no longer qualified to be associated with its programs as a church worker, employee, or volunteer in any capacity.
Applicant's Signature
Date
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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Good Shepherd Volunteer Form

Step 1 of 8

Children's and Youth Ministry Application

Applicant Identification

Disciplinary and Legal Background

Church Activity

Previous Youth Work

Employment History

References

Consent and Signature

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