Fellowship Bible Church Volunteer Ministry Application Form

This application form is to be completed by all volunteers desiring a ministry position involving the supervision or custody of children and/or youth. This form will be completed at the onset of ministry and resubmitted every five years. It is being used to help the church provide a safe and secure environment for those children and youth who participate in our programs and use our facilities.

Your name *

Email address *

Address *

Phone number *

Occupation *

Place of Employment *

Please list the names and dates of any other churches you have previously attended regularly. *

Do you have any experience working with children? If so, please describe. *

Please list any other Fellowship Bible Church ministries in which you are involved. *

Do you have any medical training or are you CPR certified? *

Is there any health related reason that would keep you from effectively working with or cause any potential harm to children? If yes, please explain. *

Personal References

Please provide us with the names of two persons over the age of 18 years old and not related to you as a references. Include their first and last name and their phone number. Please give references of people outside the church that you have known for at least 2 years.

Reference 1 *

Please include full name and contact information

Reference 2 *

Please include full name and contact information

Safety & Security Questions

The questions below are necessary in order to help ensure a safe and secure environment for our children and for our volunteers. All information is held strictly confidential. Please answer these questions. If you have any concerns regarding the questions please contact Rica Shepherd.

Have you been convicted for the use or sale of drugs? *

Have you been hospitalized or treated for alcohol or substance abuse? *

Have you been arrested for a criminal offense, excluding minor traffic violations? *

Have you ever been denied participation in supervising children/youth activities by any organization? *

Please explain any “yes” answers

Applicant’s Statement:

The information contained in this application is correct and complete to the best of my knowledge. I authorize any references, churches, or other organizations listed in this application to give you any information they may have (including employer’s opinions) regarding my character and fitness for working with children/ youth and I hereby release all such references, churches, or other organizations from liability for damages of whatever kind or nature that may result from furnishing such evaluations to you. I waive any right I may have to inspect any information provided about me by any person or organization identified by me in this application.

I acknowledge that I have read the FBC Child Protection Policy and have received copies for my personal use.
I agree to follow the Child Protection Policy and to refrain from any inappropriate conduct in the performance of my services on behalf of the church. I understand that any violation of the policy or misrepresentation of information that I have provided may result in termination of employment or volunteer service with children/youth.

I authorize that a Criminal and Civil Records Background check may be conducted on me and that any information which pertains to any record of convictions contained in police files or any criminal or civil file maintained on me, whether state or local, be released to the church. In so authorizing, I release any law enforcement agencies, Fellowship Bible Church or those individuals receiving the results of the check from any and all liability resulting from such disclosure.

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 IN EXCHANGE FOR THE OPPORTUNITY TO SERVE AS A FBC VOLUNTEER. This is a legally binding agreement, which I have read and understand. I understand that the personal information will be held confidential by the professional church staff.

Applicant's Signature

Date

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