Children & Youth Worker Application Form

General Information:

Name

This address will receive a confirmation email

Phone

Address

Check the program(s) you will be or are willing to serve with:

Nursery Sunday School PV Kids SHINE Middle / High School Youth Group Youth Mentor Other

If you checked "Other" please specify:

Do you regularly attend our worship services?

Yes No

If yes, when did you start attending? (approximate date)

Authorization for Criminal Background Check

Type full name:

Maiden/Former Name (when applicable):

Date of Birth

Applicant's signature:

Date:

References:

List 2 references whom you have known for at least 2 years and have specific knowledge of your character and ability to work with children, youth, and vulnerable adults.

1. Pleasant View Church (or previous church) pastor, member, or staff person:

Name

Nature of association:

Length of time known:

Phone

This address will receive a confirmation email

2. Other Person Not Related to You:

Name

Nature of association:

Length of time known:

Phone

This address will receive a confirmation email

Personal Disclosure Information:

1. Have you ever been arrested, convicted, or plead guilty to a crime, abuse, or sexual misconduct? Yes/No If yes, please explain:

2. Has your driver's license been suspended or revoked within the last 12 months?

Yes No

3. Is there any fact, circumstance, or pattern involving your background that would make it inappropriate for you to serve with minors or would compromise the integrity of the church? Yes/No If yes, please explain:

Church History and Prior Ministry Involvement:

Previous church or non-church work involving children, youth, or vulnerable adults (list church or organization name, city, state, and type of work performed):

Applicant's Statement:

The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, or organizations listed in this application to give you any information and opinions that they have regarding my character and fitness in my work where I could have access to children, youth, or vulnerable adults. I authorize the release of the information contained in this application to any individuals who make decisions about placing applicants in available positions. In consideration of the receipt and evaluation of this application by Pleasant View Church, I hereby release Pleasant View Church and any individual, church, youth organization, charity, employer, reference, or any other person or organization, both collectively and individually, from 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 agree that, as long as I volunteer at Pleasant View Church in ministry to children, youth, and volunerable adults, I will attend a Safe Church training session each year.

I further state that I have carefully read the foregoing release and know the contents thereof and sign this release as my own free act.

Applicant's Signature:

Date:

Children & Youth Worker Application Form

Description

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