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VOLUNTEER APPLICATION FORM

First NameFirst Name
LastLast Name
MIMiddle Name
Date of BirthDate of Birth
Home AddressAddress
Apartment NumberApartment
CityCity
StateState
Zip CodeZip
Home Phone NumberHome Phone
Cell Phone NumberAddress
List the Ministry and the Position(s) for which you are applying for (ex: afterschool, basketball, vbs, etc)List Ministry and Positions
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Which date would you be available to start volunteering?Volunteer Date
Social Security Number (needed for background check)ssn

PREVIOUS HOME ADDRESSES WITH APPLICABLE DATES

(List last two):

Home AddressPrevious Home Address
Apartment NumberPrevious Apartment
CityPrevious City
StatePrevious State
Zip CodePrevious Zip
Dates lived thereof appointment
to
Last day living there
Home AddressPrevious Home Address 2
Apartment NumberPrevious Apartment 2
CityPrevious City 2
StatePrevious State 2
Zip CodePrevious Zip 2
Dates lived thereof appointment
to
Last day living there

NAME, PHONE NUMBER AND ADDRESS OF CHURCH OF WHICH YOU ARE A MEMBER.

Namename church
PhonePhone church
AddressAddress church
CityCity church
StateState church
Zip CodeZip church

LIST OTHER CHURCHES YOU HAVE ATTENDED REGULARLY DURING THE PAST FIVE YEARS

Namename past church
Phonename past phone
Addressaddress past church
Apartment Numberapartment number past church
Citycity past church
Statestate past church
Zip Codezip past church
List all previous church or secular volunteer work involving youth/children/adults (identify church/ organizations, location, dates, and type of work):allergies
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List any skills, gifts, callings, training, education or other factors that have prepared you for volunteer work with children / youth / adults.list skills
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Have you had any driver's license or other license (e.g., professional) suspended or revoked? If so, give full details. (fill this only if you are going to volunteer with bus ministry or driving ministry) (Have you ever been arrested or charged with driving under the influence? If so, list each such arrest or charge, when and where it was made and its outcome)list skills
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Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor? If so, please explain.list abuse
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Has any formal or informal charge, claim, or complaint ever been made that you engaged in inappropriate sexual behavior? If so, give full details.list inappropriate
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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 young people?list background
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PLEASE FURNISH THE NAMES OF TWO PERSONS, OTHER THAN RELATIVES OR PRESENT OR FORMER EMPLOYERS, TO SERVE AS PERSONAL REFERENCES

Namename reference
Phone #phone reference
Addressaddress reference
Apt#apartment reference
Citycity reference
Statestate reference
Zip Codezip code reference
Namename reference
Phone #phone reference
Addressaddress reference
Apt#apartment reference
Citycity reference
Statestate reference
Zip Codezip code reference

Under penalty of perjury, I swear or affirm that the information given above is true, complete, and correct.  I understand and agree that a complete background investigation may be conducted with respect to me, and that this information may be verified by contacting persons and organizations with whom I have had contact or which may have information concerning me.  I hereby release and agree to hold harmless from liability any person or organization that provides such information.  I also agree to release and hold harmless the church and (name of congregation), their officers, employees, agents, and volunteers from any and all liability as it relates to any investigation taken by them regarding the information contained in this application, or any action by them as a result of such investigation. 


Applicant's Signature:signature
Print Name Here:print name
Datedate of applicant
Parent/Guardian's Signature (if applicant is under 18 years old):signature
Print Name of Parent/Guardian Here:signature
Datedate of applicant
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