Confidential Volunteer Application Form Sample (Page 2 of 2) in pdf

Church History

Church (Membership) Name ______________________________________________________________

Church Address _______________________________________ Church Phone (____) _______________

City/State/Zip __________________________________________________________________________

Type of work involving children _______________________________ Dates of Service _______________

Church Name ____________________________________________ Dates of Service _______________

Church Address _______________________________________ Church Phone (____) _______________

City/State/Zip __________________________________________________________________________

Type of work involving children ____________________________________________________________

Church Name ____________________________________________ Dates of Service _______________

Church Address _______________________________________ Church Phone (____) _______________

City/State/Zip __________________________________________________________________________

Type of work involving children ____________________________________________________________

References

Personal References (not former employers or relatives)

Name

Address

City/State/Zip

Phone

_______________________________________________________________________________________

List all previous non-church work involving children. Attach additional sheet if necessary.

Organization

Address

City/State/Zip

Phone

_______________________________________________________________________________________

Applicant Statement (Please read and initial each statement.)

_____ The information contained in this application is correct to the best of my knowledge.

_____ I authorize references or churches listed in this application to provide information (including opinions)

they may have regarding my character and fitness for working with children.

_____ I release all such references from any liability for furnishing such evaluations, provided they do so in

good faith and without malice.

_____ I waive any right I may have to inspect references provided on my behalf.

_____ Should my application be accepted, I agree to be bound by the bylaws and policies of this church and

to refrain from unscriptural conduct in the performance of my services on behalf of the church.

_____ I further state that I have carefully read the forgoing release and know the content there of and I sign

this release as my own free act. This is a legally binding agreement which I have read and understand.

Applicant’s Signature ____________________________________________ Date _____________________

Witness ______________________________________________________ Date _____________________

Confidential Volunteer Application Form Sample Page 2