Volunteer Application | Bethesda Community Church

Name*

First Name

Middle Name

Last Name

Address*

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Business Phone

Email*

Date of Birth*

Gender*

Male

Female

Marital Status*

Social Security Number*

Other names by which you have been known (Nicknames, maiden name, aliases)

No. of Children*

Are you a member of Bethesda Church*

Yes

No

If so, how long?

Have you been born again?*

Yes

No

Have you been baptized in water?*

Yes

No

List the name and address of other churches you have attended during the past five years:

List any gifts, callings, training, education, or other factors that have prepared you for children's ministry:

Have you been involved in children's ministry before?*

Yes

No

If yes, in what areas?

With what church or organization?

Do you have a preference of age or group with whom you wish to work?

Yes

No

If yes, what age and why?

Do you have any physical handicaps/conditions that would affect your ability to work with or relate to children?*

Yes

No

If yes, please explain:

Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor? *

Yes

No

If yes, please explain:

Have you ever been reported to any organization or registry for abuse or misconduct involving children?*

Yes

No

If yes, please explain:

Do you have any disciplinary action/investigation pending by an employer, organization, professional association or licensing body, for violence, sexual misconduct, or misconduct involving children? *

Yes

No

Have you ever been convicted of any other criminal offense (excluding minor traffic violations)?*

Yes

No

If yes, please explain:

Have you ever been disciplined or dismissed from any volunteer position or employment for any reason or following an allegation of sexual misconduct, physical aggression, verbal aggression or other inappropriate behavior or conduct?*

Yes

No

If yes, please explain:

Have you ever been reprimanded, or asked to leave or end your membership in a church?*

Yes

No

If yes, please explain:

Do you now or have you ever sought out child pornography?*

Yes

No

Have you been involved in homosexual activity within the last five years?*

Yes

No

Do you use illegal drugs?*

Yes

No

Do you believe you were abused as a child? (You may discuss your answers in confidence with a pastor or church leader rather than answering on this form. Answering *

Yes

No

I understand that we are teaching our children to remain sexually pure until marriage. Because I understand that my lifestyle is an example to the children with whom I will be working, I see the importance of being sexually pure myself. I affirm that this lifestyle is true of me at this time.*

Yes

No

I agree to contact the Children's Ministry if that situation changes, and to step down from my responsibilities with children until those issues are resolved. *

Yes

No

Is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance or care of children?*

Yes

No

If yes, please explain:

Ministry Work

Please answer the following questions. Assume the age of the child being discussed is similar to the age of the child for which you are volunteering in Children's Ministry.

1. What is it about working with children that interests you?*

2. Describe your philosophy for how best to minister to children?*

3. Describe a time that you have had to deal with a child having behavior problems. How did you handle the situation?*

4. Have you ever lead a child to Christ?*

Yes

No

5. How would you lead a child to Christ?*

6. Bethesda Community Church does not allow the use of physical punishment such as spanking. Would it be difficult for you to follow this policy?*

Yes

No

Please Explain:

Personal / Pastoral References*

Include Name, Address, and Phone Number.

Personal / Pastoral References*

Include Name, Address, and Phone Number.

Please initial after each of the following statements:

I declare that all statements contained in this application are true and that any misrepresentation or omission is cause for rejection of my application, or dismissal from my ministry involvement.*

I understand that my references and employment contacts will be contacted and that a thorough criminal background check will be conducted. I authorize investigations of all statements contained in the application.*

I understand that I must have at least 6 months of active involvement at the church and be interviewed and recommended by a member of Bethesda Community Church Staff before I begin my ministry or position.*

I understand that I can withdraw from the application process at any time.*

I understand that Bethesda Community Church has zero tolerance for abuse and takes all allegations of abuse seriously. I further understand that Bethesda Community Church cooperates fully with the authorities to investigate all cases of alleged abuse. Abuse of any kind is grounds for immediate dismissal and possible criminal charges.*

I declare that I am not a pedophile or child molester and that I have not perpetrated physical abuse, sexual abuse, emotional abuse or neglect against a child or an adult and that I have never been accused of these acts.*

I understand and agree that false statements and/or omissions regarding past conduct and/or present situations may be grounds for denial of application to provide volunteer services and that refusal to inform Bethesda Community Church of the contents of a sealed criminal record will result in the automatic denial of the application.*

I authorize Bethesda Community Church and/or its agents to make an independent investigation of my background, references, criminal, or police records, including those maintained by both public and private organizations and all public records. *

Please type your full name to serve as your electronic signature*

Date*

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