VOLUNTEERAPPLICATION
Confidential
This application is to be completed by any applicant for a volunteer positionat City Ministries. It is used to help the City Ministriesprovide a safe and secure environment for those who participate in our programs.Until all the necessary steps in the applicationprocess have been completed by City Ministries, you will be a prospective volunteer.You must be a member in good standing at City Church or another affiliated Ministry and sign our statement of faith.Please fill out this application completely, attach a copy of your photo ID (driver’s license or other legal ID with birthdate) and turn this application in to the City Ministries office.
Personal Information:
Date Social Security Number
Name
(First Name) (Middle Name) (Last Name)
Birthdate* / / E-mail Address
(Month) (Day) (Year)
*You are not required to provide your birthdate.
Address
Phone: Home WorkMobile
How long have you lived in Washington State?
How long have you lived your present address?
If less than 7 years, please provide all addresses for the last seven years:
Personal History and Qualifications:
List any gifts, callings, training and education that have prepared you for ministering to children, or your area of volunteerism, including prior work at City Ministries, churches and other organizations involving children: ______
What church do you attend and how long have you attended there?
_____
List other churches you have attended regularly during the past five years. Please give the church’s name and complete mailing address.
ChurchAddress
Briefly describe when and how you came to accept Jesus Christ as your personal Savior:
Background Information:
Have you ever (please check yes or no):
Yes No
Been convicted of a crime?
Had a finding made against you in any civil adjudicative proceeding asdefined in RCW 43.43.830 (relating to domestic violence, abuse, sexual abuse, neglect, or exploitation or financial exploitation of a child)?
Participated in or been accused of any crime against a child or any questionable activity involving a child?
Viewed child pornography?
Participated in or been accused of drug abuse or illicit or illegal drug possession or use?
Participated inany activity that may affect or bring into question your fitness for working with or supervising children?
If yes, please explain:
References:
Please list two City Ministries, churches or other organizations where you have worked with children or in your requested volunteer capacity and the person to contact at the organization. If you have not worked with two organizations, please list leaders at The City Church (or affiliated ministry)that know you personally (such as a Small Group Leader, Care Pastor, or Staff Pastor).
Organization
Contact Name
Address
Phone_____
Organization
Contact Name
Address
Phone_____
Applicant Declaration, Authorization and Waiver:
I agree to be bound by the articles of incorporation, constitution, bylaws, City Ministries, including the following leadership commitment:
I understand my responsibility to live an exemplary life of Christian character, I therefore state:
• I have received Jesus Christ as my personal Lord and Savior.
• I have been baptized in water and in the Holy Spirit, and believe in the evidence of speaking in other tongues.
• Prayer and personal Bible study are an active part of my life and I believe the Bible is the inspired Word of God that has the answer for our every need.
• I understand my obligation to be an example to the children and to avoid anything that might cause them to stumble (Matt. 18:6; Rom. 14:13). I therefore commit myself to avoid the appearance of evil and to abstain fromsexual immorality, alcohol or drug abuse, illegal drugs, pornographic materials and other sinful conduct.
I authorize City Ministries and any person acting on its behalf to contact any individual, organization or entity to obtain information concerning me. I request that any individual, organization or entity contacted by City Ministries(even if not listed as a reference or a contact person in this application), give to the City Ministries any information they have that could be relevant to my application or my character and fitness for children’s ministry. I expressly authorize each such individual, organization or entity to give this information to the City Ministries. I release and waive any and all claims against or with regard to the any such individual, organization or entity or the City Ministries, The City Church, or any of their directors, officers, employees or agents, which claims arise from or are related to this application, any information given to the City Ministries or any action taken with regard thereto. I hereby waive any right that I may have to inspect the information or to have it disclosed to me.
During the application process and at any time during my time of service with the City Ministries, I authorize the City Ministriesand ChoicePoint Services Inc. or any other company or agent selected and acting on behalf of the City Ministries, to procure consumer reports, background checks or other reports, checks or verification deemed necessary by the City Ministries, which I understand may include information regarding areas such as my character, general reputation, personal characteristics, criminal background, employment history, educational history, identity, driving record, credit worthiness, credit standing, credit capacity, and mode of living. The reports, checks or other verification may be compiled with information from sources such as credit bureaus, courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source with information relevant to my application or my service with the City Ministriesor relevant to verify any information that I have voluntarily supplied. I understand that except with regard to the information provided under the second paragraph of this declaration, authorization and waiver, I may request a complete and accurate disclosure of the nature and scope of the reports, checks or other verification, to the extent they include information bearing on my character, general reputation, personal characteristics or mode of living. I understand that my employment or volunteer position is in a probationary period until the completion of all background checks and agree to cooperate withthe background checks.
I understand that the City Ministries can terminate my position or status to serve at the City Ministriesat any time, without expressed cause or prior notice, regardless of any other oral or written statements by the City Ministriesprior to, at, or following the date I commencement of my position or status.
A copy of this declaration, authorization and waiver shall be as effective as a signed original.
Under penalty of perjury, I hereby declare that the information contained in this application is correct and complete to the best of my knowledge.
Applicant’s SignatureDate
Revised April 2015
City Ministries Volunteer Application—Pg. 1