APPLICATION FOR CHILDREN/YOUTH WORKERS

This form is to be completed by all applicants for any position involving the supervision or custody of minors. It is being used to help the church provide a safe and secure environment for the children and youth who participate in our programs and use our facilities.

Full Legal Name

First Name

Last Name

Cell Number

Home Phone

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Age Range

18 or younger

19–25

26 or older

Tell us how you came to know and trust Jesus as your Savior.

In which program(s) do you want to become involved? Awana, Kids church, Youth group, or events?

What skills would you bring to the children’s/youth program?

Do you have any physical limitations that may restrict your ability to work with minors?

What other children’s/youth work experience do you have? (Please list Organization, Program/Activity, Dates, & Contact)

Church Activity: What church or churches have you attended in the past five years, including this one? (Please list Church name, Pastor’s name, & Years attended)

References (Other than relatives): Please provide at least three. (Name, Relationship, Email, & Phone)

Have you at any time ever:

Been arrested for any reason?

Yes

Been convicted of, or pleaded guilty or no contest to, any crime?

Yes

Been accused, investigated, arrested, or convicted for neglect, physical abuse, sexual abuse, assault, or other acts of violence?

Yes

Are you aware of:

Having any traits or tendencies that could pose any threat to children, youth, or others?

Yes

If the answer to any of these questions is “yes,” please explain in detail:

Children’s/Youth Work Verification and Release

I recognize that First Baptist Church of Charlotte, MI is relying on the accuracy of the information I provide on the Children’s/YouthWork Application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize First Baptist to contact any person or entity listed on the Children’s/Youth Work Application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release First Baptist Church and any such person or entity listed on the Children’s/Youth Work Application form from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary.

I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth assigned to my care or supervision at all times. I also agree to refrain from any unscriptural conduct in the performance of my services on behalf of the church.

Signature

Date Input

Witness (Parent or guardian if applicant is a minor)

Date Input

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