Grove Bible Church

“Because We Care”

Children and Youth Ministries Volunteer Application

This form is to be completed by anyone desiring a position involving the supervision or custody of minors. It is being used to help Grove Bible Church provide a safe and secure environment for those children and youth who participate in our ministries.

THIS FORM IS CONFIDENTIAL AND RESTRICTED.

Name:	First Middle Last

Please return completed form to:

Grove Bible Church

Attn: Children's Ministry Committee

6990 E. Price Road, St. Johns, MI 48879

For Church Office Use Only: Application Completed: _____/_____/_____	DVD Questionnaire Signed: _____/_____/_____ Clear Investigative Advantage Background Check: _____/_____/_____ By: ______________________ Result: Acceptable __ Unacceptable __ Reference #1 Received: _____/_____/_____ Reference #2 Received: _____/_____/_____ Comments: __________________________________________________________________________________

Part 1: Personal Information

(Please Print)

1.	Name: First Middle Last.

2.	Maiden Name: Name	3. Social Security Number: 000-00-0000

4.	Address: Street Address City State Zip Code

5.	Home Phone: (000)000-0000 Work Phone: (000)000-0000

Cell Phone: (000)000-0000

6.	Email: youremail@mail.com. 7. Date of Birth: 01/01/2000

8.	Driver’s License Number: Driver’s License #. 9. State of Issuance: State.

10.	Please indicate the following areas in which you are interested in serving:

Nursery	Sunday School	Junior Church	AWANA

Sports Week	Youth	Enter Other Areas in which you’d like to serve

Permission to Obtain a Background Check

(This form authorizes the church to obtain background information and must be completed by the applicant.

The church must keep this completed form on file for at least five years after requesting a background check.)

I, the undersigned applicant (also known as “consumer”), authorize Grove Bible Church to procure background information (also known as a “consumer report and/or investigative consumer report”) about me. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records.

I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Grove Bible Church, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.

Signature: Type Full Name to Sign. Date: Click or tap to enter a date.

Part 2: Church History and Experience

1a.	Are you a member of Grove Bible Church?	Yes	No (if no, please answer 1b)

1b.	Please write out your salvation testimony and share why you are not a member:

Please Type your Testimony here: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2.	How long have you lived at your current address? Years. If less than five years, please list your previous addresses:

Dates	Street	City & State	County & Zip
Enter dates	enter Street address.	City, State	Zip
Enter dates	enter Street address.	City, State	Zip
Enter dates	enter Street address.	City, State	Zip

3.	List other churches you have attended regularly during the past five years:

Church Name	City, State	Were you a member?	Dates Attended
Church Name	City, State	Yes No	Enter dates
Church Name	City, State	Yes No	Enter dates
Church Name	City, State	Yes No	Enter dates

4.	List all previous church work involving children or youth (use separate sheet if necessary):

Church Name	City, State	Area of service	Dates of service
Church Name	City, State	Area Name	Enter dates
Church Name	City, State	Area Name	Enter dates
Church Name	City, State	Area Name	Enter dates
Church Name	City, State	Area Name	Enter dates
Church Name	City, State	Area Name	Enter dates

5.	List all previous non-church work involving children or youth (use separate sheet if necessary):

Place of work	City, State	Area of work	Dates of work
Place Name	City, State	Area Name	Enter dates
Place Name	City, State	Area Name	Enter dates
Place Name	City, State	Area Name	Enter dates
Place Name	City, State	Area Name	Enter dates
Place Name	City, State	Area Name	Enter dates

6.	Personal References. (Please do not use relatives or members of the Children’s Ministry Committee. References should be able to testify to your suitability for working with children or youth. Please use the attached forms. Two references are required.) Please list the two people that you intend to use as references with their phone numbers:

Reference #1 Name Phone: Reference #1 Phone Number

2. Reference #2 Name Phone: Reference #2 Phone Number

Part 2: Volunteer’s Statement

Please choose “Yes” or “No” for the following statements. If you answer “yes” to any of these questions, be prepared to discuss this in a meeting with the Children’s Ministry Committee.

Have you ever been convicted of, or pled guilty or no contest to a crime (other than a minor traffic violation)?	Choose an item.
Are you now under charges for any criminal offense?	Choose an item.
Have you ever engaged in any child molestation or abuse?	Choose an item.
Have you ever been the subject of a civil lawsuit involving sexual misconduct, harassment, or other such behavior?	Choose an item.
Have you ever been disciplined by a church for any offense regarding a child?	Choose an item.
Are there any physical limitations that might hinder your ministry to children and youth (including communicable diseases, conditions such as seizures, etc.)?	Choose an item.

Please initial each statement.

Initial	The information contained in this Volunteer Form is correct to the best of my knowledge.

Initial. I understand that a criminal records check may be conducted on me, and I consent to any such check. I understand that this information will not be released to other persons or used for any other purposes.

Initial.	I acknowledge that I have re-read Grove Bible Church’s “Because We Care” Children and Youth Policy Manual in the past three weeks (from the date by your signature below). I understand it and agree to abide by it.

Initial.	Should I be accepted to serve in the children and youth ministries of Grove Bible Church, I agree to be bound by the bylaws and policies of the church, and to refrain from unscriptural conduct in the performance of my services on behalf of the church.

Initial	Should I not be accepted to serve in the children and youth ministries of Grove Bible Church, I understand I will be given an explanation and I agree to peacefully accept the decision.

I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand (please seek legal advice if you are uncertain about signing this document).

Volunteer’s Signature: Type Full Name Date: Click or tap to enter a date.

Children’s Workers Seminar Questionnaire

Please answer the following questions while/after watching the DVDs

If allegations are made, the victim’s lawyer asks, “What did your church do to Answer this Answer from Answer?”

The two types of abuse to look for are harm and Answer harm.

What kind of bruises should a children’s worker look for? Answer.

Sexual Abuse is mainly identified by a Answer of the child/teen.

When listening to a child/teen, the children’s worker’s job is not to identify the Answer of the child/teen.

How soon after hearing of potential abuse should a report be made? Answer.

Who should make the one report from Grove Bible Church to Child Protective Services? Answer.

Give one example of neglect: Answer

Give one example that does not constitute neglect: Answer.

Physical Contact – Workers should avoid physical contact with children that could in any way be misconstrued as Answer.

I have watched the Grove Bible Church Children’s Workers Seminar DVD.

Signature: Type Full Name to Sign Date: Click or tap to enter a date.

Questions/Comments (use the back if necessary): Click or tap here to enter response.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________