Name
*
First Name
Last Name
Birthdate
*
MM
DD
YYYY
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
*
(###)
###
####
Mobile Phone
*
(###)
###
####
Work Phone
(###)
###
####
Email
*
CPR/AED Certified?
*
If "YES", Card Expiration Date:
MM
DD
YYYY
Campus you are applying to serve at
*
Have you at any time ever been arrested for any reason?
*
Have you ever been convicted of, or pleaded no contest, to any crime?
*
Have you at any time ever engaged in any child molestation, exploitation, or abuse?
*
Have you at any time ever been accused of any child molestation, exploitation, or abuse?
*
Are you aware of having any trait or tendencies that could pose any threat to children or others?
*
Are you aware of any reason why you should NOT work with children or others?
*
If you answered YES to any of these questions, please explain in detail:
*
If you DID NOT answer yes to any of the above questions, you may input N/A or Non Applicable.
If you answered YES to any of the above questions would you be willing to speak with a pastor about it?
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Age level you are interested in serving
What is the approximate date you became a Christian?
Briefly share your experience of salvation and your spiritual growth since then.
How long have you attended New Life church?
Why do you want to work with our children?
Have you had any opportunities to work with children in the past? If so, in what capacity and for how long?
Please list any spiritual gifts, training, education, or other factors that have prepared you to work with children:
Is there anything we should know about you, your health, or anything else?
Is there something in your lifestyle, or a situation in your past that would be important for us to be aware of?
Reference 1
First Name
Last Name
Relationship:
Contact Number:
Reference 2
First Name
Last Name
Relationship:
Contact Number:
Reference 3
First Name
Last Name
Relationship:
Contact Number:
Applicant Statement and Release
*
I recognize that the organization to which this application is being submitted is relying on the information contained herein. Accordingly, I attest and affirm that all of the information that I have provided is absolutely true and correct.
If applicable, I authorized New Life Church to contact the references I have listed and perform a background investigation. I release my
references from liability for any damage that may result from furnishing such evaluations to New Life Church. I waive my right to inspect these references.
I agree to abide by all polices and procedures of the organization, and to protect the health and safety of the children at all times.
Signature
*
Date
*
MM
DD
YYYY
New Life Church believes that the safety of our children is a priority. We are committed to creating a safe place for children to treasure God and to grow in Jesus Christ. To ensure the safety of children, protect volunteers and paid staff from false accusation, and to safeguard the reputation of our church and the Christian community, all child workers, whether paid or volunteer, agree to follow the safety protocols as described in New Life Church’s Child Safety Policy. With my signature below, I acknowledge that I have read the policy and that I will follow the safety protocols described within it.
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Signature
*
Date
*
MM
DD
YYYY
