Personal Information

Name *

Other names known by

Mobile Phone *

Email *

Address *

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Birthdate *

Marital Status

Member Status

Driver's License Number and State Issuing *

Social Security Number *

Christian Walk

Please share how you came to know the Lord *

Are you faithfully walking with the Lord currently? *

YES

Not Sure

Do you regularly attend Algonac Church of Christ? *

YES

List other churches attended in the past 5 years: (Pastor's name, Church name, contact info)

Please list any gifts the Lord has given you to edify the Body of Christ:

Experience

List all previous experience with children and youth: *

Other church volunteer experience:

Interest & Availability

Please select area of interest

What is your availability *

Will you commit to volunteer training when provided? *

YES

MAYBE

Legal Information

Have you ever either pled “guilty” or “no contest” to, or been found guilty of, any misdemeanor, other than a speeding or parking violation? *

YES

Have you ever either pled “guilty” or “no contest” to, or been found guilty of, a felony? *

YES

Have you ever neglected, abandoned, sexually abused, or physically abused any child under the age of 18 years or ever been accused by anyone of having done so? *

YES

Are you aware of having any traits or tendencies that could pose any threat to children, youth, or others? *

YES

Have you ever been accused by anyone of engaging in sexual harassment or inappropriate sexual conduct? *

YES

Have you ever been asked to leave a church or otherwise terminate your voluntary service of any other program? *

YES

If the answer to any of the above questions is “yes”, please explain in detail. Please use an additional sheet of paper if necessary.

Please list two personal references from current church members who have known you for more than one year. (Name, Church, Contact Info) *

Applicant Statement

The information contained in this application is correct to the best of my knowledge. I authorize, by my signature below, any of the churches, organizations or references I have listed to give you any information (including opinions) that they may have regarding my character and fitness for youth work. I also submit to and authorize Algonac Church of Christ to contact law enforcement officials to screen local and national records using my name and all related personal data I have provided on my own.

In consideration of the receipt and evaluation of this application by Algonac Church of Christ, I hereby release any an all persons or organizations providing or using the information from any and all liability for damages that may result due to compliance or an attempt to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

I understand that if there are allegations of my having committed improper behavior, I will be required to step down from my responsibilities until such time as the Board of Elders allows me to resume those responsibilities, even if I contend I did not behave improperly.

Should my application be accepted, I agree to abide by the policies of Algonac Church of Christ and to refrain from unscriptural and illegal conduct in the performance of my services on behalf of the church.

I have carefully read and agree to abide by the Child Interaction Policy of Algonac Church of Christ and to protect the health and safety of the youth at all times.

I hereby acknowledge that the information given above is accurate and I give permission to the community for the use of my photographs that are taken by staff/volunteers in order to use for social media.

Applicant Name *

Date *