This application is to be completed by all applicants for any position (volunteer or compensated) involving the supervision or custody of minors. It is being used to help the church provide a safe and secure environment for those children and youth who participate in our church programs. Our programs are conducted in the church building, in private homes, and in some cases include travel.
Applicants Name: ______________________________________________________
Present Address: _______________________________________________________
Home Phone: (___) _____ - ___________
How long have you attended New Life Community Church? (A person must be a regular attender at NLCC for 6 months prior to working in a child related ministry) ________________
If you are currently in a ministry, how long have you been serving in that capacity?
____________________________________________________________________
Have you ever been involved in or convicted of child abuse, or a crime involving actual or attempted sexual molestation of a minor? (not as a victim)
yes no
Do you use any illegal drugs, even periodically?
yes no
Do you struggle with sexual addiction(s) or do you habitually view sexually explicit materials?
yes no
Are you involved in any premarital, extramarital, or homosexual relationships?
yes no
Please review the following list entitled "Warning Signs of a Drinking Problem."
WARNING SIGNS OF
A DRINKING PROBLEM No single sign identifies a problem drinker, but a pattern of behaviors can indicate a problem: Loss of Control -- attempts to cut down or control drinking fail. Repeated promises to "be more careful" or to "cut down on drinking." Gets drunk when intending to stay sober. Black Outs -- unable to recall all or part of a drinking episode. Doesn't remember what was said or done when drunk (blacking out is different than passing out). Increased Tolerance -- needs more alcohol than before to get the same effects. For anyone, tolerance increases with regular drinking, but being able to outdrink others is an early sign of problem drinking. Drinking Causes Problems -- continues drinking even though it causes academic, legal, health, financial, or relationship problems. Personality Changes When Drinking -- a normally nice person, becomes mean or abusive when drinking. Neglects Responsibilities -- absent or late for classes, meetings, appointments, or work due to hangovers or intoxication. Preoccupation With Drinking -- frequently thinks about drinking. Gives up activities which don't involve drinking. Avoids socializing with friends who don't drink. Pre-Partying -- drinks alcohol before going to a party where alcohol will be served. Also, "gulps" drinks to get drunk as quickly as possible. May also sneak drinks so others don't know how much he/she is really drinking. Denial and Minimizing -- claims not to drink excessively, despite evidence to the contrary. Minimizes the amount of drinking ("I only had a couple of drinks"). Avoids talking about his/her own drinking -- Justifies drinking and tries to characterize it as normal, despite problems. Susceptible to Accidents, Injuries, or Illnesses -- more likely to be hurt in falls, in fights, or by "bumping" into things. Drinking to Feel Normal -- drinks to cope, to escape from problems, to solve a problem, or to feel like everyone else. Drinking to Start the Day -- drinks in the morning to control tremors or shakes after drinking the night before. |
Four or more of the above probably indicates a drinking problem. |
Based on the information you have just read, do you currently have a drinking problem?
yes no
If yes, may we refer you to the church elders?
yes no
Have you ever drank alcoholic beverages before or during any NLCC child/youth related activity?
yes no
Are you currently involved in any activities that do not align themselves with traditional Christian moral values?
yes no
Do you have difficulties working with handicapped children?
yes no not sure
Are you currently taking, or do you periodically take, any medication that may impact your ability to work with children?
yes no
Have you ever been convicted of a misdemeanor or a felony?
yes no
If yes, please explain: ___________________________________________________
____________________________________________________________________
Studies have shown that people subjected to emotional, physical, and sexual abuse have the potential to abuse. Has anything happened to you in your lifetime which may make you inclined to abuse children in your care?
yes no
If you have answered yes, please take the following space to tell us how the Lord has healed you related to these abuse issues.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
To help us understand how you might react in a ministry situation, please give brief answers to the following:
"When things don't go my way my general response is . . ." _____________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
"When I disagree with those in authority I . . ." _______________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
"If I were asked to change ministries by church authorities, my response would be...."
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
"I deal with rage or anger by ..." __________________________________________
__________________________________________________________________
__________________________________________________________________
Would a child be safe in your home?
yes no
Are weapons secured and inaccessible to children in your home?
yes no NA
Do you consider yourself a safe driver?
yes no
Are you free of traffic tickets or convictions in the past five years?
yes no
If no, please explain: ___________________________________________________
The reference information that you provide in this section may be used by the interviewers to contact churches, organizations, or individuals regarding your character and suitability for working in a child related ministry. By providing the information it is understood that you are authorizing any reference or church listed in this application to give your interviewer any information (including opinions) that they may have regarding your character and suitability for child related ministry. It is also understood that you waive any right you may have to inspect any information that the reference provides to the interviewer. The information provided by the reference will be confidential between the reference and the interviewer.
Please list all previous church work involving children, including youth:
Dates Ministry Church Address and/or phone #
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
List two personal references (not including relatives) with telephones numbers (No more than one reference may be a NLCC member/attender. No Child Safety Program committee member or elder may be used as a reference):
___________________________________ Phone _______________________
___________________________________ Phone _______________________
Please list the church you attended prior to New Life. Please provide name, pastor, and any contact information (address/phone number) you have:
__________________________________________________________________
__________________________________________________________________
The information I have given in this application is correct and complete to the best of my knowledge. I understand that false information or significant omissions may disqualify me from further consideration for service and may be considered justification for dismissal if discovered at a later date. I do understand a background check will be done.
I authorize any references or churches listed in this application to give the interviewer any information (including opinions) that they may have regarding my character and suitability for volunteer work. I waiver any right that I may have to inspect any information provided about me by any person or church identified in this application.
Should my application be accepted, I agree to be bound by the Constitution, Bylaws, and policies of New Life Community Church, and to refrain from activities that are illegal or unethical in the performance of services on behalf of the church. I fully understand the two adult rule with respect to child/youth/young adult ministries. I agree to abide by that rule.
Confirm identity with a state drivers license or other photographic identification.
________________________ signature of verification.
Applicant's Signature ____________________________ Date ___/___/___
Witness' Signature ______________________________ Date ___/___/___
For Committee Use OnlyBackground check completed: Date ___/___/___ Circle the appropriate designation: Helper, Assistant,
Leader, Adults Only |