Volunteer Application and Background Check

Our church cares about the children and youth in our programs, and desires to ensure their safety while they are in the church’s supervision. Because we care for children and youth, our church asks any staff or volunteer who will be providing supervision/leadership with minors to complete this disclosure form. The information obtained on this form is for internal use by Village Church Rolesville.

Please answer each question below and print. Your responses will be treated confidentially.

Your name *

Last name

Email address *

Phone number *

Phone type

Address *

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

What is your current occupation and employer? *

As a staff member/volunteer at VCR, do you agree to observe all church policies regarding working with minors? *

YES

Have you ever been convicted of a criminal offense? *

YES

Do you have any criminal charges pending? *

YES

Have you ever been convicted of child neglect or abuse? *

YES

Do you have any charges of child neglect or abuse pending? *

YES

In addition to the above, is there any fact or circumstances involving you or your background that would call into question your being entrusted with the supervision, guidance, and care of young people? (If yes, explain.) *

Do you have a driver’s license? *

YES

Please List State of issue and DL Number:

List two references, other than family members, who are familiar with your character as it relates to working with minors. Please include name, address, phone, relationship. Reference forms must be on file. *

List all other churches, if any, that you have attended regularly in the last 7 years (name and location) *

List all organization through which you have volunteered with minors *

Is this information correct? *

This information that I have provided may be verified, if necessary, by contacting persons named in this application, or by contacting any person or organization that may have any information concerning me. I hereby release and agree to hold harmless from liability any person or organization that provides information. I also agree to hold harmless and its paid staff members and volunteers. I waive any right to inspect any information provided about me by any person or organization. In signing this form, I agree to be guided by the policies and regulations of VCR. I affirm that the information I have given on this form is true, correct and complete. I understand by checking yes, this is my virtual signature for this form.

YES

Village Church Rolesville
vcrolesville@gmail.com
9195252850