Grace Chapel

VOLUNTEER

Personnel Form

Application for work with children, youth, or adults

We recognize that this form is extensive, but ask for your patience in completing the form in its entirety. Your cooperation will assist church leaders in their efforts to provide a secure environment for you as a volunteer, as well as the children, youth, and adults who participate in our ministry programs and use our facilities. Your responses will be maintained confidentially, although there may be circumstances where such information may be provided on a “need to know” basis to individuals working with our ministry and to other individuals in order to evaluate your application and/or comply with applicable legal requirements. If you prefer that your application only be viewable to Pastors and elders, please indicate on this cover page.

NOTE: If you live in a state where laws exempt you from providing any of the information requested below, you need not answer the questions requesting such information. For example, you need not disclose information that is contained in sealed or expunged court records, or that involves a criminal arrest that did not result in a conviction.

* Indicates required question

General Info:

Full Name (first, middle last)

Birthdate

If you have ever used other names, please provide complete name(s) and date in use: (if none, just answer none)

Main Phone Number

* Please check to approve

I acknowledge, agree, and will comply with Grace Chapel’s required performance of my background check.

Click here to read our Privacy Policy

Current Address

Country/Region

Address

City

Zip / Postal code

Marital Status

Single

Married

Widow

Divorced

Previous Address

Are you a member of Grace Chapel?

Yes

Do you regularly attend church services? (two or more services a month)

Yes

Which church do you consider to be your home church?

Personal Testimony

Have you been water baptized?

Yes

Have you been baptized in the Holy Spirit?

Yes

Unsure

(Is there evidence of both gift(s) and fruit(s) of the Spirit at work in your life? Acts 2:17, 1 Cor. 12, & Gal. 5:22-23)

Briefly outline your spiritual journey, including when you received Jesus Christ as a Savior:

Ministry Experience

Have you taken any courses or received any training that would equip you for Christian ministry? If so, please explain:

Have you attended the CSAP class? (Child Sexual Abuse Prevention Training)

Yes

Ministry History

Please list churches you have attended and the ministry organizations in which you have participated within the last five years: (name of church, address, Pastor's name, and phone number)

Please list any present and previous ministry experience and the overseeing Pastor or supervisor:

Briefly share your motivation for wanting to serve in the ministry of this local church:

On what date would you be available to begin serving?

Describe any condition or limitation that might restrict or prevent you from performing certain activities involved in the volunteer position for which you are being considered.

Do you have any contagious or infectious disease or condition which could be transmitted to others in the volunteer work you would be performing?

Yes

Explanation of contagious or infectious disease or condition that can be transmitted.

Background

Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor traffic violations)?

Yes

You will need to answer "YES" if you have entered into a plea agreement, including a deferred sentence or a deferred judgement arrangement, in connection with a criminal charge.

Have you ever been convicted of a sexual offense, offense relating to children or crime of violence (that is not covered in question above)?

Yes

Have you ever been involved in sexual activity with a minor, or a sexual offense toward a minor, or any criminal offense relating to a minor, regardless of weather you were accused, arrested, or charged for that activity?

Yes

Have you ever been reported to a social services agency, law enforcement authority, child abuse registry, or similar organization regarding abuse or misconduct involving children? (Yes or No -- please explain if you answer "YES")

Explanation of whether or not applicant has been reported regarding abuse or misconduct involving children.

To the best of your knowledge, have you had a painful experience (personal abuse in any form) that has better equipped you, or may hinder you from a productive ministry? (Yes or No -- please explain if you answer "YES")

Explanation of whether or not applicant has had a painful experience (personal abuse in any form) that has equipped or hindered them from productive ministry .

Have you ever been a subject of a civil lawsuit involving sexual misconduct, sexual harassment, or other immoral behavior or conduct involving adults or children? (Yes or No -- please explain if you answer "YES")

Explanation of whether or not applicant has been a subject of a civil lawsuit involving sexual misconduct, sexual harassment, or other moral behavior or conduct involving adults or children.

Have you ever been a subject of a complaint or disciplinary proceeding against a professional license or other license held by you - including but not limited to a license to provide childcare or similar services? (Yes or No -- please explain if you answer "YES")

Explanation of whether or not applicant has been a subject of a complaint or disciplinary proceeding against a professional license or other license held by them - including but not limited to a license to provide childcare or similar services.

Have you ever been a subject of any disciplinary action, transfer or dismissal, or been named as a defendant in a civil lawsuit as a result of an accident or mishap involving children? (Yes or No -- please explain if you answer "YES")

Explanation of whether or not applicant has been a subject of any disciplinary action, transfer or dismissal, or been named as a defendant in a civil lawsuit as a result of an accident or mishap involving children.

Do you have any drug, alcohol, or substance abuse problems? (Yes or No --please explain if you answer "YES")

Explanation of whether or not applicant has any drug, alcohol, or substance abuse problems.

Do you practice a sexually pure lifestyle as taught in the Scriptures?

Yes

References and Statement

*Please give us the name, phone number, and email address of TWO individuals to whom we can send a form of reference to fill out:

Referral #1

Name of Referral #1

Referral #1 Phone Numer

Email of Referral #1

Referral #2

Name of Referral #1

Referral #1 Phone Numer

Email of Referral #1

Please check the appropriate line:

I approve of having someone delegated by the pastors check the references

I ask that my references be checked by a pastor or elder only

Check all that apply.

The responses I have provided in completing this application form are complete, truthful and accurate. I hereby authorize Grace Chapel (hereunto referred to as “the Church”) to make inquiries concerning my background in connection with evaluating the information I have provided on this form and the application process, including criminal records check if deemed necessary by the Church. I hereby authorize all persons associated with me, including churches, employers, law enforcement agencies, licensing and social services agencies, to release any information contained in their files or records concerning me to the Church and its representatives.

In consideration of the receipt and evaluation of this application form by the Church, I hereby release Grace Chapel and their directors, employees, agents, representatives and any other person or organization, including record custodians, that may release information concerning me both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or family on account of inquiries concerning my background and any disclosures of information concerning me to Grace Chapel.

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 HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENT OF IT, AND I SIGN THIS RELEASE AS MY OWN FREE AND VOLUNTARY ACT.

I understand that my service with the Church shall be volunteer service. In addition, my volunteer service shall be at-will and the Church shall be entitled to terminate my services at any time, with or without cause or advance notice. I understand and agree that I am not an employee of the Church and that I have no expectation of future employment. As a volunteer, I have no entitlement to or expectation of compensation, health insurance or other employee benefits, or unemployment or worker’s compensation insurance benefits.

I affirm that I will strictly comply with all policies and procedures of Grace Chapel including but not limited to its Safe Place Plan. If at any time I find that for any reason I am unable to support the vision, policies, procedures, or doctrine of this church, I will resign my volunteer position. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal, or in disciplinary action, all at the discretion of the Church. I will report any known or suspected child abuse or other violation of policy to the senior pastor, a member of the church staff, an elder or the designated authority.

I confirm that I have read this statement in full and understand it.