Volunteer Service Application

Please fill this out completely. If a question does not apply to you, mark N/A.

We acknowledge that this form asks for a lot—even from volunteers who do not work with kids, littles, or teens. Because the care and protection of our children and teens here at City Church Melissa is of the utmost priority, and we do not know where God will lead you to serve now or down the road, we're asking for the same information for every service role.

We believe for littles, kids, and youth to hear the Gospel, they must first feel safe and secure when they come to church. Though our ministries already have policies and procedures in place to guard our young people, we are partnering with ECAP to increase and strengthen those efforts.

Thank you for taking the time to complete this form!

Your name *

Email address *

Gender/Sex *

Phone number *

Address *

Previous 5 years addresses *

* Years occupied Street address City, State, Zip Code

Volunteer History Information

Child safety is a priority at City Church Melissa. As such, we ask all volunteers to complete the following background information which ensures that we provide the safest environment possible for our students.

What other children's/youth volunteer experience do you have? * *

* Please list the organization, position, dates involved, and a contact name and phone number for the organization

Have you at any time ever been convicted of, plead guilty, or plead no contest to any crime? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Have you at any time ever been dismissed or forced to resign due to inappropriate or questionable behavior? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Have you ever been investigated by an agency charged with protecting the well-being of children and youth? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Have you at any time ever participated in, been accused of, convicted of, or plead guilty or no contest to abuse or any sexual misconduct? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Have you ever had an addiction with drugs, alcohol, or pornography? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Have you ever been accused or convicted of any type of workplace or ministry misconduct? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Is there anything in your lifestyle or past that would call into question your ability to work with children, youth, or others? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

Are you aware of any reason why you should not work with children, youth, or others? *

Checking “Yes” does not automatically disqualify you from serving in this ministry.

What other churches have you attended in the past five years? *

Please include the church name, a contact person at the church, email and a phone number. For example: City Church - Jessica Hendrickson - jessica@citychurchmelissa.com - 214-414-0997

References

No relatives. Ministry leaders, employers, teachers, and coaches are preferred.

Reference #1 *

Please include their name, relationship, a contact phone number.

Reference #1 email address *

Please provide a current email address.

Reference #2 *

Please include their name, relationship, a contact phone number.

Reference #2 email address *

Please provide a current email address.

Proof of Identification

Please Upload a Photo of your current Government-Issued ID. *

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Choose 1 file. Maximum file size 10 MB.

Acknowledgement

Please read below and type your name to verify the above information. Your name here will be considered your signature that you acknowledge this information is correct.

I recognize that City Church Melissa is relying on the accuracy of the information I provide on the Volunteer Leader Application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the Volunteer Leader Application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organization and any such person or entity listed on the Volunteer Leader Application form from liability involving the communication of information relating to my background or qualifications.

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