First Name
*
Middle Name
Last Name
*
Today's Date
*
MM
DD
YYYY
Email Address
*
Primary Phone Number
*
(###)
###
####
Birth Date
*
Marital Status
*
Married
Single
Spouse's Name (if applicable)
Number of Children (if applicable)
Ages of Children (if applicable)
Emergeny Contact Name
*
Emergency Contact Phone
*
(###)
###
####
In which areas would you like to serve? Select all that apply.
*
Nursery
Preschool
Elementary
Middle and High Schoolers
How long have you been attending Sovereign Grace Church?
*
0-1 Years
1-3 Years
3-5 Years
5+ Years
Are you a member of Sovereign Grace Church?
*
Yes
No
List any skills, training, or education that have prepared you to work with children or youth.
Please list any other Sovereign Grace Church ministries in which you are involved.
Why do you want to work with children or youth at Sovereign Grace Church?
Name
*
First Name
Last Name
How long have you known the reference?
*
0-1 Years
1-3 Years
3-5 Years
5+ Years
Relationship
*
Email
*
Phone
*
(###)
###
####
Name
*
First Name
Last Name
How long have you known the reference?
*
0-1 Years
1-3 Years
3-5 Years
5+ Years
Relationship
*
Email
*
Phone
*
(###)
###
####
1) Have you ever been convicted of a crime?
*
Yes
No
2) Have you ever been accused, arrested, or convicted of child abuse, neglect, or a crime involving actual or attempted sexual molestation of a minor or other sexually related crime?
*
Yes
No
3) Do you use illegal drugs?
*
Yes
No
4) Have you ever been convicted of or plead guilty to the use or sale of drugs?
*
Yes
No
5) Have you ever been hospitalized or treated for alcohol or substance abuse?
*
Yes
No
6) Is there any health related reason that would keep you from effectively working with children/minors or cause any potential harm to our children?
*
Yes
No
7) Are there any circumstances involving your lifestyle or background that would call into question your ability to work with children or youth?
*
Yes
No
8) Have you ever had sexual relations with any minor after you became an adult?
*
Yes
No
9) Have you ever struggled with any sin involving a child or youth?
*
Yes
No
10) Have you ever been charged with a crime or misconduct at your workplace?
*
Yes
No
11) Have you ever been accused of improper conduct by an employer or as a volunteer for any reason?
*
Yes
No
12) Is there any other information that will be revealed through a background check?
*
Yes
No
13) Do you presently have any communicable diseases?
*
Yes
No
14) Have you ever been a victim of any form of child abuse?
*
Yes
No
If you answered "Yes" to any of the questions above, please provide a written explanation here.
Please be prepared to discuss your answers with a pastor or ministry leader. By clicking below you agree to immediately inform Sovereign Grace Church of any subsequent information, including any accusations, convictions, or other occurrences that relate to the areas of inquiry set forth above.
I agree.
Full Name
Date
MM
DD
YYYY
Country of Birth
State of Birth
County of Birth
City of Birth
Driver's License Number
State of License
Any previous names used.
Current Residence
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Previous Address(es) (if less than 2 years at current address)
Acknowledgement
*
I acknowledge receipt of Sovereign Grace Church Children's Ministry Policies and Procedures manual.
Full Name
Date
MM
DD
YYYY