Application for Working with Minors

Applicant Information

Legal Name

Middle Name

Birthdate

Phone

Address

Have you received Jesus Christ as your personal Lord and Savior?

No Yes

Have you ever been convicted of or pleaded guilty to a crime?

No Yes

If you answered 'yes' to the above question, please explain.

Volunteer History

List all previous volunteer work involving minors. Include work performed, location, and dates, if available.

List any gifts, callings, training, education, or other factors that have prepared you for ministry with children.

Personal References

Please list two references that are not related to you. If possible, include one reference from Access Church.

Reference #1

Reference #2

Policy Agreement

Every volunteer working with minors must read the Working with Minors Policy. You may read it after submitting this form.

Open Working with Minors Policy in a new window.

I will read the Working with Minors Policy

Yes

Self Disclosure

Volunteers must affirm that they have
a) been a continuous resident of Pennsylvania for the past 10 years AND
b) not been convicted of a Reportable Offense that would prohibit them from volunteering.

I have been a resident of Pennsylvania for the past 10 years

No Yes

I certify under penalty of law that the statements made in this form are true, correct and complete. I understand that false statements herein, including, without limitation, any failure to accurately report any conviction for a Reportable Offense, shall disqualify me from volunteer service with State College Access Church.

Yes

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children’s work. 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 agree to work under the leadership team established at State College Access Church, and to refrain from unscriptural conduct in the performance of my services on behalf of the church. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement, which I have read and understand.

Yes

Description

Please fill out this form, read and agree to the policy, and submit. Please email info@scaccesschurch.com with any questions.

Application for Working with Minors

Description

Please Fix the Following