List previous church or organization work involving preschoolers/children/youth under age 18 Church/Org & Location Type Work Performed
From
Church/Org & Location
Type Work Performed
To From
Church/Org & Location
Type Work Performed
To From To Church/Org & Location
Type Work Performed
From To
Church/Org & Location
Type Work Performed
From To
Name
Personal References (not former employers or relatives) Address Phone
Name
Address
Phone
Name
Address
Phone
Worker Application Form
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 working with preschoolers, children and/or youth. I authorize Sugar Land Baptist Church to perform a background check at its expense, which for employees may include a credit report. In consideration of the receipt and evaluation of this application by Sugar Land Baptist Church, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, 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 compliance or any attempts to comply, with this authorization. Should my application be accepted, I agree to be bound by the Bylaws and policies of Sugar Land Baptist Church, including, but not limited to, policies and procedures of the Child/Youth Protection Program, and to refrain from inappropriate conduct in the performance of my services on behalf of the church.
for Preschool and Children’s Ministries
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. I do/do not 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. Applicant’s Signature ______________________________________________________ Date ____________________ Witness _________________________________________________________________ Date ____________________
Office Use Only Application Received by App/Background Check Review by (Ministry Staff Member)
Date Received Approved? YES NO
App/Background Check Review by (Personnel Committee Member) Approved? YES NO (only required if employee application)
Date Reviewed Date Reviewed
Dr. Phil Lineberger Senior Pastor Lisa Keeling Associate Pastor for Preschool and Children
[email protected] 281.980.4431
Preschool/Child/Youth Worker Application
Application Form for Preschool and Children’s Workers
Sugar Land Baptist Church Thank you for agreeing to serve in the preschool and children’s church ministry. We are blessed by your desire to partner with us to provide a safe, secure and loving Christian environment for our children. In order to accomplish this goal, we ask that you fill out the following information so that we may get to know you better.
This application is required of all applicants for any position (volunteer or paid) involving the supervision or care of preschoolers/children/youth. This is not an application for employment, but is used to help the church provide a safe and secure environment for those preschoolers, children and youth who participate in our programs and use our facilities.
Name (Last)
(First)
(Middle)
Date
Position for which you are volunteering
1) How long have you been attending Sugar Land Baptist Church? 2) Are you currently a member of Sugar Land Baptist Church? 3) Why do you want to serve in the preschool and children’s ministry?
Applicant Information Legal Name
Last
First
Middle
Please provide any other names used (nicknames, aliases)
Last
First
Middle
Last
First
Middle
Date of Birth (mm/dd/yyyy) 4) List any other experience, training, or education that you feel prepares you to work with preschoolers or children.
Home Phone
Social Security Number (required for background check) Cell Phone
Name as it appears on Driver’s License 5) Have you ever been convicted, charged, or plead guilty to sexual abuse, molestation, or related crimes? Yes
No
Work Phone Driver’s License Number/State
Have you ever been convicted of or pleaded guilty to a crime? (Circle one. If “yes”, please explain below.)
6) Are you currently under investigation or currently under charges for any criminal offense? No
NO
If yes, please explain CPR training in past 2 years? (If “yes”, please include expiration date.)
Yes
YES
YES
First Aid training within the last 2 years? (If “yes”, please include expiration date.)
NO YES
NO
If yes, please explain Residential History (List all residential addresses in the last 7 years)
7) Have you ever received counseling, psychological, or medical treatment for problems connected with substance abuse, anger control, or mental, physical, or sexual abuse of a person? Yes
No
If yes, please explain
8) Have you ever received treatment for any type of substance abuse? Yes
No
If yes, please explain
9) Have you ever been the victim of abuse or molestation? (If you prefer not to answer this question or if you would like to discuss this with a minister, please feel free to leave the answer blank. Not answering the question will not necessarily disqualify an applicant from working with the preschool or children’s ministry.) Yes
Current Street Address
City/State/Zip
From
Present Previous Street Address
City/State/Zip
From
To
Previous Street Address
City/State/Zip
From
To
Previous Street Address
City/State/Zip
From
To
Previous Street Address
City/State/Zip
From
To
Church History and Prior Work With Preschoolers/Children/Youth Name and location of church where you are currently a member
No
10) Do you have any health conditions that you feel that we should know about so that we may better protect you as well as the preschoolers/children?
To
List name and location of other churches where you have attended regularly during the past five years
