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First Name
Last Name
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Apartment, suite, etc.
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Marital Status
Single
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Do You Have a Current Driver's License?
Yes
No
Current Driver's License #
Driver's License State
Employer
Have you ever been charged with, indicted for, or pled guilty to an offense involving a minor?
Yes
No
Please describe all incidents:
Have you ever made a personal profession of your faith in Christ?
When and where were you baptized?
Have you requested official church membership of Calvary Baptist Church?
Yes
No
If you are not a member or have been a member for less than a year, please provide previous church membership information:
Church Address
Church Phone Number
Church Email
Previous types of church service involving children/youth:
Previous non-church work with children/youth:
I have read a copy of the CBC Child Protection Policy
Yes
No
I understand and agree that youth workers must be at least 14 years old and are to serve under the supervision of an adult. The number of youth workers will be limited to one per class.
Yes
No
I authorize individuals or churches listed in this application to provide info they may have regarding my character and fitness for working with children/youth.
Yes
No
I release all such individuals and churches from any liability for furnishing such evaluations, provided they do so in good faith and without malice.
Yes
No
Should my application be accepted, I agree to be bound by the bylaws and policies of this church and to refrain from unscriptural conduct in the performance of my services on behalf of the church.
Yes
No
I authorize Calvary Baptist Church to complete a full background check, including but not limited to police/sheriff's department records of charges and convictions contained in its files, whether said file is a local, state, or national file. I release the police/sheriff's department and/or reporting agency from all liability that may result from any such disclosure made in response to this request.
Yes
No
The information contained in this application is correct to the best of my knowledge.
Yes
No
I have carefully read the forgoing release and know the content thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand.
Yes
No
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