Volunteer & Background Check Application

Name

Maiden Name

Marital Status

Single Married Separated Divorced

Gender

Date of Birth

Have you been a resident of Pennsylvania for the past ten, consecutive years?

Yes no

If you answered no to the answer above, have you had FBI fingerprinting completed since living here? yes no

Address

Primary Phone

This address will receive a confirmation email

Occupation

Employer

Westminster Member

Yes No

Year of Membership

How long have you been attending Westminster?

Commitment

I trust Jesus Christ as my personal Savior and endeavor to follow him obediently.

Yes No

I agree that the Bible is the Word of God.

Yes No

I agree to submit to the leadership and discipline of Westminster Presbyterian Church.

Yes No

I agree to be faithful in attending the worship service of Westminster Presbyterian Church or the following church

Yes No

Other church:

I commit to fulfilling the responsibilities of the ministry.

Yes No

Which ministry are you applying to serve (check all that apply)?

Children/Youth Teacher Children/Youth Helper Nursery Explorers Ministry (Special Needs) Safety ESL Missions Bible2School Refugee

Experience

Describe any interests, hobbies or special abilities that you would want to use to serve:

Do you have any limitations which require special accommodations in order to volunteer?

Yes No

If yes, please explain:

References (Non-family members)

Please list two references of individuals outside your family who may comment on your character and ability to serve.

Reference #1: Name

Reference #1: Address

Reference #1: Phone

Reference #2: Name

Reference #2: Address

Reference #2: Phone

Applicant's Agreement & Release

The information I have given in this application is true,

correct and complete to the best of my knowledge. I

authorize any references, churches or other organizations

listed in this application to provide you with any

information (including opinions) that they may have

regarding me or my character and fitness for children's

work. I hereby release, indemnify and hold harmless

Westminster Presbyterian Church, its officers, employees

and members, and all corporations, partnerships,

organizations, institutions and persons providing reference

data of and from past, present or future claims, demands

or damages, in law or in equity I or any heirs, successors or

assigns may have arising from, connected with or resulting

from the acceptance, tabling or rejecting of this application.

I further agree to adhere to the policies and procedures of

Westminster Presbyterian Church. I also understand that

because my service will be within a facility providing child

care and/or may directly involve child care duties, I expressly

authorize Westminster Presbyterian Church to contact any of

my prior employers for information regarding my employment

history and I expressly authorize Westminster Presbyterian

Church to conduct or have conducted on its behalf a criminal

records background check at the local, state and national level.

Type your name here if you agree with the statement above

Volunteer & Background Check Application

Description

Please Fix the Following