Otter Creek Church of Christ

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Otter Creek Church of Christ Confidential Volunteer Application Form This application is to be completed by all applicants for any position involving the supervision or custody of minors. This information is used to help the church provide a safe and secure environment for those children and youth who participate in our programs and use our facilities. General Information Date Full Name Marital Status ___Married

Maiden Name ___Single

___Divorced

___Separated

___Widowed

Spouse's Name Children (Names & Ages) __________________________________________________________________________ Address

City

Home Phone

Work Phone

State ______

Zip ______________

Cell Phone

Email address __________________________________________________________ Background Information How long have you worshipped at Otter Creek? ___________________________________________________________ ________________ In what areas of church ministry are you presently involved? _______________________________________________ ___________ Date of baptism? ____________(year) Briefly tell us about your spiritual journey that led you to accept Jesus Christ. ____________________________________ ___________ ___________________________________________________________________________________________ ___________ Previous church attended __________________________________ Dates attended ______________________ ___________ What were your volunteer roles at the previous church? Provide a reference for that work with email and phone # : _________________________________________________________________________________________________

Provide two NON-FAMILY references with email addresses and telephone #s: ___________________________________________________ ___________ ___________ ___________________________________________________________________________________________ ___________ Please comment about your reasons for involvement with OC's Children's or Youth Ministry: _________________________________________________________________________________________________ _________________________________________________________________________________________________ Are you currently participating in lifestyle choices which would compromise your example to children/youth? _________ Please describe: _______________________________________________________________________________ Have you ever been accused of, charged with, or committed any act of neglecting, abusing or molesting any minor? ____yes ____no If yes, explain in detail, providing date and place of incident ____________________________ ___________ ______________________________________________________________________________________________ ___________ Have you ever used illegal drugs?____yes ____no If yes, explain _____________________________________________________________________________________ _________________________________________________________________________________________________ Have you ever misused prescription drugs? ____yes ____no If yes, explain _________________________________________________________________________________ ___________ _____________________________________________________________________________________________ ___________ How often do you consume alcohol? ___________________________________________________________________ Have you ever had any involvement with pornography? ____yes ____no If yes, explain ____________________________________________________________________________________ Is there any health related reason that would keep you from effectively working with minors or cause any potential harm to them? yes ____no____ If yes, explain ____________________________________________________________________________________ APPLICANT'S STATEMENT The information contained in this application is correct to the best of my knowledge. SIGNATURE __________________________________________________ PRINT NAME _______________________________________________ ____________________________________________

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