Application for Children's Ministries

This application is to be completed by all applicants who regularly engage in the supervision of children or serve as supervisors of children's volunteers at Kent City Baptist Church. It is being used to help the church provide a safe and secure environment for the children who participate in our children's programs and to protect the volunteers who work with them.

Your name *

Last name

Email address *

Middle name: *

Birthday *

Date of Child Safety Seminar Attended

Other names you have used (legal name, maiden name, etc.): *

Address *

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Phone number *

Phone type

Please list all addresses you have lived at in the past five years and your approximate dates of living there.

List the name and city of other churches you have attended regularly during the past five years.

How long have you attended Kent City Baptist Church? *

Are you a member at Kent City Baptist Church? *

List all previous work (volunteer or paid) involving children (identify place/organization and type of work):

What age group of children/youth are you interested in working with? *

Please list any particular areas in which you are gifted or interested in serving and share any experience or training you have had with them. (e.g. Music, crafts, administrative work, teaching, games, etc.)

Do you have any certifications that are beneficial to working in children or youth ministry? (e.g. CPR, First Aid, etc.)

Check all that apply.

First Aid

CPR

Lifeguard

Babysitting/Child Care Certification

First Responder

EMT

Paramedic

AED (Automated External Defibrillator)

MD (Medical Doctor)

RN (Registered Nurse)

LPN (Licensed Practical Nurse)

CNA (Certified Nursing Assistant)

ALS (Advanced Life Support)

BLS (Basic Life Support)

HAZMAT (Hazardous Materials)

CPL (Concealed Pistol License)

Other

Have you ever been charged with, arrested for, or convicted of child abuse, actual or attempted sexual molestation of a minor, or any other crime? *

(If you prefer, you may refuse to answer this question, and you make discuss your answer in confidence with a pastor rather than answering on this form. Answering yes, or leaving the question unanswered, will not automatically disqualify an applicant for children's ministry.)

Personal References

(Someone who has known you at least 5 years and is not related by birth or marriage. Please don't put one of KCBC's pastors.)
The applicant waives the right to view reference statements.

Reference #1 Name *

Reference #1 Email *

Reference #2 Name *

Reference #2 Email *

Applicant's Statement

The information contained in this application is correct to the best of my knowledge. I authorize Kent City Baptist Church to contact any references or organizations listed on this application and I authorize those references and organizations to provide Kent City Baptist Church with any information (including opinions) they may have regarding my character and fitness for working with children or youth. I also release Kent City Baptist Church from any liability or responsibility that may result from receiving or acting upon information obtained in this screening process.

I understand that Kent City Baptist Church runs a criminal background check on all applicants. I acknowledge that I have been notified of this check and that all information will be kept confidential. I consent to having Kent City Baptist Church run this background check and I release the Michigan State Police and all other law enforcement agencies from any and all liability resulting from such disclosure.

Should my application be accepted, I agree to be bound by the bylaws of Kent City Baptist Church and the rules and regulations of the specific ministry in which I am involved.

Applicant's Signature *

Typing your name below will be considered your signature affirming the above statement.

Today's Date *

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Kent City Baptist Church
info@kentcitybaptist.org
616-678-5773