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RESPONSIBILE SCREENING OF VOLUNTEERS

A Regular Volunteer is a person who works with preschoolers or children on a regularly recurring schedule. An Occasional Volunteer is a person who works with preschoolers or children on an infrequent basis.

All volunteer workers for any and all positions involving work with preschool or children will be screened

All adult volunteers working with preschoolers or children are required to be members of Life Community Church for a minimum of six months or approval by the Children’s Pastor.

Adults who have been convicted of either child sexual or physical abuse may NOT volunteer service in any church sponsored activity or program involving preschoolers or children.

Adult survivors of childhood sexual or physical abuse need the love and acceptance of this church family. Individuals who have such a history should discuss their desire to work with preschoolers or children with one of the pastoral staff prior to engaging in any volunteer service.

PROVIDING A SAFE ENVIRONMENT

All volunteers must observe the “two adult” rule. This rule requires that adults are never alone with preschoolers, children or youth without another adult partner present.

All church staff and regular volunteers who work with preschoolers or children will complete the training that is recommended and offered in regard to the nature of child abuse; and, in regard to carrying out our policies to prevent sexual abuse.

Pertinent state law information concerning child abuse reporting obligations will be posted in the Nursery Office.

Reporting procedures and response strategy regarding any suspected incident of child and/or sexual abuse are to be developed and periodically updated jointly by the church staff and the Nursery Director/Coordinator.

PROVIDING A PROPER RESPONSE

All volunteers must immediately report any behaviors, which seem abusive or inappropriate to the appropriate Director, Children’s Pastor or staff member.

Response to any and all media inquiries, if an incident occurs, shall be the responsibility of the senior Pastor only.

Life Community Church takes our policies to prevent molestation and/or sexual abuse seriously and intends to see that the policies are enforced.

APPLICATION PROCEDURES

All potential volunteers are subject to a background investigation (including but not limited to) criminal and personal.

All potential volunteers will be interviewed by the Children’s Pastor and approval from the appropriate director from that department they wish to volunteer with.

VOLUNTEER FORM

POTENTIAL WORKER'S PROFILE FOR REGULAR VOLUNTEERS WITH PRESCHOOLERS OR CHILDREN

--------------- CONFIDENTIAL --------------

TELEPHONE

This application is being used to help the church provide a safe and secure environment for children who participate in our programs and use our facilities.

BIOGRAPHICAL DATA

FIRST

MIDDLE

LAST NAME

SOCIAL SECURITY #

DATE OF BIRTH (Mo/Day/Year)

PLACE OF BIRTH (City, County, State)

CURRENT STREET ADDRESS (Apt. No, City, County, State, Zipcode)

LIST PREVIOUS ADDRESSES WITHIN THE LAST FIVE YEARS

LIST ALL PREVIOUS CHURCH WORK INVOLVING PRESCHOOL OR CHILDREN (LIST EACH CHURCH'S NAME AND ADDRESS, TYPE OF WORK PERFORMED, AND DATES)

LIST ALL PREVIOUS NON-CHURCH WORK INVOLVING PRESCHOOL OR CHILDREN (LIST EACH ORGANIZATION'S NAME AND ADDRESS, TYPE OF WORK PERFORMED, AND DATES)

WHY DO YOU FEEL CALLED TO WORK WITH PRESCHOOLERS OR CHILDREN?

HAVE YOU EVER BEEN CONVICTED OF OR PLEADED GUILTY TO A CRIME?

IF YES, PLEASE EXPLAIN

WERE YOU A VICTIM OF ABUSE OR MOLESTATION WHILE A MINOR? IF YOU PREFER, YOU MAY REFUSE TO ANSWER THIS QUESTION OR YOU MAY DISCUSS YOUR ANSWER IN CONFIDENCE WITH THE PASTORAL STAFF RATHER THAN ANSWERING IT ON THIS FORM. ANSWERING YES, OR LEAVING THE QUESTION UNANSWERED, WILL NOT AUTOMATICALLY DISQUALIFY AN APPLICANT FOR CHILDREN OR YOUTH WORK.

CHURCH BACKGROUND

NAME OF CHURCH OF WHICH YOU ARE A MEMBER AND HOW LONG YOU HAVE ATTENDED?

(with location & demonation)

LIST OTHER CHURCHES YOU HAVE ATTENDED REGULARLY DURING THE PAST 5 YEARS

WHAT DO YOU UNDERSTAND IT TAKES FOR A PERSON TO GO TO HEAVEN?

CHARACTER REFERENCES

PLEASE LIST THREE PERSONAL REFERENCES (not a relative or employer)

NAME

RELATIONSHIP TO YOU

ADDRESS

HOME PHONE

CITY, STATE, ZIP CODE

DAYTIME PHONE

NAME

RELATIONSHIP TO YOU

ADDRESS

HOME PHONE

CITY, STATE, ZIP CODE

DAYTIME PHONE

NAME

RELATIONSHIP TO YOU

ADDRESS

HOME PHONE

CITY, STATE, ZIP CODE

DAYTIME PHONE

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 work with preschoolers or children. In consideration of the receipt and evaluation of this application by Life Community 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 compliance or any attempts to comply, with this authorization.

Should my application be accepted I agree to be bound by the policies, and moral and spiritual teachings of Life Community Church, and to refrain from unscriptural conduct in the performance of my services on Behalf of the church.

This release, when presented by a representative of the Life Community Church, will constitute my consent and authority to examine and obtain copies and abstracts of records and to receive statements and information regarding my background. I understand that this verification may include an inquiry into my criminal records as well as other public record information. I authorize the release of such data as may be necessary to verify the information I have provided. I release and hold harmless from all liability any individual or entity requesting or supplying information with respect to my application for volunteer work.

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.

SIGNATURE OF APPLICANT

DATE

Information regarding disclosure of your Social Security Number under 6552a.5 U.S.C., if applicable.

Disclosure by you of your Social Security Number (SSN) is mandatory to obtain the services, benefits, processes that you are seeking. The SSN is used as an identifier throughout your career from the time of application through retirement. It will be used primarily to identify your records that you file. The SSN also will be used in connection with lawful requests for information about you from your former employers, educational institutions and other organizations.

The information gathered through the use of the number will be used only as necessary in personnel administration process carried out in accordance with established regulations and published notices of systems of records. The use of the SSN is made necessary because of the large number of employees and applicants who have identical names and birth dates and whose identities can only be distinguished by the SSN.

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myLIFE

MEMBER USERNAME

PASSWORD

OR SIGN UP

I HAVE COME THAT YOU MAY HAVE LIFE ... JOHN 10:10