Volunteer and Employee Application | Bethlehem Baptist Union

(In compliance with Safe Sanctuary Policy)

In order to provide a safe environment that allows for spiritual growth, the Bethlehem Baptist Union requires that every employee and any individual who desires to volunteer with any union-sponsored ministry or activities involving persons under the age of 18 to complete this application.

Full Name

Date

Nickname

Date of Birth

Gender

Current Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Daytime Phone

Evening Phone

Cell Phone

Email

Current Employer

Educational Field of Study

Educational School Attended

Current Occupation

Hours per week

Place of Work 1

Years at Place 1

Place of Work 2

Years at Place 2

Place of Work 3

Years at Place 3

Place of Work 4

Years at Place 4

Place of Work 5

Years at Place 5

Place of Work 6

Years at Place 6

Spouse’s Name (if applicable)

List children and ages (if applicable)

Previous Addresses: Please list addresses for the past 10 years (attach sheet for additional addresses

Address 1

City 1

St 1

Zip 1

Address 2

City 2

St 2

Zip 2

Address 3

City 3

St 3

Zip 3

Address 4

City 4

St 4

Zip 4

Address 5

City 5

St 5

Zip 5

References: Please list three personal references (people who are not related to you by blood ormarriage) and provide complete address and phone information for each. References areconfidential.

Reference 1

Reference 1 Name

First

Last

Reference 1 Address

Ref. 1 Daytime Phone

Ref. 1 Evening Phone

Ref. 1 Relationship

Ref. 1 Length of time known

Reference 2

Reference 2 Name

First

Last

Reference 2 Address

Ref. 2 Daytime Phone

Ref. 2 Evening Phone

Ref. 2 Relationship

Ref. 2 Length of time known

Reference 3

Reference 3 Name

First

Last

Reference 3 Address

Ref. 3 Daytime Phone

Ref. 3 Evening Phone

Ref. 3 Relationship

Ref. 3 Length of time known

Have you ever been charged, convicted of, or pled guilty to any crime, either a misdemeanor or a felony?

No

Yes

If yes, please explain fully

Have you ever been exposed to an incident of child abuse or neglect?

Yes

No

If yes (have been exposed to an incident of child abuse or neglect), please explain fully

Are you willing to submit to a law enforcement background check?

Yes

No

Have you received a Covid 19 Vaccination?

Yes

No

If not Vaccinated, are you willing to receive a Covid 19 Vaccination?

Yes

No

Have you tested positive for Covid19 within the past 14 days?

Yes

No

Are you willing to follow the CDC Guidelines established for K-12 Schools (e.g., wearing masks, social distancing, washing of hands, daily temperature screening, etc)?

Yes

No

The information contained in this document is complete and accurate to the best of my knowledge. I authorize any references listed to give information they have in regard to my character and ability to work with children and/or youth.
Signature

Signature Date

If the applicant is a minor, the minor’s parent of guardian must also sign and certify the provided information.

If the applicant is a minor, the minor’s parent of guardian must also sign and certify the provided information. I have read the information and agree that the information provided is true and accurate. I know of no reason why the applicant should not be allowed to work with minors.
Parent or Guardian of Minor Signature

Parent or Guardian of Minor Date