VOLUNTEER AND EMPLOYEE APPLICATION (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 EducationHSBSMSPhDOther 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 5References: 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 NameFirstLast Reference 1 Address Ref. 1 Daytime Phone Ref. 1 Evening Phone Ref. 1 Relationship Ref. 1 Length of time knownReference 2 Reference 2 NameFirstLast Reference 2 Address Ref. 2 Daytime Phone Ref. 2 Evening Phone Ref. 2 Relationship Ref. 2 Length of time knownReference 3 Reference 3 NameFirstLast 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? NoYes If yes, please explain fully Have you ever been exposed to an incident of child abuse or neglect?YesNo 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? YesNo Have you received a Covid 19 Vaccination?YesNo If not Vaccinated, are you willing to receive a Covid 19 Vaccination? YesNo Have you tested positive for Covid19 within the past 14 days?YesNo 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)?YesNoThe 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. SignatureClear Signature DateIf 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 SignatureClear Parent or Guardian of Minor DateSubmitReset