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Capitol Hill Baptist
Childrens Deacons

Children's Ministry Volunteer Pre-Screening Form

Warning: Confidential Information—Read Carefully!

This document is designed to collect information about you that we need to qualify you for service in children's ministry at Capitol Hill Baptist Church.  This information is treated as confidential and will be read only by you, the children's ministry administrator and the elder for Children & Families. Persons who review, duplicate, distribute, or disclose any portion of this document without authorization may face one or more of the following consequences: (1) Termination of employment, if an employee. (2) Dismissal from any official position within the church, if a volunteer. (3) Possible criminal liability. (4) Possible civil liability.

If at any time you determine that the information you provided in this document is not true--or if it changes in a way that substantively impacts your qualification to serve in childcare, you are requested to notify the associate pastor for families and counseling as soon as possible.

ELECTRONIC SIGNATURE NOTICE

This notice is intended to provide you with important information required by the Electronic Signatures in Global and National Commerce Act (E-Sign Act).

Consent: By entering your name, you consent to submit your application and Background Check Disclosure and Authorization Form and all related forms, documents and information electronically.  You further consent to conduct any matters related to the recruiting, application, background check and/or onboarding process electronically.  Typing your name in the textbox on a form, entering your login password, and clicking on "Submit", will constitute your electronic signature.

Right to Withdraw Consent: You have the right to withdraw your consent to receive disclosures and submit information electronically.  If you choose to withdraw your consent, the (on-line) application process will be terminated.  You may withdraw consent by contacting the Children's Ministry Administrator.

Children's Ministry Application

 

Current Address*

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( )   -

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What type of training did you do?

Date you completed Childcare Initial Training

Please indicate your current status:

In dependence on the Holy Spirit and by God's grace, I commit to:*

Personal Commitment Statement (please check all)

Personal References

Please provide 2 personal references who are:

  • NOT related to you
  • a pastor or other church leader from your previous church
  • a person who has served with you in ministry
  • a person who knows you, such as a co-worker, employer, teacher, coach, friend, etc.

Note: You cannot use CHBC members as references if you have been a member for less than one year. (NO EXCEPTIONS)

Please provide contact info:

 

Address

,    

( )   -

Please provide contact info

 

Address

,    

( )   -

Personal information is protected under Privacy Act and will be guarded accordingly.

 

Reports are confidential and viewed only by CHBC elders and kept in a secure file.

 

Note: Any reported misdemeanor or felony will be discussed between you and the elders and may be grounds for denial of application to work with children.

Confidential Information

The following questions are designed to help us promote a safe, secure, and loving environment for the children who participate in our programs.  They are meant for child protection purposes.

 

This information will be kept confidential, viewed only by the Pastor for Family Ministry or other elders he deems necessary and appropriate.

 

If you would like to discuss any of these matters further with the pastor overseeing children’s ministry, please simply indicate that below or leave the form blank.

 

Answering “yes’ to any of these questions will not necessarily disqualify you from participating in children’s ministry at Capitol Hill Baptist Church.

1. Have you ever been accused of, participated in, plead guilty to, or been convicted of child abuse, child neglect, or any other crime against a minor?*

2. Have you ever been convicted of or plead guilty to a crime (other than minor traffic violations)?*

3. As a child or teenager, did you ever have sexual interaction or contact with a child?*

4. Have you deliberately and repeatedly viewed pornography in the past 3 years?*

(This includes reading, watching, listening to, or in any other way using pornographic material, including books, magazines, television shows, movies, the Internet, or telephone services.)

Have you ever viewed child pornography?*

5. Do you have any ongoing sin struggles that you think would keep you from ministry to children?*