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VCS Child & Youth Worker Application
Thank you for showing interest in serving our church! This application will be used to help the church provide a safe and secure environment for children who participate in our programs and use our facilities. We will keep this application secured and confidential among pastors/directors.
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Email
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Your email
Last Name
Your answer
First Name
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Middle Name
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Maiden and/or other used name(s)
Your answer
Gender
Female
Male
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Date of birth
MM
/
DD
/
YYYY
E-mail address
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Best phone number
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Address
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What month and year did you begin regularly attending The Vineyard Church?
Your answer
Do you agree with the following statements? Check all that apply:
I have read and understand the Child Safety Policy of the Vineyard Church. I have had an opportunity to ask questions, and I agree to comply with the policy.
I understand the necessary background check procedures, and I will obtain & share the necessary records with the church staff.
I will sign the disclosure statement 23 Pa. C.S Section 6344.2, stating that I am NOT required to obtain FBI clearance (fingerprinting) based on the criteria presented in the disclosure (I am applying for an unpaid position, I have been a resident of Pennsylvania during the entirety of at least the last ten-year period, and I have not committed a crime).
Check any or all that apply:
I have a history of being sexually abused.
I have a criminal history
Please list a local reference who is over 18 years of age who are not family members: Name, Phone, Email, City, State, Relationship/How long:
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Please list a local reference who is over 18 years of age who are not family members: Name, Phone, Email, City, State, Relationship/How long:
Your answer
Please list a local reference who is over 18 years of age who are not family members: Name, Phone, Email, City, State, Relationship/How long:
Your answer
Previous church attended:
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Pastor's name of previous church:
Your answer
Please describe your present relationship/experience/attitude toward Jesus:
Your answer
Please describe why you want to work with children/youth and provide any examples of previous experience:
Your answer
What are your passions/gifts in ministry? And what specific area do you see yourself serving at The Vineyard?
Your answer
Is there anything in your past that you’d like us to be aware of before serving with our children/youth? (If yes, please describe)
Your answer
Are there any present struggles that you would you like talk to a pastor about before serving?
Your answer
Electronic Signature
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Your answer
Send me a copy of my responses.
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