Child/Youth Worker Application Form
It is the goal of SAYMA to create a safe and secure environment for all children and workers who are involved in SAYMA activities. To facilitate this emphasis, it is necessary to gather pertinent information from those who desire employment or offer volunteer services to our children and youth program. This information will be used for the sole purpose of helping SAYMA provide a safe and secure environment for children and workers. Both criminal and motor vehicle records may be searched.
Contact Information
Name *
Your answer
Current Street Address *
Your answer
City, State & Zip *
Your answer
Current Phone Number (Home)
Your answer
Current Phone Number (Cell)
Your answer
Email Address *
Your answer
Please respond to all questions below that apply to the position for which you are applying/volunteering.
Position applying/volunteering for: *
Do you have a valid Drivers License?
If yes, choose the type.
Is there any reason you should NOT work with or around children or youth? *
Have you ever been the subject of a child abuse investigation? *
If yes, please provide details:
Your answer
Have you ever been convicted of or pleaded guilty to any criminal offense? *
If yes, please provide details:
Your answer
Please provide the following Friends Meeting information:
What, if any, Friends Meeting affiliation do you have? *
Your answer
How long have you attended that Meeting?
Your answer
Are you a member?
Your answer
List other Meetings with which you have been affiliated:
Your answer
Have you ever worked with youth or children? *
List where:
Your answer
Please list two references:
(must be of a business, Quaker, or organizational nature)
Name *
Reference #1
Your answer
Phone *
Reference #1
Your answer
Address *
Reference #1
Your answer
Years Known *
Reference #1
Your answer
Name *
Reference #2
Your answer
Phone *
Reference #2
Your answer
Address *
Reference #2
Your answer
Years Known *
Reference #2
Your answer
Signature
I hereby give permission to make a thorough investigation of my past employment, education, and background, and release from liability all persons, companies, or corporations supplying such information. I also release SAYMA from any liability that might result from making such an investigation. I understand that any false statements or implications made by me on this application or other required documentation shall be considered sufficient cause for denial of employment or discharge.
Electronic Signature
Please type your full name
Your answer
Submit
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