Kidron Mennonite Church Volunteer Application
Please answer the following question.
Full name (First, Middle, Maiden, Last) *
Your answer
Date of Birth *
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DD
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Social Security Number
Your answer
Home phone *
Your answer
Cell phone
Your answer
Email *
Your answer
Address *
Your answer
Other states in which you have lived as an adult.
Your answer
Are you a member of Kidron Mennonite Church *
List the name and location of any other churches you have attended within the past 5 years.
Your answer
For which program(s) are you planning to volunteer? *
Required
What qualities, experiences or training will assist you in your volunteer position?
Your answer
Have you ever been involved in any vehicle accidents or received a fine other than for speeding or parking? If yes, please explain in comment box at the end. *
Have you ever been accused of or charged with injuring, abusing or molesting a minor? If yes, please explain in comment box at the end. *
Are there any circumstances in your life that could be perceived as impairing your ability to work with minors? If yes, please explain in comment box at end. *
Applicant Verification and Release: I recognize that the organization to which this application is being submitted is relying on the accuracy of the information contained herein. Accordingly, I attest and affirm that all of the information that I have provided is absolutely true and correct. I authorize the organization to contact any person or entity listed in this application, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications. I voluntarily release the organization and any such person or entity listed herein from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary. I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth at all times. *
Please initial
Your answer
If you have attended Kidron Mennonite Church for fewer than 5 years, or answered yes to any of the questions above, please provide the names and phone numbers of 3 individuals not related to you who could act as references.
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Use this space to explain any yes answers or other information that would be helpful.
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