ETERNITY CHRISTIAN CHURCH

Application for Children/Youth Workers

CONFIDENTIAL
This application is to be completed by all applicants for any position (volunteer or compensated)
involving the supervision or custody of minors. It is being used to help the church provide a safe and
secure environment for those children and youth who participate in our programs and use our facilities.

PERSONAL
Todays Date: _____________
Name: _______________________________________________________________________________
Present (Physical) Address: ______________________________________________________________
Number
Street
City
State
Zip
Date of Birth: _____________ State of Birth: _____________ Sex: ______ Race: _______
Social Security Number: ________________________________________________________________
Drivers License Number/State: ___________________________________________________________
Home Phone: ______________________________ Cell Phone: _________________________________
Work Phone: ______________________________ Email: _____________________________________
What type of children/youth work do you prefer?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
One what date would you be available? _____________________________________________________
Marital Status: Married ____
Remarried ____

Single ____
Engaged ____ Separated ____ Divorced ____
Widowed ____

Have you any physical handicaps or conditions preventing you from performing certain types of activities
relating to youth or childrens work? Yes____ No ____ If yes, please explain: ____________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation
of a minor? Yes____ No____ If yes, please explain: _________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

CHURCH ACTIVITY
Name of church of which you are a member or attend: _________________________________________
List (names and addresses) other churches you have attended regularly during the past five years, and
pastors name.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

List all previous church work involving children/youth (identify church, supervisor or pastors name and
type of work.)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

PERSONAL REFERENCES
(not former employer, relatives, or FPBC pastoral staff)
Name: ___________________________
Address: _________________________
Phone: ___________________________

Name: __________________________
Address: ________________________
Phone: __________________________

APPLICATION STATEMENT
The information contained in this application is correct to the best of my knowledge. I authorize any
references or churches listed in the application to give you any information they many have regarding my
character and fitness for children/youth work. I release all such references from liability for any damage
that may result from furnishing such evaluations to you, and I waive any right that I may have to inspect
references provided on my behalf. Should my application be accepted, I agree to be bound by the policies
of Eternity Christian Church, which I have read and fully understand, and agree to refrain from
unscriptural conduct in the performance of my services on behalf of the church.
A criminal background check will be run on all new preschool, children, and youth paid and volunteer
workers prior to beginning ministry service. By signing below, I give consent to Eternity Christian
Church to perform a background screening check, and run new checks periodically.
Applicants Signature: _____________________________________________ Date: ________________

Witness: ________________________________________________________ Date: ________________

Risk Management Policies

Children and Teenagers
Eternity Christian Church
Commitment to Ministry Integrity

My Commitment to Ministry Integrity

Understanding the need to protect all children who are under the care of Eternity Christian Church and its
ministries, and desiring to serve these children with the utmost care and godly leadership, I will adhere to
the stated Risk Management policies of Eternity Christian Church.

Name (print): __________________________________________

Signature: _____________________________________________

Date: ______________