Volunteer Worker's Application - Heritage Baptist Church

Your name *

Email address *

Personal Information

Name (first, middle, and last) *

Ministry Preferences

What type of ministry do you prefer? Please check all categories that apply.

Ministry Programs *

Heritage Kids (Sunday morning)

Awana (Wednesday evening)

Heritage Student Ministries (Wednesday evening)

Mom's Alive (Second Friday of each month)

Ministry Interest *

Teacher

Helper

Administration

Check-In Desk

Music

Arts/Crafts

Games/Activities/Drama

Limitations or Restrictions for Serving *

Describe any condition or limitation that might restrict or prevent you from performing certain activities involved in the volunteer position for which you are being considered (i.e. health concerns/diseases, lifting, handling an emergency, driving, participating in certain sports, etc.).

Ministry History

Please list the most recent church you have attended regularly, other than Heritage Baptist Church.

Dates you attended *

Ministry Leader/Pastor *

Ministry References

Please provide 2 individuals (non-family members) that we may contact who will provide an accurate evaluation of your character.

Email address (preferred method) *

Legal Questionnaire

Check yes or no *

Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor traffic violations)? You will need to answer “yes” if you have entered into a plea agreement, including a deferred sentence or deferred judgment arrangement, in connection with a criminal charge.

Yes

Check yes or no *

Have you ever been convicted of a sexual offense, offense relating to children or crime of violence (that is not covered in question 1 above)?

Yes

Check yes or no *

Have you ever been reported to a social services agency, law enforcement authority, child abuse registry or similar organization regarding abuse or misconduct involving children?

Yes

Check yes or no *

Have you had any painful experience (personal abuse in any form) that has better equipped you, or may hinder you from a productive ministry?

Yes

Check yes or no *

Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment or other immoral behavior or conduct, involving adults or children?

Yes

Check yes or no *

Have you ever been the subject of a complaint or disciplinary proceeding against a professional license or other license held by you, including but not limited to a license to provide child care or similar services?

Yes

Check yes or no *

Have you ever been the subject of any disciplinary action, transfer or dismissal, or been named as a defendant in a civil lawsuit, as a result of an accident or mishap involving children?

Yes

Check yes or no *

Have you ever been subject to any disciplinary action (including discharge) or investigation by a church, religious or other organization or by an employer?

Yes

Check yes or no *

Have you ever struggled with drugs, alcohol, pornography or any other addiction; or has anyone ever suggested that you may have a problem with any of the above?

Yes

Check yes or no *

Have you ever had any DUI convictions?

Yes

Check yes or no *

Do you practice a sexually pure lifestyle as taught in the Scriptures?

Yes

Applicant’s Statement

CONFIDENTIAL - Your responses will be maintained confidentially, although there may be circumstances where such information may be provided on a “need to know” basis to individuals working with our ministry in order to evaluate your application and/or to comply with applicable legal requirements.

• The responses I have provided in completing this application form are complete, truthful and accurate.

• I hereby authorize Heritage Baptist Church (hereunto referred to as “the church”) to make periodic inquiries concerning my background in connection with evaluating the information I have provided on this form and in the application process. I hereby authorize all persons associated with me, including churches, employers, law enforcement agencies, licensing and social services agencies, to release any information contained in their files or records concerning me to the church and its representative.

• In consideration of the receipt and evaluation of this application form by the church, I hereby release the church and their directors, employees, agents, representatives and any other person or organization, including record custodians, that may release information concerning me, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or family on account of inquiries concerning my background and any disclosures of information concerning me to the church.

• I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

• I understand that my service with the church shall be volunteer service. In addition, my volunteer services shall be at-will and the church shall be entitled to terminate my services at any time, with or without cause or advance notice. As a volunteer, I have no entitlement to or expectation of compensation, health insurance or other employee benefits, or unemployment or worker’s compensation insurance benefits.

• I affirm that I will strictly comply with all policies and procedures of the church including, but not limited to, its Child Protection Policy, which I have read in its entirety. If at any time I find that for any reason I am unable to support the vision, policies, procedures or doctrine of this church/organization, I will resign my volunteer position. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal, or in disciplinary action, all at the discretion of the church. I will report any known or suspected child abuse or other violation of policy to the senior pastor, a member of the church staff, a deacon or the designated authority.

• I have carefully read the foregoing statement and know the contents of it, and I sign this statement as my own free and voluntary act.

ATTENTION – IF YOU HAVE CURRENT CLEARANCES, PLEASE SEND TO INFO@WEAREHBC.COM.

Signature *

By typing your full name, you are signing this form electronically and are acknowledging that you have read and understand the above statements.