Volunteer Application Form

Confidential ADULT Volunteer Application for

Children and Student Ministries

This application is part of a comprehensive effort to provide a safe environment for the children/youth entrusted to our care at Valley Church.

BEFORE filling out this form, you may wish to gather the following information:
1. All addresses where you have lived for more than 30 days during the past 10 years.
2. All churches you have attended in the past 5 years. Include their names, city/state and the dates you attended.
3. Three personal references (other than an employer or relative) and their contact information.
APPLICANT INFORMATION
First Name
Last Name
Middle Name
Maiden Name or Aliases
Gender
Current Address

Street Address

Apt.

CityState

Zip Code
How long have you lived at this address?
Home Phone
Work Phone
Cell Phone
Email Address
Occupation
Date of Birth

MonthDayYear
Place of Birth
City, State, Country
Drivers License Number
Marital Status
Spouse's Name
Children's Names and Ages
CHURCH ATTENDANCE
Are you a member of Valley Church?
If YES, date joined:

MonthDayYear
Are you a regular attendee of Valley Church?
If YES, for how long?
Please list all the churches you have attended in the last 5 years, starting with the most recent, including Valley Church.
Current Church
City, State
Current Church
Dates Attended
Current Church
Previous Church #1
City, State
Previous Church #1
Dates Attended
Previous Church #1
Previous Church #2
City, State
Previous Church #2
Dates Attended
Previous Church #2
WORK EXPERIENCE
Have you ever worked (or volunteered) at a church in a ministry or other work involving children or youth?
If YES, please list where you have worked and what your role was (including Valley Church):
Church/Organization #1
City, State
Church/Organization #1
Your Role
Church/Organization #1
Church/Organization #2
City, State
Church/Organization #2
Your Role
Church/Organization #2
Church/Organization #3
City, State
Church/Organization #3
Your Role
Church/Organization #3
PERSONAL REFERENCES
Please list 3 personal references, other than an employer or relative, including their phone number and email address.
Personal Reference #1*
Name
Phone Number
Email
Personal Reference #2*
Name
Phone Number
Email
Personal Reference #3*
Name
Phone Number
Email
ADDITIONAL INFORMATION
Have you ever been charged with or convicted of any of the criminal offenses listed in the following question below?
If YES, please select all that apply:

Child AbuseChild Molestation/RapeAssault/BatteryHarassmentAny other sex-related crimeUse or sale of drugs
If you selected any of the above criminal offenses, please give the date, place, nature and current status of the offense.
List any other crimes you have been charged with or convicted of in the last 10 years:
Have you ever been hospitalized or treated for alcohol or substance abuse?
If YES, please explain:
Would you object to the church conducting a criminal background check on you?
Would you object to the church conducting a driving record check on you?
Have you been convicted of a traffic violation other than parking tickets in the last five years?
Please list all addresses where you have lived for more than 30 days during the past 10 years:
In your own words, please explain why you want to work or volunteer for this ministry of the church.
I certify that the information contained in this application is correct, complete, accurate, and not misleading in any material way. I give my approval for you to check any references I have given, including churches, individuals, or official government records listed in this application, and also to check any sources not listed in this application which may have information that in your opinion will help evaluate my application.

I give my permission for any of the references you check to give you any information that they may have regarding my suitability and fitness for children's/youth work. I fully and voluntarily release all such references from any liability they might otherwise have for furnishing any information to you, including stating their own subjective opinions. I waive any right that I might have to read or examine information given to you by my references.

If I am accepted for any position at Valley Church, I agree to abide by all policies of the church, including the corporate Articles and Bylaws, and the stated policy of the church.

I understand that the position in which I am applying is strictly an "at will" position, and that the church or I may end the position at any time, without liability.
Signature

Powered by Jotform SignClear
Date

MonthDayYear
If you'd like a copy of this form, please provide your email address:
10885 N. Stelling Road Cupertino, CA 95014 408-739-4642 www.valleychurch.org
Should be Empty:

Confidential ADULT Volunteer Application for

Children and Student Ministries

APPLICANT INFORMATION

CHURCH ATTENDANCE

WORK EXPERIENCE

PERSONAL REFERENCES

ADDITIONAL INFORMATION