MCC- Application for Working with Minors

MCC- Application for Working with Minors

First Name*

Please provide your legal first name (i.e. the name on your Social Security card)

Last Name*

Preferred Name

Do you have a name other than your legal name that you prefer?

Other Names

Please list any other names by which you have been known, including maiden or married names.

Phone Number*

Phone

Birth Date*

Email Address*

Gender*

Select or enter value

Marital Status*

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Spouse Applying?

If you are married, is your spouse also applying?

Select or enter value

Do you hold a driver's license?*

The kind of background check we can run is determined in part by whether or not the applicant holds a driver's license.

Select or enter value

Current Street Address*

How long have you lived at your current address?*

How long have you lived in the area?*

Former Address*

If residing at the current address less than five years, please list your previous address.

Former Cities/States*

Please list all other cities and states in which you have lived as an adult.

Occupation*

MCC Attendance*

How long have you been attending Montecito Covenant Church's worship services (if applicable)?

If this is not applicable, mark "NA"

Other Church Attendance*

Please list all other churches you have regularly attended over the past ten years. Please include the location of each church's city and state (and country, if applicable).

If this is not applicable, mark "NA"

Volunteer Service*

Are you involved with or volunteering in any other church, ministry, or child-serving organization? If so, please describe your involvement.

If this is not applicable, mark "NA"

Military Service*

Please list any military service. If you served, did you fulfill your term of service and what was your discharge status?

If this is not applicable, mark "NA"

What are your hobbies or recreational activities?*

APPLICANT HISTORY

MCC Child, Student, and Family Ministries strive to provide a safe environment for children who participate in ministry programs. The following questions are in no way meant to offend or embarrass any applicant. For any ‘yes’ answer, please provide a detailed explanation in writing. An affirmative answer does not disqualify an applicant from volunteering, and this document will be kept highly confidential.

Have you ever been convicted of a criminal offense (felony or misdemeanor) involving moral turpitude or violence? (Crimes of moral turpitude involve fraud, theft or dishonesty.)*

Answer ‘yes’ if you have entered a plea agreement, including a deferred sentence or deferred judgment arrangement in connection with a criminal case.

Answering ‘yes’ does not necessarily preclude an applicant from volunteering at MCC Child and Student Ministries.

YES

If yes, please explain the circumstances of your conviction(s), including when and where the conviction(s) occurred.

Have you ever been charged with any felony or misdemeanor crimes for which you were not convicted?*

YES

If yes, please explain the circumstances of your charge(s), including when and where the charge(s) occurred.

Are you presently under charges for any criminal offense?*

YES

If yes, identify the case(s) pending, the date the charge(s) were issued, and the court in which the case(s) are pending, as well as any additional information you’d like to provide.

Have you ever been convicted for use or sale of drugs?*

YES

Have you ever been charged with a sexual offense, offense relating to children, or crime of violence?*

YES

Have you been arrested for sexual assault or molestation related to a child or vulnerable adult?*

YES

If yes, give date and location.

Have you been reported to any organization or registry for abuse or misconduct involving children?*

YES

Do you have any disciplinary action or investigation pending by an employer, other organization, professional association, or licensing body, for violence, sexual misconduct, or misconduct involving children or vulnerable adults?*

YES

Have you ever been disciplined or dismissed from any volunteer or employment position following an allegation of sexual misconduct or physical aggression, verbal aggression, or other inappropriate behavior?*

YES

Have you ever been reprimanded, or asked to leave or end your involvement/work in any program or organization providing services to children, youth or vulnerable adults?*

YES

Do you now or have you ever sought out or intentionally viewed child pornography?*

YES

Have you ever physically or sexually abused a child, youth or vulnerable adult?*

YES

Has someone ever accused you of physically or sexually abusing or molesting a child, youth or vulnerable adult?*

YES

Have you ever been the subject of an investigation or allegation of sexual misconduct, sexual abuse or sexual harassment involving a child or vulnerable adult?*

YES

Have you ever been the subject of a civil lawsuit involving sexual misconduct or sexual abuse of a child, youth or vulnerable adult?*

YES

Do you have any conditions or limitations preventing you from performing any activities relating to children’s work?*

YES

Further Explanation

Please give a full explanation of any question above answered ‘yes’.

PERSONAL HISTORY OF ABUSE

Did you experience physical or sexual abuse as a child?*

We realize this information is sensitive, and it will be kept entirely confidential, except in circumstances where a child is in danger. You may choose to discuss your answer in confidence with one of the pastors. Answering ‘yes’ to this question will not preclude an applicant from volunteering.

YES

If yes, at what age did the abuse occur, and how long did it continue?

If yes, have you had an opportunity to receive counseling and spiritual care in order to process the past abuse in a healthy manner? If so, when and how did this occur?

If you have not had the opportunity to receive counseling and spiritual care related to past abuse, would you consider counseling or other ministry resources to address any resulting emotional or spiritual harm?

YES

REFERENCES

We ask that you provide two references. One must be a personal or professional reference, the other must be a family or spiritual reference.

One reference must be a person of the opposite sex.

No more than one family member should be listed as a reference.

Please contact each reference, get permission to list them, and let them know that a MCC Child and Student Ministries representative will contact them shortly.

PERSONAL or PROFESSIONAL REFERENCE

Personal/Professional Reference*

A personal reference is someone who knows you well outside of a professional context.

A professional reference is someone who knows you from a professional setting such as a supervisor or coworker and can speak of your character in a work environment.

Please indicate whether this reference is a personal or professional reference using the drop-down menu below.

Select or enter value

First Name*

Please provide the first name for your reference.

Last Name*

Please provide the last name of your reference.

Gender*

Select or enter value

Phone*

Please provide the phone number for your reference.

Phone

Email*

Please provide an email address for your reference.

How long and in what capacity have you known this person?*

FAMILY or SPIRITUAL REFERENCE

Reference Type*

A family reference could be a spouse, adult sibling, parent, or other relative who knows you well and can speak to your character and trustworthiness.

A spiritual reference is someone familiar with your spiritual journey who can articulate the ways in which that journey has impacted who you are and how you live.

Select or enter value

First Name*

Please provide the first name of your Family reference.

Last Name*

Please provide last name of your Family reference.

Gender*

Select or enter value

Phone*

Please provide the phone number of your Family reference.

Phone

Email*

Please provide the email address of your Family reference.

How long and in what capacity have you known this person?*

VOLUNTEER STATEMENT AND RELEASE

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING*

I authorize Montecito Covenant Church (MCC) personnel to communicate with any prior employer or organization with whom I have volunteered in the past related to work with children, minors or vulnerable adults.

In completing this Volunteer Application, I understand that information in this application will be used to determine volunteer eligibility at MCC. In consideration of the receipt and evaluation of this volunteer application, I release the ministry, and its agents, from any and all liability for any damage that may result from furnishing such information to the ministry. 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, or any past employer, except as may be required by law.

If MCC offers me a volunteer opportunity, a potential employer may contact MCC or its representatives in the future concerning my volunteer record and performance at MCC. Specifically, I agree that MCC may share information with any future potential employer if such information relates to inappropriate behavior with moral turpitude.

I affirm that I will strictly comply with MCC policies and procedures, including those concerning protection of children, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies may result in my immediate dismissal.

The information contained in this application is true and correct. I understand and agree that any false answers or statements on this application, or any false statements made during the interview process, will be sufficient grounds for immediately discharging me from any volunteer position, no matter when discovered.

I authorize any reference or organization listed in this application, as well as any past employer or volunteer supervisor, to release any information contained in files or records concerning me. I authorize any reference, organization or past employer to provide any information (including opinions) that they may have regarding my character and fitness for any volunteer opportunity at MCC.

I release any individual, employer, reference or any other person or organization, including record custodians, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or my family, on account of compliance or any attempt to comply with this authorization. This authorization specifically includes information, opinions or records related to protection of children.

I understand to be able to volunteer, I will be required to consent and pass a Background Check investigation. I understand that adverse results of a Background Check, including ongoing Background Checks, could negate my current or continued volunteer opportunity.

I understand that I am required to notify my immediate supervisor if I am arrested, charged or accused of criminal behavior during my time of service as a volunteer at MCC. To the extent required by law, this information will be kept confidential.

I HAVE CAREFULLY READ AND AGREE TO THE FOREGOING, I UNDERSTAND AND AGREE THAT A COPY OF THIS APPLICATION WILL BE AS VALID AS THE ORIGINAL.

I OFFER THIS CHECKED BOX IN LIEU OF MY DIGITAL SIGNATURE:

VOLUNTEER STATEMENTS AND CODE OF CONDUCT

Use the checkboxes provided to affirm and authorize the following:

Reference & Background Check Authorization*

I understand that my references and contacts from prior ministry or secular work with children, youth or vulnerable adults may be contacted and that an appropriate Background Check will be conducted.

I authorize investigations of all statements contained in this application and I specifically authorize MCC to undertake a Background Check.

Withdrawl*

I understand that I can withdraw from the application process at any time.

Zero Tolerance Abuse Policy*

I understand that MCC has a policy of ZERO TOLERANCE FOR ABUSE and takes all allegations of child abuse and neglect seriously.

MCC personnel report all suspicions of abuse or neglect to relevant law enforcement agencies.

Dismissal*

I understand that MCC cooperates fully with authorities to investigate all cases of alleged abuse.

Abuse of any kind is grounds for immediate dismissal from my volunteer position and may form a basis for criminal charges.

Child & Student Ministry Handbook Affirmation*

I have read the MCC Child and Student Ministries Handbook.

(Click the link to view or download the handbook.)

I agree to and shall abide by all MCC policies, especially those concerning my conduct and behavior toward children, students or vulnerable adults.

Send me a copy of my responses

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