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Primary
Screening Application for Children or Youth Work
Confidential
Myrtle Grove
Baptist Church
1.
This
application is to be completed by all applicants for any position
(volunteer or compensated) involving the supervision or custody of minors.
This is not an employment application form. Persons seeking a position in
the church as a paid employee will be required to complete an employment
application in addition to this screening form. 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
2. Name
Date
Last
First
Middle
3.
Identity
must be confirmed with a state driver license or other photographic
identification.
Present
Street Address
City
State Zip
Home Phone
Work Phone
Please
indicate the type of youth/children’s work you prefer:
Please
indicate the date you would be available to begin:
What is the
minimum time length of commitment you can make?
4.
Have you
ever been convicted of or pleaded guilty to a crime?
Yes (If
yes, please explain in detail using a separate page)
No
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