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5.
Were you a
victim of abuse or molestation while a minor?
Yes
No
If you
prefer, you may refuse to answer this question, or you may discuss your
answer in confidence with the age group minister rather than answering it
on this form. Answering yes, or leaving the question unanswered, will not
automatically disqualify an applicant for children or youth work.
6a. Do you
have a current driver's license?
Yes If yes, driver license #
State Expir. Date
No
6b. Your
Social Security Number
Church
History and Prior Children/Youth Work
7.
List other
churches you have attended regularly during the past five years:
Name of
Church
Street
Address
State Zip
Phone Number
with Area Code
Contact
Person at Church (pastor or other staff member)
Name of
Church
Street
Address
State Zip
Phone Number
with Area Code
Contact
Person at Church (pastor or other staff member)
Name of
Church
Street
Address
State Zip
Phone Number
with Area Code
Contact
Person at Church (pastor or other staff member)
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