Volunteer Profile

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

What position/ministry are you volunteering for? REQUIRED Please fill out this field. Please enter valid data.

Times and days available REQUIRED Please fill out this field. Please enter valid data.

1. Have you ever been charged with, arrested for, or convicted of a crime other than a minor traffic violation? If so, explain fully the circumstances. (Such charge or conviction may be relevant if job related, but does not bar you from volunteering.) REQUIRED Yes No Please fill out this field.

If yes, explain: REQUIRED Please fill out this field.

2. Have you ever been the subject of an investigation involving an allegation of sexual abuse? REQUIRED Yes No Please fill out this field.

If yes, pleases explain:

3. Has a civil or criminal complaint ever been filed against you alleging, physical abuse or sexual abuse by you? REQUIRED Yes No Please fill out this field.

If yes, please explain:

4. Have you ever terminated your employment or had your employment terminated for reasons relating to allegations of physical abuse or sexual abuse by you? REQUIRED Yes No Please fill out this field.

If yes, please explain:

5. Have you ever received any medical treatment, physical or psychological, for reasons involving physical abuse or sexual abuse by you? REQUIRED Yes No Please fill out this field.

If yes, please explain: REQUIRED Please fill out this field.

B. VOLUNTEER HISTORY: Please list your last three volunteer activities, starting with the most recent. Please enter valid data.

C. PERSONAL REFERENCES: Please list the name, address and telephone number/ email address of three individuals (other than Pastor or Principal) who are sufficiently familiar with you to provide a character reference Please enter valid data.

To sign this form, type your name below: REQUIRED Please fill out this field. Please enter valid data.