Date ______________________

  TRINITY CHURCH
Children and Youth Ministry Application

Name ___________________________________________________ Phone No. (       )_________________________
                  (First)	                                   (Middle)                  (Last)  

Address ________________________________________________________ City____________________ Zip code____________

Occupation __________________________________________________   Business Phone _________________________________

E-mail address __________________________________________   Spiritual birth date ____________________________________
                                                                                                                                                              (If Known)
Name of spouse (if applicable) _______________________________________

Names of Parents or Legal Guardian (If minor) ____________________________________________________________________

Names and ages of others living in your home ____________________________________________________________________

Are you a member of Trinity Church?   q Yes	q No    Do you attend Trinity regularly?   q Yes    q No

If yes to above, what services/classes do you attend? ________________________________________________________________________________________________________________

Are you an active member of another church?  If so, please provide information on that church:

Name of Church___________________________________________________ Address ______________________________________

Name of pastor, elder, church leader whom we may contact as a reference ____________________________________

What age level and group/groups would you care to work with? ___________________________________________________

Please list any previous training/experience working with children or youth (include locations, dates, etc.), or your gifts:  ____________________________________________________________________________________________________

_________________________________________________________________________________________________________________

What (if anything) do you use for your personal devotional time?  _________________________________________________________________________________________________________________

Please briefly state your relationship to the Lord. 

_________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Have you ever been convicted of or have a case pending on any type of abuse, child pornography, child abuse, or actual or attempted molestation?       q Yes	q No

_________________________________________________________________________________________________________________

I have read “The Essentials” http://www.epc.org/about-the-epc/beliefs/essentials-of-our-faith/  and agree to believe and promote it with those to whom I minister. ________Initial

I have read the appropriate sections of “The Book of Discipline” http://www.epc.org/mediafiles/book-of-order-2010-2011.pdf  and agree to follow its policies.   ___________Initial
													
I have read and agree to the Covenant of Commitment (please see attached document) for Volunteers of Trinity. ________________Initial
											l

Please answer the following questions: (You may continue on another sheet if desired)

1) What is the meaning of Jesus’ death on the cross?

2) Why do people need to know Jesus as their Savior?

3) How do people get to Heaven?

4) How do people become a Christian?  

5) Briefly state your beliefs concerning the Bible.

APPLICANT’S STATEMENT: 

I certify that the information I have provided in this application is correct to the best of my knowledge.  I also agree to notify the Senior Pastor or staff person I report to if changes have occurred that require an update to the information contained on this application form.  I understand that this application will be kept strictly confidential by the appropriate director in a secure location.

I authorize references from churches and individuals listed in this application to give to Trinity Presbyterian Church any information including opinions they may have regarding my character and fitness for children’s/youth work.  

I authorized that Criminal Records Checks be conducted on me and that any information which pertains to any record of convictions contained in police files or criminal file maintained on me be released to the church.

If I witness any inappropriate behavior with minors by any Trinity staff member or volunteer personnel, I agree to report it to an appropriate Pastor, Trinity Presbyterian Church Staff member, or the leader of the current event in progress. 

Applicant’s Signature of Agreement _______________________________________________ Date _________________

Signature of Parent or Legal Guardian (if applicant is under 18 years of age

____________________ ____________________________________ Date___________________________________

For those 18 years of age or older:

In order for us to request a Criminal Records Check, please provide the following:

Social Security Number _______________________________________  Date of  Birth  _______ /________/___________
										        Day            Month             Year

Driver’s License Number (If applicable) ________________________________________  Exp.  Date ________________  

State Issued ____________ 

Place of Birth (City, State, County, Country) _______________________________________________________________

Maiden name or any other names by which you have been known (if applicable) 

____________________________________________________________________________________________________

To allow that a Criminal Records Check be properly made, a copy of your Driver’s License is required (if applicable).

I have attached a copy of my driver’s license    q Yes	q No

Personal References (NO relatives) These references will be asked to fill out a confidential questionnaire about their knowledge of you. 

Name: ___________________________________________   Name: ____________________________________________

Address:  ________________________________________   Address: __________________________________________ 

   ________________________________________		  __________________________________________

Phone: (       ) ____________________________________      Phone (      ) _______________________________________

Email Address ___________________________________      Email Address ____________________________________

Trinity Presbyterian Church—”Child and Youth Ministry Application”
Approved by Session, November, 2005