Parkhills Baptist Church - Background Check

Personal Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone(Required)

Work Phone

Home Phone

Birth DateDate

Are you a Member at Parkhills(Required)

Employer Name (if employed)(Required)

List any Church you have been a member in the last 5 years. (Church name, city, state, dates of membership)(Required)

How long have you known Christ as your Lord and Savior?*(Required)

Give an example of how Jesus has impacted your life.(Required)

General Questions

What Ministry would you like to serve in?(Required)

School at Parkhills

Kids Ministry (Birth-5th)

Student Ministry(6th-12th)

Young Adult Ministry

Adult Ministry

Senior Adult Ministry

List any experience you have working with kids/students(Required)

Been convicted of a felony or misdemeanor*(Required)

I have not

I have

Currently under indictment or charged in an official criminal complaint accepted by a district attorney with a felony or misdemeanor.*(Required)

I am not

I am

Been prohibited from serving in any capacity as an employee 0r volunteer working with children, youth, or adults*(Required)

I have not

I have

Been reassigned or asked to leave any position involving children, youth, or adults*(Required)

I have not

I have

Been a victim of child abuse or sexual abuse(Required)

I have not

I have

If your answer is affirmative to any of the above questions, you must speak to the minister in charge of your area. If you were personally a victim of child abuse, we require that you make this information known to the minister under whose leadership you will serve. Admitting you were a victim will not automatically disqualify you from service. Your confidence will be respected and appreciated.

References (No family member or Parkhills Baptist Church staff member may be listed as a reference.)

Name of Reference #1(Required)

First Last

Name of Reference #2(Required)

First Last

Name of Reference #3(Required)

First Last

Address Of Reference #1(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Address Of Reference #2(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Address Of Reference #3(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone of Reference #1(Required)

Phone of Reference #2(Required)

Phone of Reference #3(Required)

Email of Reference #1(Required)

Email of Reference #2(Required)

Email of Reference #3(Required)

Volunteer Statement

I hereby acknowledge and understand that with completion of this application, I give my permission to Parkhills Baptist Church and to its authorized agents to access information that may be appropriate to my qualification to serve in Parkhills' Ministries. I understand that Parkhills has the right to review this application and subsequent information, to unconditionally accept or reject my application for volunteer service, and to terminate my placement at any time. I understand that upon termination, I will return any and all properties issued to me by Parkhills Baptist Church. I agree upon placement that I will perform any volunteer responsibilities without compensation and that in performing these responsibilities, I am not acting as an employee or official representative of Parkhills Baptist Church.

Signature(Required)

Date

Prospective Organization: Parkhills Baptist Church Criminal Background Check: Nationwide Search & Social Security Verification

NOTICE TO VOLUNTEERS

Parkhills Baptist Church has contracted with Essential Screens, an agency used to verify certain information contained in your employment application or during the interview process. The information requested below is necessary to complete this task. Please complete all information requested.

Applicant's Legal Name *(Required)

First Middle Last

Name

First Middle Last

Please provide any other names used for prior employment or school that differs from above.

Date of Birth(Required)

Email(Required)

RESIDENTIAL HISTORY: List All Residential Addresses in the Last 7 Years

Address #1(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Address #1: From (mm/dd/yyyy) to (mm/dd/yyyy)(Required)

Address #2

Street Address City State / Province / Region ZIP / Postal Code Country

Address #2: From (mm/dd/yyyy) to (mm/dd/yyyy)

Address #3

Street Address City State / Province / Region ZIP / Postal Code Country

Address #3: From (mm/dd/yyyy) to (mm/dd/yyyy)

Address #4

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address #4: From (mm/dd/yyyy) to (mm/dd/yyyy)

Address/City/State/Zip It is possible that your acceptance for work may be determined in whole or part by your prospective organization using data from a report supplied by Redstar. VOLUNTEER CONSENT: I understand and agree that Redstar Backgrounds will verify all or part of the information I have given my organization. I understand that this verification may include an inquiry into my motor vehicle driving record, criminal and civil records, prior employment (including contacting prior employers), as well as Social Security verification. I authorize the release of such information as may be necessary to verify the information I have provid- ed. I release and hold harmless from all liability any individual or entity requesting or supplying information with re*

Signature(Required)

Date(Required)

Parkhills Volunteer/Staff Application

Personal Information

General Questions

References (No family member or Parkhills Baptist Church staff member may be listed as a reference.)

Volunteer Statement

Prospective Organization: Parkhills Baptist Church Criminal Background Check: Nationwide Search & Social Security Verification

NOTICE TO VOLUNTEERS

RESIDENTIAL HISTORY: List All Residential Addresses in the Last 7 Years