PCA 2023-24 Volunteer Application

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PCA 2023-24 Volunteer Application

A Volunteer at PCA is defined as Any individual desiring to work directly and/or regularly with children or youth at Plymouth Christian Academy.

Please indicate if you are a first time or returning applicant: *

First-time Applicant – Please complete sections 1, 2, and 3

Returning Applicant - Please complete section 1 and 3

Please confirm: *

I have read and agree to abide by the ‘PCA Volunteer Policy & Guidelines’ and ‘Code of Conduct’ and will support the school's ‘Statement of Faith’ (see below or www.plymouthchristian.org).

SECTION 1:

First Name: *

Middle Name: (if no middle name, indicate "N/A") *

Last Name: *

OTHER NAMES BY WHICH YOU MAY HAVE BEEN KNOWN, (i.e., maiden name):

Your Date of Birth *

YYYY

Home Street address: *

Home City: *

Home Zip Code: *

Email address: *

Best Phone Number to Use: *

LIST PCA STUDENTS TO WHOM YOU ARE RELATED:

IN WHICH CHILD/YOUTH SCHOOL PROGRAM ARE YOU SEEKING TO BECOME INVOLVED?

EDUCATION (Educational background, degrees, special skills)

EMPLOYMENT (if applicable): Provide NAME and ADDRESS of current employer

Current Job Title:

Dates of Employment:

Do Current Job Duties include interacting with children?

Yes

WHAT OTHER CHILDREN/YOUTH WORK EXPERIENCE DO YOU HAVE? (Please list any organizations or programs)

SECTION 2:

Please complete the fields below:

Have you at any time ever:

(*see below or www.plymouthchristian.org Volunteer Application for list of offenses)

Yes

Been arrested for any reason?

Been engaged in, or been accused of any child molestation, exploitation, or abuse?

Been convicted of, or pleaded to no contest to, any crime?

Been convicted of any offense listed under "Offenses" below? (*see below or www.plymouthchristian.org Volunteer Application for list

Are you currently under indictment or arraignment for any offense listed under "Offenses" below?

Yes

Been arrested for any reason?

Been engaged in, or been accused of any child molestation, exploitation, or abuse?

Been convicted of, or pleaded to no contest to, any crime?

Been convicted of any offense listed under "Offenses" below? (*see below or www.plymouthchristian.org Volunteer Application for list

Are you currently under indictment or arraignment for any offense listed under "Offenses" below?

Clear selection

If the answer to any of the above questions is “yes,” please explain in detail:

REFERENCES: First time applicants only:

1) First & Last Name/Relationship:

Reference # 1: Email

Reference # 1: Phone number

2) First & Last Name/Relationship:

Reference # 2: Email

Reference # 2: Phone number

SECTION 3:

Applicant Verification and Release

By Submitting this Application:

I hereby verify and release Plymouth Christian Academy as stated above:

Accept my typed name as my Electronic Signature: *

Guidelines for Volunteers

Submit

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