CrossPointe Church 
Volunteer application to work with minors.
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Name
Address
Phone Number
Driver's License Number
Date of Birth
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Sex
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Marital Status
How long have you lived at your current address?
Previous Address
List all other cities and states where you have lived as an adult:
Please list all previous volunteer work or employment involving children or students (List each organization’s name and address, type of work, dates, and a contact person familiar with your work there.
List any talents, vocations, preparation, training or other experiences that have equipped you to work with children or students:
Because we care for children and desire to protect them, please answer the following questions.  We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy in every possible context. It is the position of CrossPointe Winter Park that suspicions or allegations of child abuse or neglect will be reported to relevant state authorities.
Why do you want to work with children or students at CrossPointe Winter Park?
Do you have a preference concerning the age group or sex of children or students with whom you would like to work?  If so, what is the basis for this preference?
What is your philosophy concerning re-direction or discipline of children?
When you are unhappy, angry or emotional about a person or circumstance, what do you do?
Have you ever physically or sexually abused a child?
Clear selection
Has someone ever accused you of physically or sexually abusing a child, or molesting a child?
Clear selection
References
Each applicant must submit the names and phone numbers of at least one professional reference, one personal reference and one family member.  Additional professional references may be submitted if deemed helpful by applicant in allowing CrossPointe Winter Park to determine applicant’s fitness for volunteer position and qualifications.  The professional references should be familiar with the quality of the individual’s work.  One of these references should be a person of the opposite sex.

Name
Phone Number
E-mail Address
Address
Name
Phone Number
E-mail Address
Address
Name
Phone Number
E-mail Address
Address
I authorize CrossPointe to contact all individuals, organizations and references listed on this Safety Application Form in order to verify the information I have provided. I agree to release from liability any person or organization providing information related to me, including those persons I have listed as references, as well as contact persons from my previous volunteer work or employment with children. I specifically authorize CrossPointe to undertake a criminal background check concerning my past.I understand and agree that any information received from the background check and application verification will not be disclosed to me except as required by law, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form. By signing this form, I certify and affirm that the information I have given on this form is true, complete and correct in all respects.
Electronic Signature
Date
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