Youth Leader Application

The information provided in this application is the first step in the screening process for all adults working with youth. Our policy, A Safe Place for Kids, is in place to prevent the abuse of children and youth in any form, and to create a healthy environment for kids and families. All information gathered in the screening process will be kept strictly confidential within the legal requirements of the church.

Today's Date

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Full Name

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Email

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This address will receive a confirmation email

Cell Phone

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Home Phone

Address

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Have you ever used another name? If so, please list the name(s), and the dates and places where these names were used.

Name Used (if not applicable type N/A)

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Date Used (if not applicable type N/A)

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Reason Used (if not applicable type N/A)

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Are you a US citizen?

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Please select one option.

Yes No

If your answer is "no," please provide your alien registration number (if not applicable type N/A)

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Do you have a current, valid driver's license?

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Please select one option.

Yes No

If your answer is"yes," please provide your driver's license number (if not applicable type N/A)

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Are you a Partner of WellSpring?

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Please select one option.

Yes No

When did you begin coming to WellSpring?

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Please list all previous work involving children and/or youth (include name of organization, location and type of work) (if not applicable type N/A)

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If you prefer, you may discuss your answer to any of the following questions with the Lead Pastor, or a trained team leader, rather than answering it on the form. Answering yes, or leaving a question unanswered, will not automatically disqualify an applicant. As a representative for the International Church of the Foursquare Gospel, we are legally required to ask these questions.

Do you have any physical, mental, or emotional handicaps or conditions that would prevent you from performing certain types of activities related to working with Youth? (if not applicable type N/A)

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Have you ever been accused of child abuse or a crime involving actual or attempted sexual molestation of a minor?

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Please select one option.

Yes No

If your answer is yes, please explain (if not applicable type N/A)

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Were you a victim of abuse or molestation while a minor?

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Please select one option.

Yes No

Have you ever been held liable by a court in any suit based on fraud, misrepresentation, failure to discharge the duties of any office, or violation of state regulatory law?

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Please select one option.

Yes No

If your answer is yes, please explain (if not applicable type N/A)

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Have you ever been convicted by any court of a felony?

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Please select one option.

Yes No

If your answer is yes, please explain (if not applicable type N/A)

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Have you ever been convicted by any court of a misdemeanor?

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Please select one option.

Yes No

If your answer is yes, please explain (if not applicable type N/A)

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Have you been arrested for an offense for which trial is pending?

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Please select one option.

Yes No

If your answer is yes, please explain (if not applicable type N/A)

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Release for reference and background check The information contained in this application is correct to the best of my knowledge. I authorize any personal references or churches, whether or not identified in this application, to give you information regarding my character and fitness for working with Youth. In addition, I understand that for the protection of the children and Youth of WellSpring, a Live Scan will be obtained and submitted to the FBI and Department of Justice and this information shall be confidential. Should my application be accepted, I agree to be bound by the bylaws and policies of the International Church of the Foursquare Gospel and of WellSpring Christian Fellowship, and to refrain from unscriptural or inappropriate conduct in the performance of my services on behalf of the church.

Applicant's Signature (Complete in person) _______________________________________

Date ___________________

For office use:

Reviewed by Lead Pastor ___________________________________________________

Date ___________________

Reviewed by Department Lead _______________________________________________

Date ___________________

Description

The information provided in this application is the first step in the screening process for all adults working with youth. Our policy, A Safe Place for Kids, is in place to prevent the abuse of children and youth in any form, and to create a healthy environment for kids and families. All information gathered in the screening process will be kept strictly confidential within the legal requirements of the church.

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