If under 18, please give parent's name and email address:
*For which ministry are you applying?:
*What age group do you want to serve and why?:
SECTION TWO: CHURCH HISTORY INFORMATION
*Do you have a personal relationship with Jesus Christ? :
*Briefly state your testimony, including when you became a Christian:
*Are you a participating member of Hebron Baptist Church? :
*Are you a member of a Connect Group or Small Group at Hebron Baptist Church? :
*List names and addresses of other churches you have attended in the past ten years.
*List all previous church and non-church work involving minors. List each church/organization’s name, address, type of work and dates.
SECTION THREE: SAFETY INFORMATION
*Bearing in mind that your proposed service may involve access to minor children, students and/or vulnerable adults, is there anything in your personal history or experience that indicates that you have any problem whatsoever involving sexual attraction to children or any related tendencies that could pose a risk of harm to any children you may encounter during your service? (If yes, please explain.)
*Have you ever been the subject of a complaint of child abuse or any other type of mistreatment of children? (If yes, please explain.)
*Certain types of behavior may reflect negatively on your fitness to serve in this ministry. Have you ever been charged with or convicted of any crime or misdemeanor involving (1) a minor child, (2) stalking or harassment, (3) sex or lewd behavior (e.g. rape, sexual assault, prostitution, public indecency) or (4) violence against another person? (If yes, please explain.)
*Have you ever been convicted of or plead guilty to a crime other than a minor traffic violation or are there any charges currently pending against you? (If yes, please explain.)
*Have you ever been addicted or concerned that you were addicted to drugs, alcohol, pornography, or any other harmful addictions; or has anyone ever suggested that you may have a problem with any of the above? (If yes, please explain.)
*Is there any reason, including those that are physical or mental health related, that might keep you from effectively working with children/youth or that may cause a child potential harm? (If yes, please explain.)
*Please list any gifts, callings, training, education or other factors that have prepared you to volunteer in your area of choice.
*List all traffic violations/automobile accidents within the past 3 years.
*Have you been convicted of driving under the influence of drugs or alcohol anytime within the past 7 years? (If yes, please explain.)
*Have you ever been charged with, indicted for, or pled guilty to a crime, including traffic violations? (If yes, when and where?)
SECTION FOUR: REFERENCE INFORMATION
Please submit references that are familiar with your character and deemed helpful in determining your fitness to volunteer for the position you are requesting. Please notify your references that we will be contacting them on your behalf. References must have known you a minimum of one year, be over the age of 18, and be non-family members. You may use Hebron Staff as references.
SECTION FIVE: CHILD PROTECTION POLICIES, STATEMENT OF FAITH AND RELEASE STATEMENTS
*In consideration of the receipt and evaluation of this application by HEBRON BAPTIST CHURCH, I agree and represent that the information contained in this form is correct to the best of my knowledge. I authorize HEBRON BAPTIST CHURCH and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, driver record, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications as a volunteer now and, during my tenure as a volunteer with HEBRON BAPTIST CHURCH.
*I authorize any references, or any other person or organization, whether or not identified in this application, to give you any information (including opinions) regarding my character and fitness for volunteer service. I hereby release any individual, church, denominational agency or official, reference, or any other person or organization, including record custodians, both collectively and individually, and whether or not identified in this application, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization, excepting only the communication of knowingly false information. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT.
*This is a legally binding release which I have read and understand. I understand that I may consult with an attorney before signing this document. A facsimile or photocopy of this authorization shall be as valid as the original.
*I understand that the Child Protection Policies of Hebron Baptist Church provide guidelines and summary information about providing a safe environment for our children and youth. I also understand that it is my responsibility to read, understand and become familiar with the policies. I further understand that the church leadership reserves the right to modify, supplement, rescind or revise any of the policies and forms from time to time, with or without notice, as they feel necessary and appropriate as so lead by the Lord. When and if such Policy updates are provided to me, I understand that it is my responsibility to read such updates, place updated material in the proper location of the Policies and disregard the outdated material.
*I understand that as of July 1, 2012, all volunteers and employees are required by law to report suspected child abuse to the appropriate authorities when there is reasonable cause to believe that a child has been abused. An oral report should be made immediately, but in no case later than 24 hours from the time there is reasonable cause to believe a child has been abused, by telephone or otherwise and followed by a report in writing, if requested, to a child welfare agency providing protective services, as designated by the Department of Human Services, or, in the absence of such agency, to an appropriate police authority or district attorney.
*I understand that anyone suspecting an incident of abuse is required to immediately contact the ministry Leader of the department they serve in.
Statement of Faith (read and acknowledge):
We believe there is one God: The Father, the Son, and the Holy Spirit, who subsist in unity and also as three separate distinct Persons.
Jesus Christ Is God’s Son We believe Jesus Christ is God's Son. He was born of a virgin as both God and man, lived a sinless life, died to atone for the sins of human beings, was buried, arose from the grave, ascended into heaven and will literally return to earth.
The Holy Spirit
We believe the Holy Spirit is the divine helper, assistant, counselor and instructor and His work is to reveal Christ, to convict of sin, to lead to repentance, to guide believers, to comfort, to strengthen, and to sanctify the soul.
We believe the Bible is God’s Holy Word, without error and is the sole authority for life.
Man’s Need for God
We believe human beings are the special creations of God, made in His image. They fell through the sin of the first man, Adam, and all human beings are sinners in need of salvation.
We believe salvation is a gift through repentance toward God and faith in Jesus Christ. Every person who is truly saved is eternally secure in the Lord Jesus Christ and will spend eternity in heaven, while those who die in their sins will spend eternity in hell.
We believe baptism is by immersion after salvation and is done in obedience to Jesus Christ’s command.
Believer’s Access to God
We believe each believer has direct access to God through the Lord Jesus Christ.
We believe the Church is a local body of baptized believers with the Lord Jesus Christ as the Head.
Marriage and Sexuality
We believe that term “marriage” has only one meaning and that is marriage sanctioned by God which joins one man and one woman in a single, exclusive union, as delineated in Scripture. We believe that God intends sexual intimacy to only occur between a man and a woman who are married to each other. We believe that God has commanded that no intimate sexual activity be engaged in outside of a marriage between a man and a woman.
We believe that any form of sexual immorality, such as adultery, fornication, homosexuality, bisexual conduct, bestiality, incest, pornography or any attempt to change one’s sex, or disagreement with one’s biological sex, is sinful and offensive to God.
We believe that in order to preserve the function and integrity of the church as the local Body of Christ, and to provide a biblical role model to the church members and the community, it is imperative that all persons employed by the church in any capacity, or who serve as volunteers, should abide by and agree to this Statement on Marriage and Sexuality and conduct themselves accordingly.
We believe that God offers redemption and restoration to all who confess and forsake their sin, seeking His mercy and forgiveness through Jesus Christ.
We believe that every person must be afforded compassion, love, kindness, respect and dignity. Hateful and harassing behavior or attitudes directed toward any individual are to be repudiated and are not in accord with scripture nor the doctrines of the church.
*Please read and sign the following Agreement Statement: I agree with, adhere to and practice the beliefs of the preceding Statement of Faith. I understand that if at anytime while I am in a leadership position at Hebron Baptist Church I cease to agree with, adhere to and practice the beliefs of this Statement of Faith, I may be asked to resign from my leadership position. I authorize Hebron Baptist to contact all individuals, organizations and references listed on this application in order to verify the information I have provided. I agree to release from liability any person or organization that provides 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. By signing this form below, I certify and affirm that the information I have given on this form is true, complete and correct in all respects.
SECTION SIX: DISCLOSURE AND AUTHORIZATION
*As evidence of my support for the child protection policy of Hebron Baptist Church, my strong desire to help Hebron Baptist Church protect all children involved in its operations and ministry, and my desire to uphold the integrity and witness of Hebron Baptist Church, I hereby authorize Hebron Baptist Church and its designated agents and representatives (including Protect My Ministry) to conduct a comprehensive review of my background. This will include Hebron Baptist Church to request that I complete a Background Application that will cause a consumer report and/or an investigative consumer report to be generated for volunteer purposes. I understand that my ability to serve as a volunteer with Hebron Baptist Church is contingent upon me passing a background check into my criminal background history.
*I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, employment credit history, education background, character references; civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.
*I hereby release the Hebron Baptist Church and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.
*The information contained in this application is correct to the best of my knowledge. I understand and agree that false statements regarding past conduct and/or present situations may be grounds for termination of any volunteer position now or in the future, and failure to reveal the contents of a sealed criminal record will result in the automatic denial of the application and opportunity to serve as a volunteer.
*I understand that I have the right, upon written request made within a reasonable amount time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to Protect My Ministry, LLC., 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618 or 1-800-319-5581. For information about Protect My Ministry’s privacy practices, see www.protectmyministry.com
*By selecting "I Agree" on the previous statements and entering my full name, I recognize that this is equivalent to my legal signature.