Riverside Children/Youth Worker Application and Agreement

Personal Information

Name

Birthday (m/d/y)

Best Phone

Other Phone

Address

Current Employer

Current Position

Employer Phone

References

Please give two (2) references with whom you have had sufficient contact over the past five (5) years. Please do not use Riverside Staff or a relative. If you are under the age of 18, please keep in mind you must use adult references.

Reference #1

Name

Relationship to you

Best Phone

Other Phone

Reference #2

Name

Relationship to you

Best Phone

Other Phone

Church and Faith History

How long have you been a part of Riverside?

Are you a Riverside Member?

Yes No

Describe your personal faith in Jesus Christ.

What Riverside Ministries have you served in and which Riverside Ministry do you now desire to work in and why?

Personal Background

Have you ever been treated for a psychiatric disorder?

Yes No

Have you ever been arrested, convicted or pleaded guilty to a crime?

Yes No

Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing or molesting any child?

Yes No

Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography or any other addiction, or has anyone ever suggested that you may have a problem with any of the above?

Yes No

Have you been convicted of the possession, use, or sale of drugs?

Yes No

Within the past 30 days have you abused alcohol, legal or illegal drugs?

Yes No

Has your driver’s license been suspended or revoked within the last twelve months?

Yes No

Is there any fact, circumstance, or pattern involving your background that would make it inappropriate for you to serve with minors or would compromise the integrity of the church?

Yes No

If yes to any of the above, please explain.

Applicant's Statement

The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to release information they may have regarding my character and fitness to work with children and/or youth, and I release all such references from liability for any damage that may result from furnishing such evaluations.
The health, safety and well-being of all children and youth are a top priority for our church. With this emphasis in mind, I understand that Riverside Covenant Church will ask me to consent to a background check every 5 years in accord with Riverside's Child Protection Policy.
I agree to abide by Riverside's Child Protection Policy at all times.

I Agree to the Applicant's Statement

Yes No

Declaration of Moral Integrity

Riverside Covenant Church expects all of its employees and volunteers that work with children and youth to model the same Christian values and lifestyle that its seeks to instill in its young people. As a potential employee or volunteer of Riverside Covenant Church, I recognize, understand, and agree to live by Christian moral standards as presented in Scripture and developed through our denomination the Evangelical Covenant Church. In addition I agree to adhere to federal and/or state law.

I agree to the Declaration of Moral Integrity

Yes No

By typing my name in this box I am electronically signing my application.

Riverside Children/Youth Worker Application and Agreement

Description

Please Fix the Following