9800 SE 92nd Avenue • Happy Valley • OR • 97086 • (503) 788-7000
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ONLINE MINISTRY VOLUNTEER APPLICATION
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Indicates required field
Today's Date (MM/DD/YYYY)
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personal Information
First Name
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Middle Name
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Last Name
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Other names you have gone by (i.e. maiden, alias, legal name changes, etc.). If not applicable mark NA
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Please list any and all names you have used in the past, including before, during and after marriage, names used for protection, or any legal name changes,
OR Drivers License
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Yes
No
OR Driver's License Number (for Background Check. Put N/A for out-of-state or no license)
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Choose One
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Male
Female
Date of Birth (MM/DD/YYYY)
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Age
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Your Email
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Home Phone
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Cell Phone
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Work Phone
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Present Mailing Address
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Line 1
Line 2
City
State
Zip Code
Country
How long at the above present address?
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01 - Previous Addresses in the past 5 years:
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Line 1
Line 2
City
State
Zip Code
Country
02 - Previous Addresses in the past 5 years:
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Line 1
Line 2
City
State
Zip Code
Country
volunteer positions where you wish to serve
Area(s) interested in serving:
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other volunteer experience
Organization
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Position or Event
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Dates (year)
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Contact Phone Number
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Organization
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Position or Event
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Dates (Year)
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Contact Phone Number
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Organization
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Position or Event
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Dates (Year)
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Contact Phone Number
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Church Activity
How long have you been regularly involved at BSLC?
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Less than 6 months
6 months or more
Are you a BSLC Member?
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Yes
No
If yes, how long?
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What church or churches have you attended in the past five years?
Church Name
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Area(s) of Service
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Dates (year 0000 - 0000)
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Contact Phone Number
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Church Name
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Area(s) of Service
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Dates (year 0000 - 0000)
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Contact Phone Number
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Church Name
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Area(s) of Service
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Dates (year 0000 -0000)
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Contact Phone Number
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Criminal History Disclosure
Have you at any time ever (check any that apply):
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Been convicted of or pleaded guilty or no contest to a criminal offense of any kind?
Participated in, or been accused, convicted or pleaded guilty or no contest to abuse or any sexual misconduct?
Been arrested for any reason?
Been asked to leave a church or a ministry for any reason?
None of the above.
Are you aware of (check either that apply):
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Having any traits or tendencies that could pose any threat to children, youth, disabled adults or others?
Any reason why you should not work with children, youth, or others.
No
If you have checked any of these items (except None or No) to the left, please explain in detail:
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Reference Information
Please provide name and emails of two references that are NOT related to you.
Reference 1
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First
Last
Reference 2
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First
Last
Reference 1 Email
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Reference 2 Email
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Child protection affirmation
Please read the Child Protection Policy (button at bottom) and then affirm that you understand and will follow each part of the policy with your initials.
(If you will not be working directly with children, please
still
initial that you understand our policy and agree with it.)
1. We will have a minimum of two approved adults (one must be over 21) at all functions for children, youth or disabled adults. The maximum ratio of child to adult is 10:1.
Initial Here
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2. Children in 4th grade and below must only be released to a parent or guardian.
Initial Here
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3. Public access bathrooms for 4th grade and below will utilize an approved adult as a monitor. If assistance is required, an approved adult will lead the child to the nursery where other approved adults are also present.
Initial Here
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4. We never physically discipline anyone. Restraint is only used when harm or damage would occur. Abusive speech is never acceptable.
Initial Here
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5. We avoid any appearance of impropriety – such as sitting older children on laps, kissing, back rubs, full hugs, etc. Never touch a person’s private area except when necessary, as in the case of changing a diaper.
Initial Here
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6. One on one meetings are always in public places with the full approval and knowledge of parents prior to the meeting.
Initial Here
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7. We immediately report suspected or known abuse to the state authorities and our ministry supervisor. This includes behavior that just doesn’t feel right. If you are unsure, ask. If we see abuse, we intervene to stop it. We don’t talk to others in the church or in the community about these details so that investigations are not compromised.
Initial Here
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8. We report any violations of this policy to our ministry supervisor as soon as possible.
Initial Here
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9. I have read, agree to, and will abide by the BSLC Child Protection Policy.
Initial Here
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Authorization and Release
I recognize that Beautiful Savior Lutheran Church, to which this application is being submitted, is relying on the accuracy of the information contained herein. I attest and affirm that all of the information that I have provided is absolutely true, correct and complete.
I authorize Beautiful Savior Lutheran Church to contact any person or entity listed in this application, and I further authorize any such person or entity to provide Beautiful Savior Lutheran Church with information, opinions, and impressions relating to my background or qualifications.
I voluntarily release Beautiful Savior Lutheran Church and any such person or entity listed herein from liability involving the communication of information relating to my background or qualifications. I further authorize Beautiful Savior Lutheran Church to conduct a criminal background investigation.
I have received a copy of the church’s Sexual Misconduct Prevention Policy. I understand that it provides policies and procedures for the prevention of sexual misconduct within BSLC ministry programs. I understand that these policies and procedures apply both on and offsite for any and all ministry programs, activities and/or events sponsored by or connected with Beautiful Savior Lutheran Church. I have read and will comply with the policy and standards that have been established.
E-Signature (Full name & DOB)
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Parent/guardian E-Signature (Full name & DOB) if applicant is a minor:
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If you do not see the below message after you click the SUBMIT button, there is at least one field that has been left blank. As you scroll up, you will see which field(s) need to be filled in as the box(es) will be outlined in red. You MUST see this message or your application has not yet been submitted.
Submit Volunteer Application
link to ministry protection policy
