Team Member Application
Background Check Renewal
Name
*
First Name
Last Name
Name you go by, if different from the first name given above
Email
*
example@example.com
Cell Phone Number
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Marital Status
*
Single
Married
Divorced
Widowed
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I am renewing my background check in
*
West Ridge Kids
Students
Special Needs
Mission Trip
Hope for Christmas
Guest Services
Facilities
Staff Member / Elder
Adult Group Leader
Care / Prayer Team
Other
West Ridge Kids
Preschool (Birth - PreK)
Elementary (Kindergarten - 5th Grade)
SURGE
Student Ministry
Middle School
High School
RUSH
Special Needs
Weekly Sunday 1:1 Team Member
Weekly Sunday Out of the Box
Weekly Wednesday World Changers
Yearly Event (Night of the Stars)
3x a Year (Breakaway)
Guest Services
Medic / Safety Team
First Time Guest Team
Baptism Team
Facilities
Golf Cart Team
Other
Adult Group Leader
Married Group
Men's Group
Women's Group
Young Adult Group
Care
Care Group Leader
Prayer Team
Other
Mission Trip
*
Which trip are you going on and when?
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Personal Situations
1. Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor traffic violations)?
*
No
Yes
If you have been convicted of such an offense, please explain and include the nature of offense, date; court where conviction occurred, and any other relevant information.
*
2. 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?
*
No
Yes
3. Have you ever been reported to a social services agency, law enforcement authority, child abuse registry, or similar organization regarding committing any act of neglecting, abusing, molesting or battering any child or adult? Or have you had any kind of a relationship with a minor that has brought sexual gratification to yourself?
*
No
Yes
4. Have you ever been the subject of any disciplinary action, transfer, dismissal, resigned from a job, or been named as a defendant in a civil or criminal lawsuit, as a result of an accident or mishap involving children?
*
No
Yes
5. Have you ever been disciplined or dismissed from employment or a volunteer position by any employer, including charitable and religious organizations, following an allegation of sexual misconduct, sexual harassment, or other immoral or inappropriate behavior or conduct?
*
No
Yes
6. Do you have any investigation, review, or disciplinary action pending by an employer, organization in which you volunteered, licensing authority, or professional association for sexual misconduct, violence, or misconduct involving children?
*
No
Yes
7. Have you ever been diagnosed or treated for any mental illness
*
No
Yes
8. Has there been any abuse in your family background with drugs or alcohol or that was emotional, physical or sexual in nature?
*
No
Yes
10. Is there any circumstance or pattern in your life, which would make it inappropriate for you to serve with minors or would compromise the integrity of West Ridge Church?
*
No
Yes
If you answered Yes to any of the above questions, please explain.
*
Applicant Statement
The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work. I authorize the release of the information contained in this application, on a confidential, need to know basis, to any Ministry at West Ridge Church in which I seek a position (volunteer or compensated). In consideration of the receipt and evaluation of this application by West Ridge Church, I hereby release any individual, church, youth organization, charity, reference or any other person or organization, including record custodians, both collectively and individually, 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. To uphold the confidentiality of the references, I waive any right that I may have to inspect any information provided about me by any person or organization, but I may contact West Ridge Church to inquire about information provided about me.Should my application be accepted, I agree to refrain from unscriptural conduct in the performance of my services on behalf of the Church.Also, I hereby request and authorize the release of any information which pertains to any record of convictions contained in law enforcement files or in any criminal file maintained on me whether local, state or national. I hereby release local, state and national law enforcement agencies from any and all liability resulting from such disclosure.I understand that should any of this information change I will be responsible for notifying the church leadership. This type of information may include: criminal convictions or accusations, mental illness, or other information that could pose a safety risk to serving with kids or students. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.
I agree to the above statement and understand this is a legally binding agreement
*
Yes
No
Your Signature (Use your mouse or finger to sign your name)
Today's Date
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Month
-
Day
Year
Date
Almost Done
Once you click submit you will be taken to Protect My Ministries to complete the final portion of the process which is a background check authorization form. You will be asked for your basic information again. In addition, you will need to give your social security number. PLEASE NOTE: You must fill out this next form so that we can complete the process.
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