Application for Working With Children/Youth

Your name *

Email address *

NOTE!

This application does not have the ability to save your progress, so it will need to be completed in one sitting. A good amount of entry is involved. Most people will prefer to use a computer keyboard if possible. You will need to have available work, personal, and family reference names and contact information. Please be sure you have at least 15-30 minutes to complete it.

OVERVIEW

Thank you for your interest in serving with children and youth at New City Fellowship. Our Child Protection Plan requires a process with the following steps prior to serving.

1. You complete New City's application form (this form).
2. Clear background check. You will receive an email from Checkr.com with their data form and necessary permissions/releases.
3. You will have an interview with the Children's/Youth Ministry Team.
4. Your references will be checked.
5. You will be notified when all is completed/approved.

Once approved, additional reading/training may be required.

Which NCF leader or ministry has asked you to complete this form? *

PERSONAL CONTACT INFO

Phone number *

Address *

EMERGENCY CONTACT INFO

Name of emergency contact *

INTERVIEW QUESTIONS

These will be discussed in a personal interview.

How long have you been attending New City Fellowship? Are you a member? *

What motivates you to want to work with children/youth? *

Which age and gender of children/youth do you prefer to work with and why? *

What previous experience do you have (volunteer or paid) in working with children/youth? *

Do you have any significant medical, psychological, or emotional conditions that could affect your work? *

Have you ever been relieved of your work or asked not to work with children/youth? If yes, explain. *

What do you consider to be acceptable discipline? *

RELEASES

Checking the box for each of these required releases is the equivalent of initialing to indicate you have read and consent/agree.

Facilities use release *

I realize the use of the New City Fellowship's facilities may involve risks that neither I nor my child(ren) may be familiar, and that I assume this risk on behalf of myself and/or my child(ren).

General liability release *

I agree to save and hold harmless New City Fellowship, their employees, agents, officers, directors and representatives from any and all claims, liabilities, suits, actions, damages, or losses, including without limitation all costs and attorney's fees, and from and against its activities, any condition of its property or act, omission or negligence of New City Fellowship.

Medical care authorization *

I hereby authorize New City Fellowship, in the event of an incident requiring emergency medical attention, medical attention in my or my child(ren)'s behalf using the services selected by New City Fellowship to transport, hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery as required.

Background check consent *

I consent and acknowledge that a criminal background check will be conducted for me if I am over 18 years of age.

In connection with my application (and as a condition) for employment or to serve as a volunteer with New City Fellowship, I understand that a "consumer report" and/or "investigative consumer report", as defined by the Fair Credit Reporting Act, will be requested by NCF for employment or volunteer purposes, whichever is applicable, from Checkr.com, a consumer reporting agency as defined by the Fair Credit Reporting Act. These reports may include information as to my character, general reputation, personal characteristics or mode of living, whichever are applicable. They may involve interviews with sources such as my neighbors, friends or associates. The report may also contain information about me relating to my criminal history, credit history, driving and/or motor vehicle records, social security number verification, verification of education or employment history, worker's compensation (only after a conditional job offer) or other background checks. Such reports may be obtained at any time after receipt of this Disclosure and Authorization and if I am hired or serve as a volunteer, whichever is applicable, throughout the course of my employment or volunteer service, as permitted by law and unless revoked by me in writing. I understand that I have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by Checkr, Inc., One Montgomery Street, Suite 2400, San Francisco, CA 94104 | (844) 824-3257 | Help Center | Candidate Portal.

COMMITMENTS

Checking the box for each of these required releases is the equivalent of initialing to indicate you have read and consent/agree.

NCF Code of Conduct and safety policies *

I have been made aware of the NCF CODE OF CONDUCT and agree to abide by its standards, and I further agree to abide by all safety rules and signage adopted by the New City Fellowship.

Moral and ethical standards *

I understand that New City Fellowship expects high standards of moral and ethical treatment of the children. I agree to strictly adhere to these standards in my voluntary or employed capacity.

Child abuse *

I have never abused children (either sexual abuse, physical abuse, or emotional abuse) or been convicted or arrested for child abuse.

Zero tolerance policy *

I understand that New City Fellowship maintains a "zero tolerance" policy to child abuse, and that any volunteer or employee found in opposition to or violating this policy may be terminated immediately.

Training and education *

I commit to attending training and educational events provided by New City Fellowship to keep informed of all policies regarding child abuse.

Sexual purity *

I commit that will not show inappropriate pictures or videos, use inappropriate sexual or vulgar language, ouch children inappropriately, or participate in sexual horseplay with children.

Reporting abuse *

I commit to immediately report any behavior that seems suspicious, questionable, abusive or inappropriate between: child to child, adult to child, and adult to adult.

Confidentiality of reporting *

I understand that ALL reporting (by law) is kept confidential and will in no way harm my position with New City Fellowship unless false allegations are found to be made.

Legal penalties *

I understand that child sexual abuse is punishable by law and that New City Fellowship is bound by law to report allegations of sexual abuse to the proper authorities.

NOTE:

If you, or someone you know is struggling with a sexual attraction to children, please opt out of working with children and call “Hope for the Heart” (866) 570-4673

Have you ever been arrested or convicted, sued or summoned for a crime or municipal ordinance violation, other than a minor traffic offense? *

Have you ever been convicted of a crime or municipal ordinance violation in any federal, state, or municipal court? *

Have you ever pled guilty, been found guilty, and entered a Plea Nolo Contendere or an Alford plea of guilty for any offense involving a minor child? *

Have you ever been placed on probation, received a Suspended Execution of Sentence or Suspended Imposition of Sentence for any offense involving a minor child? *

Have you ever been placed on any local, state, or federal registry for sex offenders? *

Have you ever been sued in a civil court of law where the allegations in the suit involved illegal, inappropriate, or sexual conduct or contact with a minor child? *

Have you ever been disciplined or dismissed from any volunteer/employment position for any reason or following allegations of sexual misconduct, physical and/or verbal aggression, or other inappropriate behavior or conduct? *

Have you ever sought out or intentionally viewed child pornography? *

Do you have any disciplinary action or investigation pending by an employer, or organization, professional association, or licensing body, for violence, sexual misconduct, or misconduct involving a child? *

If you answered yes to any of the above questions, please explain.

Use as much space as needed.

Professional Reference

Current or former supervisor or coworker

Relationship *

Explain your acquaintance

Personal Reference

Pastor, friend, teacher, coach etc.

Relatiionship *

Explain your acquaintance

Family Member Reference

Mom, Dad, Aunt, Uncle, etc.

Relationship *

Explain your acquaintance

Person of the Opposite Sex Reference

Not a family member

Relationship *

Explain your acquaintance

RELEVANT WORK OR VOLUNTEER HISTORY

Please list your work or volunteer experience which supports working with children.

Name of Company/Organization *

Name of Supervisor *

Supervisor's Phone *

Your Last Job Title *

Start and Stop Dates *

Job Duties Performed/Skills Used or Learned *

Reason for Leaving *

Name of Company/Organization

Start and Stop Dates

Job Duties Performed/Skills Used or Learned

CONCLUDING AGREEMENTS

I understand that submission of an application does not guarantee employment or the opportunity to volunteer. I further understand that, should New City Fellowship extend an offer of employment or volunteering, such an opportunity is at will, for no specific duration and may be terminated by either our organization or myself at any time, with or without cause or notice. understand that none of the documents, policies, procedures, actions, statements of New City Fellowship or its representatives used during the application process is deemed a contract of employment, real or implied. In consideration for working with New City Fellowship, if I am granted the privilege of employment or volunteering, I agree to conform to the rules, regulations, policies, and procedures of New City Fellowship at all times and understand that such obedience is a condition of employment or volunteering. I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to New City Fellowship and or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information. I consent that any dispute between me and New City Fellowship will be governed by the substantive laws of the State of Tennessee, and any mediation or suit that might occur shall be filed in the Hamilton County court system. I represent that I have accurately, completely, and truthfully completed the information requested on this application. I acknowledge that I have read and understood the terms and conditions of the forgoing agreement and release and that i will comply with the same.

Employee/Volunteer Signature *

Typing your name is the equivalent of your legal signature for this application and the above Concluding Agreements.

Parent/Guardian Signature

Required if Volunteer/Employee applicant is a minor. Typing your name is the equivalent of your legal signature for this application and the above Concluding Agreements on behalf of the minor applicant.

Application for Working With Children/Youth

NOTE!

OVERVIEW

REFERRAL

PERSONAL CONTACT INFO

EMERGENCY CONTACT INFO

INTERVIEW QUESTIONS

RELEASES

COMMITMENTS

CRIMINAL RECORD

NOTE:

REFERENCES

Professional Reference

Personal Reference

Family Member Reference

Person of the Opposite Sex Reference

RELEVANT WORK OR VOLUNTEER HISTORY

Job/Position #1

Job/Position #2

CONCLUDING AGREEMENTS