Church Safety Ministry (CSM) Application - Anaheim

Thank you for showing interest in volunteering in the Church Safety Ministry (CSM) and taking on the mission of protecting the children, adults and property at our church. Your willingness to serve is a true blessing, and we believe that God has brought you here for a purpose. All information will be kept confidential from this form.

If you have any questions, please email CSM Ministry Lead Pat Kim at phkim1@yahoo.com

Your name *

Email address *

Address *

Phone number *

Gender *

Marital status *

What is your current Occupation? *

CHURCH INVOLVEMENT

Why do you want to join Church Safety Ministry at the Church of Southland? *

How long have you been attending the Church of Southland? *

Please check all that apply: *

I have been to an Encounter Retreat at the Church of Southland.

I have taken Experiencing God Discipleship at the Church of Southland.

I do attend a Cell Group regularly at the Church of Southland.

Have you previously served in any ministries or volunteer roles in this or another church? *

BACKGROUND AND CONSENT

Have you ever been convicted of a crime? If yes, please explain: *

Do you use or have you ever used illegal drugs? If yes, please explain: *

Have you ever been hospitalized or treated for alcohol or substance abuse? *

Are there any circumstances involving your lifestyle or your background that would call into question your ability to perform duties in the Church Safety Ministry or in close proximation to children? *

Would you have any objections to undergo LiveScan electronic fingerprinting? *

REFERENCES

Please provide the names of two individuals (not relatives) who have known you for five years or more, who can provide a reference for you. If possible, please include at least one reference from someone in this church-cell leader, ministry leader, elder, pastor. All people listed as references should be informed that you have listed them.

Do you consent to the church contacting your references and conducting any necessary background checks? *

REFERENCE#1 NAME

REFERENCE#1 RELATIONSHIP

REFERENCE#1 EMAIL

REFERENCE#1 CONTACT PHONE NUMBER

REFERENCE#2 NAME

REFERENCE#2 RELATIONSHIP

REFERENCE#2 EMAIL

REFERENCE#2 CONTACT PHONE NUMBER

Declaration

I declare that the information provided in this application is true and complete to the best of my knowledge. I understand that submitting this form does not guarantee a volunteer position and that further steps, such as an interview or training, may be required.

Signature *

(Your Signature)

Date *

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