Family Ministry Safety Application - CONFIDENTIAL

PERSONAL INFORMATION

Address *

Phone number *

Gender *

Birthdate *

Marital status *

I am currently CPR & FIRST AID certified. *

MINISTRY QUESTIONS

How long have you regularly attended LTCC? *

What ministries are you currently involved in at LTCC (if any)?

Our goal is to ensure that all people serving in family ministry are members at LTCC. If you are not a member, would you please explain what is preventing you from taking this step?

In what area would you prefer to work? *

Select all that apply

Nursery

Preschool-Kindergarten

Elementary

Middle School

High School

In what ways do you think God has gifted/enabled you to work with children and/or youth? *

Have you ever worked with children and/or youth other than in a church setting? *

This includes coaching, teaching, scouts, etc. Please indicate the organization's name, the position you held or are currently holding, and a contact person familiar with your work there.

REFERENCES

Please list TWO references of people - one family member and one friend - who have knowledge of your interactions with children/youth. *

Include name of reference, phone number, and how you know him/her

Please list a reference from the last church you attended regularly if you have been at LTCC for less than FOUR years.

Include church name, phone number, address, reference name, and area of ministry that you were involved in:

CHILD SAFETY

Because we care for children and desire to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy in every possible context.

It is the position of this church that suspicions or allegations of child abuse or neglect will be reported to relevant state authorities.

When you are unhappy, angry or emotional about a person or circumstance, what do you do? *

What is your philosophy concerning re-direction or discipline of children? *

Have you experienced any significant physical or emotional stressors within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis?

This question is optional

Have you ever physically or sexually abused a child? *

Have you ever been accused or convicted of physically or sexually abusing a child, or molesting a child? *

AGREEMENTS

If you have not already done so, please read the documents in Step 1 of this application process found here:
https://www.laketappscc.org/familyministrysafetyapplication

Have you read LTCC's Core Values and Statement of Faith, and do you agree with them? *

I have read and agree to perform to the best of my ability and with God's strength THE GENERAL STANDARDS OF MINISTRY listed below. *

I agree to allow LTCC to run a national background check on me through Checkr if mine is out of date or if I've never had one done before *

You will receive an email from Checkr to proceed with the background check (no personal information will be seen by LTCC - only that you've passed the check) and no information will be disclosed to you except what is required by law.

I authorize this church to contact all individuals, organizations and references listed on this Family Ministry Safety Application to verify the information I have provided. *

I agree to release from liability any person or organization providing information related to me, including those persons I have listed as references, as well as contact persons from my previous volunteer work or employment with children.

I certify and affirm that the information I have given on this form is true, complete and correct in all respects. *

THANK YOU SO MUCH FOR TAKING THE TIME TO FILL OUT THIS APPLICATION COMPLETELY

After reviewing your application, the Family Ministry Deacon will contact you to set up a personal interview.