Dakota Conference

Sharing the unchanging love of Jesus in a changing world.

Staff/Volunteer Application Form

The Dakota Conference of Seventh-day Adventists,

its churches, schools and camps, is committed to diligently protecting the children in our care. It is because of this commitment that we require permission to conduct a check on each potential employee and volunteer.

I am applying for a position as

Paid full-time staff Paid part-time staff Volunteer

Please check all that apply Adventurers/Eager Beavers/Little Lambs Camp Campmeeting Children's Ministries/Sabbath School Education/Schools Pathfinders Vacation Bible School

Other

Personal Information

Name

Address

Work or Cell Phone

Email Address

Are you a member of the Seventh-day Adventist Church?

Yes No

Years/Months

The name of the church you currently attend

If less than five years, please list name of previous church, city and state.

Do you have any injury/sickness that might limit your involvement in Children's Ministries activities?

Yes No

If yes, please explain

Education/Training Information

Formal education

Informal education

Certification(s) held

Experience

List all experience (VBS, SS, etc) that might qualify you to work with children.

Position/type of work; Church/Organization; Date

List all skills, hobbies or interests you have in which you would be willing to help or teach.

Information provided

on this form will be kept in the strictest of confidence. Forms retained for permanent record will be kept in a secure location.

References

List below three individuals (other than family members) who could recommend you for service in Children's Ministries.

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

Unlawful Conduct

Have you ever pled guilty, no contest, been accused of, charged, convicted or are you currently under investigation for any unlawful sexual conduct, child abuse and/or child sexual abuse?

Yes No

If yes, please explain by listing type of conduct, date(s), place(s) and circumstances of the accusation

Have you ever been convicted of any other type of criminal offense? (Answering in the affirmative does not necessarily disqualify you from working with children.) Yes No

If you answered yes

to either of the above, please give the name and address of a reference/professional who can verify your suitability to work with children.

Name

Address

Phone

Applicant's signature is required

Date

Note

Please be sure to answer every question and signed your name above. Approved status is ongoing unless concerns that demand investigation become evident in the course of service. To protect your privacy only the front of this form will be returned to the church organization. The original form will be kept in a secure location at the Dakota Conference office.