Legal Name*
Name by which you prefer to be called*
Street Address including apartment number*
City, State and Zip Code*
Phone*
Email*
Previous Addresses for past 5 years
To keep you informed of what is going on in CEF Silicon Valley ministry, we email a newsletter and prayer letter once per month. Do you wish to receive these updates?* YesNo. You will still receive emails directly related to your volunteer activities and requirements.
Have you ever been convicted of a crime?* YesNo
If yes, please explain and give county and state where you were convicted of the crime.
Have you ever been accused of child abuse?* YesNo
If yes, please explain.
Please explain briefly your salvation experience.*
List any experience that has prepared you for children’s ministry.*
Please list three references. Provide name, phone number and email.
My pastor.*
Previous Employer.
Adult non-relative.
Release Authorization
In connection with my future involvement as a volunteer or staff member working with children, I understand that CEF will conduct a background check to determine my ability to minister in this role. It may include information concerning my character, work habits, performance and any court records that may have a bearing on my job responsibilities. I acknowledge that a photocopy shall be as valid as the original.
I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, church or non-profit organization, reference, or insurance company contacted by CEF or its agents to furnish the information described above.
I understand that if any of those records contains information which is used to deny my employment in Child Evangelism Fellowship, I will be notified of my rights and where I can obtain a copy of the information.
By signing below, you hereby release Child Evangelism Fellowship and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any liability or damages of whatever kind, which may at any time result to you, your heirs, family or associates because of compliance with this authorization and request to release information. You may be contacted as indicated below. A copy of this authorization (if not previously destroyed in accordance with record retention policies) will be provided to you, provided you request it in writing.
The information contained in this screening form is correct to the best of my knowledge. I authorize any references listed on this form to give you any information (including opinions) they may have regarding my character and fitness for children’s work. I hereby release any individual, church, youth organization, employer, charity, reference, or any other person or organization, both individually and collectively, from any and all liability for damages of whatever kind or nature, which may at any time result to me, my heirs or my family because of compliance with this authorization, excepting only the communication of knowingly false information.
As a volunteer or paid worker for Child Evangelism Fellowship Inc. I agree to abide by the Child Protection Policy and to refrain from unscriptural conduct in the performance of my services on its behalf.
I further state that I have read carefully the foregoing release and know the contents thereof. This is a legally binding agreement which I have read and understand.
Type your full legal name, which counts as your signature*
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