This application is to be completed by all applicants for any volunteer position involving the supervision or custody of minors. This is not an employment application form.

General Information

Your Name*:

Address*:

City*:

Zip Code*:

Home Phone:

Work Phone:

Cell Phone:

Your Email*:

Date of Birth*:

Do you regularly attend our worship services?  Yes No

If yes, when did you start attending (approx. date)?

Church History and Prior Children’s Work

Previous church work involving children (list church name, city, state, and type of work
performed)

Previous non-church work involving children (list each organization name, city, state,
and type of work performed)

Are you currently serving in another church Ministry? If so, please list:

I have chosen to work with children at Resonate Atlanta because…

Have you personally and publicly professed Jesus Christ as your Lord and Savior and are you committed to striving to display the character of Jesus through your life?

 Yes No

References

List 3 adults you have known for at least 2 years, who are not related to you who have specific knowledge of your character and ability to work with children and who fit the classifications set forth below. Please provide us with the best way to contact your references.

Resonate Atlanta (or previous church) member or staff person:

Name*:

Nature of Association*:

Length of Time Known*:

Phone or Email*:

Social Friend or Neighbor

Name*:

Nature of Association*:

Length of Time Known*:

Phone or Email*:

Employer or fellow employee (if unemployed, a second social friend or neighbor)

Name*:

Nature of Association*:

Length of Time Known*:

Phone or Email*:

Personal Disclosure Information

Have you ever been treated for a psychiatric disorder?

 Yes No

Have you ever been molested or abused as a child or an adult?

 Yes No

If yes, have you sought counseling or treatment?

 Yes No

Would you like to seek counseling or treatment?

 Yes No

Have you ever been arrested, convicted, or plead guilty to a crime?

 Yes No

If you answered 'yes' to previous question, please explain:

Have you ever been accused, charged, or alleged to have, or have you ever committed any act of neglecting, abusing, or molesting any child?

 Yes No

If you answered 'yes' to previous question, please explain:

Have you ever been convicted of the possession, use, or sale of drugs within the last 7 years?
 Yes No

If you answered 'yes' to previous question, please explain:

Within the past 30 days have you abused alcohol, legal or illegal drugs?

 Yes No

Has your driver’s license been suspended or revoked within the last 12 months?

 Yes No

Is there any fact, circumstance, or pattern involving your background that would make it inappropriate for you to serve with minors or would compromise the integrity of the church?

 Yes No

If you answered 'yes' to previous question, please explain:

By clicking submit, you are agreeing to these terms:

The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, or organizations listed in this application to give you any information (including opinions) that they have regarding my character and suitability for children’s ministry. I authorize the release of the information contained in this application to any individuals who make decisions about placing applicants in available positions. In consideration of the receipt and evaluation of this application by Resonate Atlanta, I hereby release the church and any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

Should my application be accepted, I agree to uphold the vision and mission of Resonate Atlanta.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement that I have read and understand.