ADULT Plan to Protect Application (ages 18+)

Volunteer Application Form

Name

Birthdate

Gender

Male Female

Address

Phone

This address will receive a confirmation email

Volunteer area of interest

KidZone Nursery KidZone Preschool KidZone Elementary KidZone Host team ISC Youth Day Camp

Current Occupation and Employer

Hobbies, skills, talents, interests

Spiritual History

How long have you attended UDAC (Years/Months)?

Do you regularly attend 2 or more services a month?

Yes No

Are you a member?

Yes No Interested

Have you been baptized as a believer?

Yes No Interested

When did you accept Jesus Christ as your Savior?

In a brief paragraph, please outline your spiritual journey.

What strengths would you bring to the ministry program?

References

Please provide the names of three individuals, excluding relatives, who could provide a reference for you. Include at least one reference from outside the church.

1. Name

Phone

City/Province

Nature of relationship

How long have you known this person?

2. Name

Phone

City/Province

Nature of relationship

How long have you known this person?

3. Name

Phone

City/Province

Nature of relationship

How long have you known this person?

Ministry History

Please list any other churches you have attended in the last 5 years and any previous ministry experience you may have had there

1. Name of church, City, Province:

Dates attended:

Adherant Member

Ministry experience at that church:

Ministry supervisor:

2. Name of church, City, Province:

Dates attended:

Member Adherant

Ministry experience at that church:

Ministry supervisor:

Declarations

In order to provide a safe and secure environment for our children and youth, we believe it is necessary to include the following questions as part of our application process. All information will be kept confidential by church leadership and the Plan to Protect team. Police may access this information, under warrant, if requested. Answering yes to any of the questions may not necessarily preclude your involvement in ministry. Thank you in advance for your understanding.

1. Are there any circumstances involving your lifestyle or background that would call into question your ability to work with children or youth? (e.g. pornography, use of illegal substances, etc.)

Yes No

2. Have you ever been accused of impropriety with children and youth?

Yes No

3. Have you ever been convicted for the use or sale of illegal drugs?

Yes No

4. Have you ever been through treatment for alcohol or substance abuse?

Yes No

5. Have you ever been convicted of a criminal offense (excluding minor traffic violations)?

Yes No

6. Have you ever been arrested or convicted for any abuse related crimes?

Yes No

7. Have you been investigated by the Child Welfare Agency for suspected child abuse?

Yes No

8. Have you ever been the subject of a civil lawsuit involving sexual harassment or other immoral behaviour or conduct involving children, youth or adults?

Yes No

9. Have you ever been the subject of any disciplinary action, transfer or dismissal, or been named as a defendant in a civil or criminal lawsuit as a result of an accident or mishap involving children or youth?

Yes No

10. Have you ever been subjected to expulsion, reprimand, or other discipline by a church, denomination or other religious organization?

Yes No

11. Have you ever been the subject of any disciplinary action (including discharge) or investigation by a church, religious or other organization, or by an employer?

Yes No

12. Do you have any health concerns of which we should be aware (e.g. medical, physical, psychiatric)?

Yes No

If you have answered yes to any of the above questions, please explain.

Release of Information and Declaration of Intent

I hereby give University Drive Alliance Church consent to verify the information provided herein and to contact the references listed. I waive any right to confidentiality and any right to pursue damages against the church caused by the reference’s response.

I agree to adhere to the protection policies as adopted by this church.

I further grant the church permission to perform an internet search on me and to review and consider any information found by me on the internet.

I understand that if my character or morals are deemed by church leadership to be inappropriate and/or criminal at any time during my volunteer service, University Drive Alliance Church will be entitled to terminate my assistance without expressed cause or prior notice regardless of any other oral or written statement by University Drive Alliance Church prior to, at, or following the date of volunteer service.

I understand that University Drive Alliance Church is responsible for the welfare of any person or persons entrusted to my care. I will cooperate fully with the staff in the fulfillment of my duties and will keep all information I encounter, in my role as a volunteer, confidential.

If at any time I, or my supervisors, find that for any reason I am unable to support, or am in conflict with, any of the policies, procedures or doctrine of University Drive Alliance Church, and are unable to resolve the issue, I will gracefully and quietly resign my volunteer position.

By typing my name below, I hereby acknowledge that, to the best of my knowledge, that the information contained in this application for volunteer ministry is true and correct and I agree with the release of information and declaration of intent.

UDAC Statement of Faith
https://www.udac.ca/statement-of-faith

Applicant signature

Signed on:

ADULT Plan to Protect Application (ages 18+)

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