Please enable JavaScript in your browser to complete this form. - Step 1 of 4Applicant InformationThis application should be completed by all applicants for any position (volunteer or employment) involving the supervision of children or students. The purpose of this form is to assist in the creation of a safe environment for children or students who participate in the programs of Graham Church or use Graham Church facilities. Some of this information is quite personal, and we are committed to protecting your confidentiality.NameFirstLastEmailPhoneOkay to text this phone numberYesNoDate of BirthMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow long have you lived at your current address?Marital StatusPrevious AddressList all other cities and states where you have lived as an adultPlease list all previous volunteer work or employment involving children or students (List each organization's name and address, type of work, dates, and a contact person familiar with your work there.)NextTestimony of Personal Faith in Jesus ChristWriting your story of personal faith in Jesus Christ helps us to get to know you and your relationship to God. Utilize this outline below to help tell your story.Briefly tell how, when, and why you trusted Jesus Christ as our SaviorDescribe as best as possible about surrendering your life to Christ. What was happening at the time? How did Christ get your attention? If possible, share the month and year you were saved.Give one or two ways Christ has changed your lifeBe practical. Share how you are growing in your walk with ChristNextList any talents, vocations, preparation, training or other experiences that have equipped you to work with children or students.Why do you want to work with children or students at Graham Church?Do you have a preference concerning the age group or sex of children or students with whom you would like to work with? If so, what is the basis for this preference?NextHave you ever been accused of, participated in, plead guilty to, or been convicted of child abuse, child neglect, or any other crime against a minor?YesNoI would like to discuss If you suffered in any way related to physical, emotional, or spiritual abuse we want to help. Counseling and resources (available through Graham Church) are available to address any emotional or spiritual harm or damage. I would be interested in talking with a counselor or pastor I authorize Graham Church to contact all individuals, organizations and references listed on this Child Safety Application in order 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 specifically authorize Graham Church to undertake a criminal background check concerning my past. I understand and agree that any information received from the background check and application verification will not be disclosed to me except as required by law, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form. By signing this form, I certify and affirm that the information I have given on this form is true, complete and correct in all respects. SignatureDateSubmit