Driver's License Number*
SSN: (Used for background check)*
All volunteers must have a background check completed before volunteering in HPBC Children's Ministry.
Have you ever been charged, indicted, or pled guilty to an offense involving a minor? (If you wish, you may refuse to answer this question. Or, you may choose to discuss your answer in private with one of the ministers rather than answer on this form.)
If yes, please list all convictions.
Have you ever made a profession of faith in Jesus Christ?*
Have you been baptized?*
Are you a member of HPBC?*
If no, of which church are you a member or active participant?
Please list the names and addresses to the best of your ability of any other churches you have regularly attended over the past 5 years.
Please list any church activities where you have been involved with preschoolers, youth, or children. (Never worked in Children's Ministry before? That's alright too!)
Please list any NON-church activities where you have been involved with preschoolers, youth, or children.
Personal Charactor References
(Not employment or relatives)
Name of Character Reference *
Current Address of Character Reference *
Phone Number for Character Reference*
Name of 2nd Character Reference *
Current Address of 2nd Character Reference *
Phone Number for 2nd Character Reference*
APPLICANT'S STATEMENT: The information contained on this form is correct to the best of my knowledge. I authorize references or churches listed in this application to provide information and opinions they may have regarding my character and fitness from working with preschoolers, children, or youth. I release all such references from any liability for furnishing such evaluations, provided on my behalf. I agree to be bound by the bylaws and policies of HPBC of Panama City and agree to refrain from unscriptural conduct in the performance of my service. I further state that I have carefully read and foregoing release and know the content therein, and I sign this release as act of free will. This is a legally binding agreement that I have read and understand.
By typing my full name I hereby sign this document electronically understanding that this action carries the full legal weight of my personal signature.*