Program Personnel Application Form (youth)

In our desire to reduce the risk of abuse within Dorion Evangelical Church programs, we believe this information is necessary to protect our Children, Youth, Vulnerable Adults and our Volunteers and to effectively place our Volunteers in Program positions. Thank you in advance for your partnership.

Personal Information

First Name

Last Name

Address

Apartment, suite, etc.

City

Prov

Zip/Postal Code

First Name Parents

Last Name Parents

Phone Number

Are your parents supportive of your Program involvement?

Yes

If no, please explain

Personal History

Hobbies, Interests or Skills

Volunteer Experience and Part-time Jobs

Program Questionnaire

Describe why you would like to be part of our Children’s Program Team.

What strengths or assets would you bring to our Children’s Program?

What areas of concern do you have in working with Children?

Do you see yourself as a team player?

Yes

Please explain.

Please list the area of Program in which you would like to serve.

List three adults that you’ve known for at least one year and who have a definite knowledge of your character and ability to work with Children. You may include one reference from a relative, but must also include references from your youth director, employer or teacher.

References 1

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

First Name

Last Name

Phone Number

Nature of Relationship

How long have you known this person?

References 2

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

First Name

Last Name

Phone Number

Nature of Relationship

How long have you known this person?

References 3

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

First Name

Last Name

Phone Number

Nature of Relationship

How long have you known this person?

Date Input

Signature of Applicant

Printed Name

Date Input

Signature of Parent/Guardian

Printed Name

Information received is confidential and is being gathered for the purposes of screening Program Personnel and placing them into Program with Children, Youth and Vulnerable Adults. The information gathered here will be used for the purposes of supporting the programs at Dorion Evangelical Church.

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Program Personnel Application Form (youth)

Personal Information

Personal History

Program Questionnaire

References 1

References 2

References 3

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