Under 18 Safe Ministry Screening Questionnaire • Green Point Baptist Church

Please Note: This is a sensitive document that must be stored in a confidential manner accessible only by a limited number of authorised persons

First Name *

Previous Name

Date of Birth *

Phone Number *

Please outline any health conditions that may affect your volunteer role?

Last Name *

Gender

Email Address *

Home Address *

Parent/Guardian #1 Name *

Parent (#1) Phone Number *

Please choose either YES or NO for each of the following questions

If “yes”, please give details on a separate page or discuss with the Senior Pastor or the person holding an equivalent leadership role in your church. A ‘yes’ answer will not automatically rule an applicant out of selection. Please note that, if you disclose any potentially criminal actions, the church may need to report this information to the police or other relevant government authorities.

Have you ever been charged with or convicted of a criminal offence?

To your knowledge, has there ever been any allegations made against you regarding any abuse of a child, physical abuse or sexual misconduct?

Have you had a history of alcohol abuse or substance abuse (including prescription, over-the-counter, recreational or illegal drugs)?

Church Attendance

Have you attended any other churches regularly during the last 3 years? *

Yes

Please give details including: Church names, locations, when attended (month/year) and any positions held.

Referees

Please provide details of two referees who are over eighteen years of age and able to give a verbal report on your character and suitability for ministry. Referees may be part of the Church but are preferably not related to you.

Referee 1:

Name *

Email *

Phone *

Relationship to you *

Referee 2:

Name *

Email *

Phone *

Relationship to you *

Consent & Declaration

By submitting this application, I agree to the following:

I consent to verification of my WWCC number (if required) and a National Police Check (staff only).

I consent to the information contained in this application, including any subsequent pages, to be kept by our Church. I understand that this information will be kept in a confidential file and used only for screening purposes. 

I sincerely declare that: 

The information I have provided in this application is true and correct to the best of my knowledge and belief. 
I understand that if I provide false or misleading information or withhold relevant information from this questionnaire, the church leadership may determine that I am unsuitable to serve in any role in the Church. 
I have received a copy of the Code of Conduct and am willing to uphold it.

Full Name of Applicant

Full name of Parent/Guardian who is aware of and approves of this application

Date