Date of Birth*
Drivers License No.
State of License
Marital Status *
If married, spouses name
Have you ever had or used a different name? Or a maiden name?*
If yes, please list all other names and dates during which you used those names
How long have you been a member of Kenwood Baptist Church? *
Please list all church memberships and dates of membership for the past 5 years. List church names and city/state of churches. *
Please express your purpose in desiring to volunteer for children’s ministry at Kenwood Baptist Church. *
Please list previous church and non-church work involving children. For each, include where, duration of work, and in what capacity you served. Also please describe any special training, education or other factors (including medical/musical) that would apply to your ministry to children.
Have you ever been convicted of a misdemeanor or felony?*
Has a civil or criminal complaint ever been filed against you that alleged sexual misconduct or child abuse by you or participation in or facilitation of such activities?*
Have you ever chosen not to renew or continue employment or volunteer service, had your employment or volunteer service terminated, or been subject to disciplinary action for reasons relating to allegations of sexual misconduct or child abuse by you?*
Personal Reference #1: A pastor or church leader (not a family member) from the church you most recently attended.
Personal Reference #2: A person (not a family member) with whom you have worked/served in the past who knows you well. (If you served in children’s ministry, please list someone who served with you in this context.)
Personal Reference #3: A co-worker or friend unrelated to your church ministry who knows you well (not a family member).
Are you available to serve on the Wednesday evening rotation?*
This information is true, correct, and complete. Any misstatement or omission of fact may result in the
cessation of my volunteer services. I grant permission for Kenwood Baptist Church to check my references
listed and release Kenwood Baptist Church from any and all resultant liability, claims, or lawsuits in regards to
the information obtained. In addition, I submit to a criminal background check and online sex offender check.*