Mentor Application - Alongsiders

Your name *

Email address *

Address

Phone number

Which Sunday would like to mentor? *

FIRST SUNDAY

SECOND SUNDAY

THIRD SUNDAY

FOURTH SUNDAY

REFERENCES

Please provide the following information for three people who are over the age of 18 years of age and are able to provide a reference supporting your integrity and character in relation to working with children or young people.

Reference 1 *

Please provide the following information: name, years you have known them, email address and phone number

Reference 2 *

Please provide the following information: name, years you have known them, email address and phone number

Reference 3 *

Please provide the following information: name, years you have known them, email address and phone number

FAITH JOURNEY

Can you describe your relationship with God and your history in/of faith: *

How long have you been participating in/at/with Alongsiders Church? *

What church community did you previously attend? *

Do you have any physical, mental, or emotional conditions/challenges that would prevent you form performing certain types of activities related to working with children/youth? *

Yes

Is there any circumstance or pattern in your life that would make it inappropriate for you to serve with children or youth, or would compromise the integrity of Alongsiders Church? *

Yes

Have you ever been convicted of child abuse or neglect, or a crime involving actual or attempted sexual molestation of a minor? *

Yes

Have you been a victim of abuse, molestation, or neglect? *

Yes

Have you ever had a traffic citation that was over $500.00* *

*Other than citations/convictions expunged, sealed, set aside by law, or otherwise protected by applicable law from disclosure on this employment/volunteer application. A condition includes a guilty verdict, guilty finding, guilty plea, or “no contest” plea, whether or not a sentence was imposed.

Yes

Have you ever been convicted of a crime anywhere? *

Yes

Do you have any criminal charges pending against you? *

If you are unsure how to complete these questions, or do not know whether a conviction meets these criteria, please consult with your criminal attorney before completing this form.

Yes

APPLICANT'S STATEMENT

I agree; *

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed on this application to give any information (including options)that they may have regarding my character and my fitness for work with children or youth. I release all such references from any liability for furnishing such evaluations to you, providing they do so in good faith and without malice. I waive any rights that I may have to inspect references provided on my behalf. I am striving to live a Jesus centered life and agree to set a Jesus-like example while working with the children and/or youth of this church.
I understand this is not an application for employment.
I further understand that Alongsiders Church takes abuse very seriously and that abuse in any form will not be tolerated. I am aware that my participation in abuse of any form is cause for my removal from volunteering immediately.