Adult Volunteer Background Screening

Step 1 of 7

14%

About You
About You
Are you currently employed?*
- Yes
- No
Current Employer*
Current Occupation*
Relationship Status*
- Married
- Single
- Living Together
- Other
Spouse or Significant Other's Name*
First Last
Do you have any children?*
- Yes
- No
Children's Name & Age*
First Name Last Name Age

Click the + to add another child.
How long has James River Church been your church home?*
Briefly describe your relationship with Jesus Christ:*

Personal References
Personal References
Provide three personal references- NOT related to you. Must have known you for at least one year.

Note: Minors may not be used as references.
Reference #1
Reference #1
Name*
First Last
Relationship to You*
Email*
Daytime Phone*
Reference #2
Reference #2
Name*
First Last
Relationship to You*
Email*
Daytime Phone*
Reference #3
Reference #3
Name*
First Last
Relationship to You*
Email*
Daytime Phone*

GROW TRACK DREAM TEAM COMMITMENTS

Please read the following sections detailed in Step 4 of the Grow Track book and initial each statement to express your commitment:
*
- I am willing to adhere to James River Chuch's Dream Team Commitment. (see page 85)
To review page 85, click here.
*
- I have read the James River Church Abuse Policy Acknowledgement and I agree to report any suspected abuse to the staff person who oversees the area in which I serve. (see page 87)
To review page 87, click here.
*
- I am in agreement with James River Church's Statement of Beliefs. (see page 37) For full statement of beliefs, please visit https://jamesriver.church/beliefs
To review page 37, click here.
By signing below, I am stating that the information contained in this application is complete, accurate, and not misleading in any way. Should my application be accepted, I agree to comply with the policies and procedures of James River Church.
Signature*
Today's Date*

Criminal Records Check
Authorization for Criminal Records Check
(All applicants must complete this section; only those 18 and older are subject to check.)

I hereby authorize a criminal background check and the release of any information which pertains to any record of convictions in its files or in any criminal file maintained on me whether local, state or national. I hereby release any criminal law enforcement agency from any and all liability resulting from such disclosure. Any person or entity relying on this request may rely on a photocopy or facsimile as if it were an original.
Legal Name*
First Middle Last
Applicant's Electronic Signature*
Place of Birth*
City State
Social Security Number*
Date of Birth*
Please list all other names you have used (including maiden name):
Today's Date*
Data Security
This is an encrypted and secure website. Any information you submit on this form will be kept confidential and secure at all times.

Applicant Statement
Applicant Statement
The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for working with or around children. In consideration of this evaluation by James River Church and James River Charities, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

Should my application be accepted, I agree to be bound by the Bylaws and policies of James River Church and James River Charities and to refrain from unscriptural conduct in the performance of my services on behalf of the church.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
Applicant's Electronic Signature*
Today's Date*
For any further questions, contact the church office at (417)-581-5433

Adult Volunteer Background Screening

Step 1 of 7

Contact Information

Contact Information

About You

About You

Personal References

Personal References

Reference #1

Reference #2

Reference #3

GROW TRACK DREAM TEAM COMMITMENTS

To review page 85, click here.

To review page 87, click here.

To review page 37, click here.

By signing below, I am stating that the information contained in this application is complete, accurate, and not misleading in any way. Should my application be accepted, I agree to comply with the policies and procedures of James River Church.

Criminal Records Check

Authorization for Criminal Records Check

Confidential Information

Confidential Information

Applicant Statement

Applicant Statement