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Midland Evangelical

Free Church

Sunday Worship 9:00 & 10:45 AM

The Portal

Volunteer Application: Part 3 - Background Check

PART 3: BACKGROUND CHECK
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Complete Part 3 if you will work in any leadership capacity and/or with children, youth, or senior citizens, the developmentally disabled.

*For which ministry are you completing this form?:
*Date of Birth:
*Are you 18 years or older?:
 **IF YOU ARE UNDER 18 YEARS OLD DO NOT FILL OUT THIS FORM.**
*Race:
*Social Security Number:
*Have you ever been convicted of any crime whether by plea or trial (this would include pleas of "no contest")?  Are you currently under investigation or are you currently charged with committing a crime?  If the answer is "Yes" for either of these questions, please provide the location and date so that we can do a due diligence follow up investigation. Please note that a criminal conviction may not necessarily disqualify you from consideration.
Offense:
Location:
Date:

REFERENCES

If this is the first time you have completed this Background Check section of the Volunteer Application, you MUST provide references. If not, you can skip down to the Volunteer Statement. 

Please provide the names of two personal references who are not related to you:

Reference #1:
Name:
Address:
City, State, Zip:
Relationship:
Phone #:
Email:
Known for how long?:


Reference #2:
Name:
Address:
City, State, Zip:
Relationship:
Phone #:
Email:
Known for how long?:


VOLUNTEER’S STATEMENT—READ CAREFULLY!

In consideration of the receipt and evaluation of this application by the church, I agree and represent that:

The information contained in this application is correct to the best of my knowledge. I am obliged to tell Midland Free if I find out that I am under criminal investigation or have been recently convicted of a crime. If I do not do so, this will result in immediate removal from my volunteer position. 

I authorize any references, or any other person or organization, whether or not identified in this application, to give you any information (including opinions) regarding my character and fitness for volunteer service. I hereby release any individual, church, denominational agency or official, reference, or any other person or organization, including record custodians, both collectively and individually, and whether or not identified in this application, 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, excepting only the communication of knowingly false information. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGNED THIS RELEASE AS MY OWN FREE ACT. This is a legally binding release which I have read and understand.  I understand that I may consult with an attorney before signing this document. A printed copy of this electronic original authorization shall be as valid as the original. 

I recognize that Midland Free requires all applicants under the aforementioned conditions to undergo investigative background inquiries. This includes a National Criminal Records report. I understand that Midland Free may be requesting information from various individuals, organizations, federal, state, and other agencies which maintain records concerning my past activities relating to criminal, civil, education, and other experiences to the extent allowed by law. I understand this report may be repeated as often as Midland Free deems necessary.

Furthermore, should my application be accepted, I agree to be bound by the bylaws and policies of Midland Free and to refrain from unscriptural conduct in the performance of my services on behalf of the church. Midland Free commits to supporting me in my appointment with affirming supervision and ongoing training as together we serve Jesus Christ and share in His love with our children.

*Electronic Signature:
*Email:
If a copy of this agreement is needed please contact the MEFC office at 989-631-4411.