Apex Volunteer Registration – Restoration Anglican Church

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Apex Volunteer Registration

Interested in volunteering with APEX? Fill out this form!

Apex Volunteer Registration Form

Name*
First Middle Last
Email*
Phone*
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date moved into current address*
Background Information
Previous Addresses in the last 5 years*
Please list addresses + dates resided.
Are you a member of Restoration Anglican Church?*
How long have you been attending Restoration?*
Where have you attended church regularly during the past five years?*
Please share name, city, and state of churches.
Please describe all your previous church or ministry work involving children or youth. Identify the church or organization, its location, the dates of your work there, and the type of work you performed.*
Please describe any callings, gifts, training, education, or other factors that have prepared you to work with youth.*
Have you ever been convicted of, or pled guilty to, or are charges pending concerning any crime or misdemeanor involving actual or attempted child abuse, neglect or molestation? Have you ever been convicted of, or pled guilty to, or are charges pending concerning any crime or misdemeanor involving actual or attempted child abuse, neglect or molestation?*
- Yes
- No
If yes, please provide details below.
Have you ever been charged with a sexual offense or crime of violence?*
- Yes
- No
If yes, please provide details below.
Have you ever been convicted of, pled guilty to, or have charges pending concerning any other crime?*
- Yes
- No
Note: Conviction of a crime that does not involve any risk to children or youth is not an automatic bar to volunteer service.
If yes, please provide details below.
Have you ever been the subject of a civil lawsuit involving, or an investigation or allegation of, sexual misconduct, sexual harassment or other immoral behavior or conduct involving adults or children?*
- Yes
- No
If yes, please provide details below.
Do you have any investigation, review or disciplinary action pending by an employer, organization in which you volunteered, or professional association for sexual misconduct, violence or misconduct involving children?*
- Yes
- No
If yes, please provide details below.
Have you at any time during the past five years used illegal drugs or other illegal controlled substances?*
- Yes
- No
Have you ever participated in the creation, dissemination, or transmission of pornography or pornographic materials of any type*
- Yes
- No
Is there any fact or circumstance about you or your background that would call into question the advisability of entrusting you with the supervision, guidance and care of children?*
Personal References
Please list three personal references (no related family members) below. Include their address, phone, & email address.
Reference 1*
Reference 2*
Reference 3*
Anything else you'd like us to know?

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