Name *
Name
Street/City/State/Zip
Cell Phone *
Cell Phone *
Birthdate *
Birthdate *
Have you ever been charged, arrested, or convicted of any crime other than minor traffic violations? *
Have you ever been accused, investigated, charged, arrested, or convicted of child abuse, sexual abuse, or sexual assault? *
Do you use illegal drugs? *
Are there any experiences in your past which might raise concerns about you being entrusted with the physical, spiritual, and emotional safety of children and youth? *
Have you ever been diagnosed with a medical condition that, due to its nature, might endanger children (T.B., Hepatitis B., HIV, etc.)? *
Have you printed and completed the separate Background Check Authorization form? (This form must be physically signed and handed to the Crossing Student Ministries Pastor.) *

The yes/no questions above will be kept confidential, as will your background check information. A CrossWay staff member involved in volunteer placement decisions will contact you to discuss any yes answers needing further explanation.

Your spiritual journey and any previous experience working with teens will be discussed in a face-to-face interview.

Personal References may be requested.