Adult Volunteer Background Screening Step 1 of 7 14% Contact InformationContact InformationIf under 18 years old, please use the Junior Volunteer Application. This screening is requested by our insurance carrier to help the church provide a safe and secure environment at James River Church and/or James River Charities. Please fill out completely. Allow two weeks for processing. You will be notified when the process is complete.Indicate which campus you would like to serve at:* South Campus - Ozark, MO West Campus - Springfield, MO North Campus - Springfield, MO Joplin Campus - Joplin, MO Online Campus Community Care Event Missions Trip Other Please provide the name of the event:*Please provide the name of the trip:*Please specify:*Legal First/Last Name* First Last Middle Name* Middle NicknameCurrent Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you lived at your current address for less than five years?* Yes No How long have you lived at your current address?*Previous Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long did you live at your previous address?*Age*Date of Birth* MM slash DD slash YYYY Cell Phone*Home PhoneEmail* About YouAbout YouAre 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 NameLast NameAge Click the + to add another child.How long has James River Church been your church home?*Briefly describe your relationship with Jesus Christ:* Personal ReferencesPersonal ReferencesProvide 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 #1Reference #1Name* First Last Relationship to You*Email*Daytime Phone*Reference #2Reference #2Name* First Last Relationship to You*Email*Daytime Phone*Reference #3Reference #3Name* 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* MM slash DD slash YYYY Criminal Records CheckAuthorization 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*FirstMiddleLastApplicant's Electronic Signature*Place of Birth* City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Social Security Number*Date of Birth* MM slash DD slash YYYY Please list all other names you have used (including maiden name):Today's Date* MM slash DD slash YYYY Data SecurityThis is an encrypted and secure website. Any information you submit on this form will be kept confidential and secure at all times. Confidential InformationConfidential InformationThe following questions are part of a process to help provide a safe and secure environment. All information is confidential.Have you ever been accused or convicted of the use or sale of illegal drugs?* Yes No Have you ever used illegal drugs?* Yes No Have you ever struggled with alcohol or substance abuse?* Yes No Are you presently facing charges for any criminal offense?* Yes No Have you ever been charged with a misdemeanor or felony?* Yes No Have you ever been accused of or charged with an offense involving children?* Yes No Are you engaged in any conduct that is contrary to the teachings of the Bible or James River Church?* Yes No Do you have any health issues that could place another adult or minor at risk?* Yes No Have you ever been diagnosed with a mental illness?* Yes No Have you ever been denied legal custody of your child/children in any legal proceedings including divorce decrees or settlements?* Yes No Have you ever been dismissed from a volunteer position for any reason?* Yes No If you answered "yes" to any of the above questions, please explain briefly. We at James River Church and James River Charities understand the life-changing power of Jesus Christ and are eager to hear how He has helped you.*Data SecurityThis is an encrypted and secure website. Any information you submit on this form will be kept confidential and secure at all times. Applicant StatementApplicant StatementThe 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* MM slash DD slash YYYY For any further questions, contact the church office at (417)-581-5433
