Volunteer Screening Questionnaire Application • Ashfield Baptist Church

Volunteer Screening Questionnaire Application (Over 18 years old)

This form is a legal requirement and supports our desire to create and maintain a safe church for our community, Ashfield and beyond.

Please DO NOT push 'ENTER' until you are ready to submit this form. Please TAB or selct each field with your mouse.

In what role are you interested in serving at Ashfield Baptist Church?

Role *

Tip: ie: youth, children, congregational care etc...

Part A General Information

We believe that the Holy Spirit enables us to serve God and each other through our gifts and abilities, time and resources. We also believe that serving alongside other people is one of the best ways to get connected to the community of faith here at ABC, and one of the ways we join in with all God is doing in the world.

By completing the questions below, you will help us discern, together with you, where God might be calling you to serve at ABC at this time. We look forward to seeing where and how God will use you, in the life of our church community.

First Name *

Last Name *

Gender

Date of Birth

Email Address

Phone Number

Mobile Number

Home Address

Home City

Home State

Home Postcode

WWCC

WWCC Expiry date

Do you have any health conditions that we should know about? If so, please set out below (or leave blank)

PART B | Safety Questions

Please answer “YES” or “No” to each of the following questions. If you answer “yes” to any one of these questions, please provide details in the text box at the bottom of the section, or discuss with the Leader responsible for this role. A “yes” answer will not automatically rule an applicant out of selection.

Please note that if you disclose any potential criminal actions, the church may need to report this information to the police or other relevant government authorities.

Have you ever been charged with and/or convicted of a criminal offence? *

Yes

As an adult (18+ years) have you ever engaged in sexual contact with someone under your care other than your spouse (such as a congregant, client, patient, student, employee or subordinate)? *

Yes

As an adult (18+ years) have you ever engaged in use, possession, production or distribution of child abuse material? *

Yes

As an adult (18+ years) have you ever engaged in sexual contact with a person under the relevant age of consent? *

Yes

Have you ever had an apprehended violence order, order for protection or the like, issued against you as a result of allegations of violence, abuse, likely harm, harassment, stalking, etc? *

Yes

Have you had a history of alcohol abuse or substance abuse (including prescription, over-the-counter, recreational or illegal drugs)? *

Yes

If the role may involve driving, has your driver's licence ever been revoked or suspended? *

Yes

Have you ever had permission to undertake paid or voluntary work with children or other vulnerable people refused, suspended or withdrawn in Australia or in any other country? *

Yes

Has a child or dependant young person in your care ever been removed from your care by relevant authorities? *

Yes

IF YOU ANSWERED "YES" TO ANY OF THE QUESTIONS ABOVE, PLEASE BRIEFLY PROVIDE DETAILS HERE:

Churches You Have Regularly Attended in the Past Three Years

Please list the details of the churches that you have regularly attended over the past three years, starting with the most recent church.

If this is ABC, please put this down.

Name of most recent church and location: *

When *

Any positions held:

Second Church

Name of church and location:

When:

Any positions held:

Third Church

Name of church and location:

When:

Any positions held:

Referees

Please provide the details of TWO referees. These referees must meet the following criteria:

They are ideally in an existing leadership role at ABC.
They cannot be a relative.
They must be over the age of 18 years old.
They need to have known you for a minimum for 12 months in order to report on your character.

Referee ONE:

Referee TWO:

Contact Details:

Declaration

WORKING WITH CHILDREN CHECK AND NATIONAL POLICE CHECK

I consent to:

Verification of my WWCC number
A National Police Check (for staff only)

CONSENT TO HOLD INFORMATION

I consent to the information contained in this application, including any subsequent page/documents, to be kept by Ashfield Baptist Church. I understand that this information will be kept in a confidential file and used only for screening purposes.

By entering my name and the date below, I declare that:

the information I have provided in this application is true and correct to the best of my knowledge and belief;
I understand that if I provide false or misleading information or withhold relevant information from this application, the church leadership may determine that I am unsuitable to serve in any role in the church; and
I understand that prior to commencing any ministry role, I will be required to read and sign a Code of Conduct.

Name:

Date: