Confidential Background Investigation Consent

Purpose

To enable ministries to carry out their missions while safeguarding those they serve.

Values

1. Protect minors 

2. Protect volunteers and staff

3. Ministry support

4. Protect the Church and its members

Explanation:

This application will be asking some very personal and private questions. It is our intention to find out more about the people we are entrusting with minors (under age 18) and vulnerable adults (i.e. Disabled adult, nursing home resident, etc.). The information contained in this application will be treated with the utmost of confidentiality and respect.   No one will have access to this form without proper authorization.

The questions contained herein are not designed to offend or to pass judgment, but rather create an environment where a person’s past will not hinder the ministry in carrying out their mission in a safe, fun and productive way. If you are a person who must answer affirmatively to any of the questions on the following page, we may contact you for a personal interview. Please be assured answering affirmatively does not necessarily preclude you from ever serving with Legacy Church.

Name *
Name
Maiden Name or Alias
Maiden Name or Alias
Mailing Address *
Mailing Address
Phone
Phone
Date of Birth *
Date of Birth
no dashes
Have you ever been arrested, convicted or pled guilty to a crime? *
Have you had an addiction to drugs, alcohol, pornography or any other addiction, or has anyone ever suggested that you may have a problem with any of the above? *
If yes, what steps have you taken or are taking to pursue healing in this area?
Have you ever been charged with, alleged to have or have you ever committed any act of neglecting, abusing, molesting or battering any child or adult? *
Is there any circumstance in your life, including those that are physical or mental health related, which would make it inappropriate for you to serve with minors, may cause potential harm to children, or would compromise the integrity of Legacy Church? *
Have you ever voluntarily left or been asked to leave a role within an organization due to a concern regarding inappropriate conduct with minors or adults? *

Thank you for completing the background screening.  You will receive an email from Adobe Sign in the next 48 hours for an e-signature.