Oregon Conference Volunteer Ministry Information Form (Page 2 of 3) in pdf

Unlawful Conduct

There is no time limit to the questions regarding criminal history. Unless a time limit is stated in a question, provide information on

ALL convictions, pleas and alternative sentencing or disposition programs that have occurred during your lifetime. Records of

offenses by minors (under age 18) are not automatically sealed and should be disclosed, except where non-disclosure is required under

state law. Conviction of a crime does not necessarily disqualify you from volunteer service, but individuals who have committed

physical or sexual abuse may not work in any church-sponsored activity or program for children.

Have you ever plead guilty, no contest, or been convicted of any criminal offense (misdemeanor or felony).

(Please circle)

YES

If yes, please explain:

Confidentiality Statement

The Oregon Conference of Seventh-day Adventists is committed to protecting the children in our churches and schools. It is because

of this commitment we require volunteers to submit to background checks if they are working with minor children.

Information provided to us on this form will be kept confidential. Forms retained for permanent record will be kept in a secure location.

Permanent local church or school records will only include the front page of this application indicating “recommended,” “not

recommended” or “recommended with caution.” Information on the reverse of this application will be kept confidential (with the

exception of discussing with local church or school leadership when necessary).

Approved status generally is for a three-year time frame, but may be revoked at any time. The three-year re-approval will include

another criminal background and driving history check.

Should you have any questions regarding this form, please contact the Risk Management Department at the Oregon Conference office

at 503/850-3500.

Background Check Authorization & Waiver

The above information is accurate to the best of my knowledge and recollection. I understand that this is strictly a volunteer position,

and I expect no remuneration for services and time volunteered.

I authorize the Oregon Conference and its affiliates to investigate my suitability for the volunteer position(s), which will include

criminal background checks and driving record history. I authorize the references and professionals identified above to release any and

all of my personal information to the Oregon Conference and its affiliates investigating my suitability for service to the Oregon

Conference and its affiliates, and to release information to government agencies.

I agree that if I am approved to serve as a volunteer, I will inform appropriate church or school leadership, including the individuals

organizing any activities I will be assisting with, of any physical limitations that I may have that may affect my ability to fully and

safely participate. I agree to abide by the Code of Conduct and Guidelines for Volunteers of the Oregon Conference of Seventh-day

Adventists.

I understand that serving as a volunteer may involve risk. Except to the extent covered by any Oregon Conference insurance policies

I, on behalf of myself, my spouse, next of kin, executors, heirs, assigns, or anyone else who might claim or sue on my behalf, fully

release and agree not to sue the Oregon Conference of Seventh-day Adventists and any of its agents, employees, and/or volunteers

from any and all liability, including but not limited to any claims, losses, or liabilities due to death, personal injury, disability, property

damage, medical expenses, and/or theft, that may arise from or relate to my participation as a volunteer, including transportation to and

from any events and any provision of medical care.

Code or Conduct and Guidelines for Volunteers

I, the undersigned, have read this document and agree to abide by the Code of Conduct and Guidelines for Volunteers outlined. I will

retain a copy of the document and keep it for reference.

Applicant’s Signature:

Date:

Required:

Social Security #

Date of Birth: Mo.

Day

Yr.

Note:

Please be sure you have answered every question and signed your name above.

Please return this form to your church leader.

To protect your privacy only the front of the form will be returned to the church or school organization.

The original application will kept in a secure location at the Oregon Conference.

Rev. 2/2012

Oregon Conference Volunteer Ministry Information Form Page 2

Related Articles

Related forms

Related Categories