Today's Date
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MM
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Complete Legal Name
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First Name
Last Name
Address
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If less than 5 years at present address, please give previous address and number of years below:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Number of Years
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Number of Years
Email Address
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Birthdate
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MM
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Cell Number
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How Long Have You Attended Crossroads?
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Are You a Member at Crossroads?
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Age Group Preference
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Desired Role or Interest
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Choose all that apply
List Ways God has gifted you Spiritually
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List Any Other Gifts, Skills, or Training That Has Prepared You for This Role
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List Any Non-Church Work Involving Students Including: Organization? Location? Type of Work?
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Personal Reference #1
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First Name
Last Name
Personal Reference #1 Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Personal Reference #1 Phone
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(###)
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Personal Reference #1 Email
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Relationship to Relationship #1
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Personal Reference #2
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First Name
Last Name
Personal Reference #2 Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Personal Reference #2 Phone
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(###)
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Personal Reference #2 Email
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Relationship to Relationship #2
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The 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 children.
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Church History
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List all other churches (names, phone numbers, locations, & pastor’s name for each) you attended regularly in the last five years. Briefly include any areas where you served students at these churches:
Personal Testimony
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Briefly describe becoming a Christian.
Please check the box with the following statements as they apply to you.
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I have been convicted of or pleaded guilty to a crime.
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*If yes, please provide an explanation.
Prior convictions concerning children will prevent me from serving in student ministry.
Should my application be accepted, I agree to be bound by the bylaws and policies Crossroads Community Church and to refrain from unscriptural or unlawful conduct in the performance of my services on behalf of the church.
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Required Signature
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By typing my name below, I verify that I agree to the statement(s) above.
First Name
Last Name
Today's Date
MM
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YYYY
Crossroads has adopted a Child and Youth Abuse Prevention Policy to protect children and youth, as well as those who work with them from incident and false accusations. All volunteers and paid staff at Crossroads who work with children or youth are Mandatory Reporters and are expected to become familiar with and follow this policy: Crossroads has the following policy in place: 1. Anyone working with children/youth must have attended Crossroads Community Church a minimum of three months. 2. Anyone 18 years or older working with children/youth will need to complete mandatory reporter training and live scan and turn in the Elevate Ministry Application 3. Anyone seeking to work with children/youth will meet with a ministry leader. 4. No person may be alone out of view with any child/youth except their own (volunteer/staff may ask a parent to wait in class until 2nd person arrives). 5. No person may be alone in the bathroom with any child except their own (another person must have their foot in the door or one leader may wait outside the door for the child). 6. Anyone working with children/youth will have an unrelated person in the room or there must be clear visibility to passersby. All classes are open to observation at any time. 7. Physical contact with a child is limited to shoulder hugs, high 5's, fist pushes, & head pats. Younger children may be carried or sit on a worker's lap if other people are present. 8. Anyone who would like to observe in a classroom or stay with their child and is not scheduled to serve in the classroom must obtain permission from NexGen leadership before entering the classroom. 9. Assistants, teachers, or small group leaders must immediately report suspected abuse (see back of page for symptoms of possible abuse) to their Point Person, Ministry Assistant, Pastor, or Elder. 10. Point People must immediately report suspected abuse to a Pastor or Elder. 11. Anyone who observes abuse of a minor will take appropriate steps to immediately intervene and provide assistance. Any inappropriate conduct must be reported to the proper authorities at Crossroads for handling. 12. The Elder or Pastor must immediately report suspected abuse to the Executive Pastor or Head Pastor, and contact law.
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DEFINITIONS OF ABUSE:
Sexual Abuse is defined as the persuasion, enticement, or coercion of any minor to engage in, or assist any other person to engage in, any sexually explicit conduct or any simulation of such conduct for the purpose of producing any visual depiction of such conduct or rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of minor, or incest with a minor, or as defined by federal and state law. This includes and is not limited to unwelcome sexual remarks, jokes, advances, leering, whistling, or sexual gestures; sexual touching, fondling, molestation, assault, or other intimate physical contact; compelling another person to engage in a sexual act by threats or fear or undue influence; and providing or displaying pornographic materials to another person.
DEFINITIONS OF ABUSE, cont.:
Child Emotional Abuse is defined as verbal or nonverbal conduct including mental exploitation, degrading communication, or humiliating or threatening conduct that may or may not include bullying or as defined by state law.
Child Physical Abuse is defined as any “non-accidental physical injury to the child” and can include striking, kicking, burning, or biting the child, or any action that results in a physical impairment of the child.
SYMPTOMS OF ABUSE:
SIGNS OF PHYSICAL ABUSE:
Has unexplained burns, bites, bruises, broken bones, or black eyes
Has fading bruises or other marks noticeable after an absence from school
Seems frightened of the parents and protests or cries when it is time to go home
Shrinks at the approach of adults
Reports injury by a parent or another adult caregiver
CONSIDER THE POSSIBILITY OF PHYSICAL ABUSE WHEN THE PARENT OR OTHER ADULT CAREGIVER:
Offers conflicting, unconvincing, or no explanation for the child's injury
Describes the child as "evil," or in some other very negative way
Uses harsh physical discipline with the child
Has a history of abuse as a child
SIGNS OF NEGLECT:
Begs or steals food or money
Lacks needed medical or dental care, immunizations, or glasses
Is consistently dirty and has severe body odor
Lacks sufficient clothing for the weather
Abuses alcohol or other drugs
States that there is no one at home to provide care
CONSIDER THE POSSIBILITY OF NEGLECT WHEN THE PARENT OR OTHER ADULT CAREGIVER:
Appears to be indifferent to the child
Seems apathetic or depressed
Behaves irrationally or in a bizarre manner
Is abusing alcohol or other drugs
SIGNS OF SEXUAL ABUSE:
Has difficulty walking or sitting
Suddenly refuses to change for gym or to participate in physical activities
Reports nightmares or bedwetting
Experiences a sudden change in appetite
Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
Becomes pregnant or contracts a venereal disease, particularly if under age 14
Runs away
Reports sexual abuse by a parent or another adult caregiver
CONSIDER THE POSSIBILITY OF SEXUAL ABUSE WHEN THE PARENT OR OTHER ADULT CAREGIVER:
Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex
Is secretive and isolated
Is jealous or controlling with family members
SIGNS OF EMOTIONAL MALTREATMENT:
Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression
Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example)
Is delayed in physical or emotional development
Has attempted suicide
Reports a lack of attachment to the parent
CONSIDER THE POSSIBILITY OF EMOTIONAL MALTREATMENT WHEN THE PARENT OR OTHER ADULT CAREGIVER:
Constantly blames, belittles, berates, or overtly rejects the child
Is unconcerned about the child and refuses to consider offers of help for the child's problems
Crossroads Community Church reserves the right to make changes in the content or application of this program and to implement those changes with or without notice.
The terms defined herein are defined for the purposes of the policy and do not suppose or establish a legal relationship. These terms are not defined for the purposes of creating a legal relationship with Crossroads Community Church or any related or associated entity and instead are to be used with this document.
Required Signature
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By typing my name below, I verify that I agree to the statement(s) above and verify that all information provided is true and correct to the best of my knowledge.*
First Name
Last Name
Today's Date
MM
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I understand I am entering into a relationship with the students, parents and church leadership at Crossroads. I have read and understood the Crossroads Student Ministry Handbook. I commit to display and adhere to the leadership qualifications, expectations and requirements listed. I will do my best to pursue my own relationship with the Lord and follow Him wholeheartedly. I commit myself to the students and my student ministry pastor. I choose to allow the Lord to use me in this ministry.
Required Signature
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By typing my name below, I verify that I agree to the statement(s) above and verify that all information provided is true and correct to the best of my knowledge.*
First Name
Last Name
Today's Date
MM
DD
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