Volunteer Screening Form

PERSONAL INFORMATION
Name*
First Middle Last
Current Address*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
Month
Day
Year
Social Security Number*
Note: Some government agencies and other information sources require your social security number when checking for records. BGC will not use it for any other purpose.
Cell Phone:*
Email*
SCREENING QUESTIONS
Do you have any lifestyle choices related to alcohol or drug use?*
- Yes
- No
Do you have any physical or mental health issues that could affect your ability to supervise children?*
- Yes
- No
Has there been any time you have been accused of molestation or sexual abuse?*
- Yes
- No
Is there any reason a parent might object to you supervising his/her child?*
- Yes
- No
AUTHORIZATION
By signing below, I recognize that TeenPact is relying on the accuracy of the information contained herein. Accordingly, I attest and affirm that all of the information that I have provided is absolutely true and correct. I authorize TeenPact to conduct a criminal background investigation, and/or contact any references I may provide if such a check is deemed necessary. I further authorize any such person or entity to provide TeenPact with information, op[inions, and impressions relating to my background or qualifications. I voluntarily release TeenPact, to include Family Resource Network and it's companies, organizations, and ministries, as well as any person or entity whose information I may provide to TeenPact from liability involving the communication of information relating to my background or qualifications.
VERIFICATION
Staffer Signature*
Parent/Guardian Signature (if under 18)*
Date*
Month
Day
Year

Subscribe to our mailing list

* indicates required

Volunteer Screening Form

Volunteer Screening Form

PERSONAL INFORMATION

SCREENING QUESTIONS

AUTHORIZATION

VERIFICATION

Subscribe to our mailing list