FCGY Student Ministries
1835 Camden Road
Sumter, South Carolina 29153
Name Today’s Date
Address (including zip code)
Date of Birth SSN
Phone (day) Phone (night/cell)
Work status: part time full time student retired
Marital status: single married divorced widowed
Education (highest grade or degree completed) Year Graduated
Other Education Year Graduated
Personal and Children and ages
Personal and Spiritual History
Describe how you became a Christian and in what ways you are growing in your
relationship with the Lord.
Do you have any personal or physical concerns that impact your commitment/involvement
in youth ministry? _______________________________
In What ways have you demonstrated yourself as a dependable and responsible
How long have you attended First Church of God?______________________
Are you a member? yes no If yes, How long? _________________________
Have you been baptized by immersion? Yes No
Describe any ministry experiences you have been involved in at FCG or other churches.
Include dates. ____________________________________________
How would you like to use your spiritual gifts in ministry?_____________________
Why do you wish to be involved in youth ministry? __________________________
What are some of your expectations of the youth ministry staff and
Legal and Lifestyle Concerns
In caring for youth, we believe it is our responsibility to seek an adult staff that is able to provide healthy and nurturing relationships.
An affirmative answer will not automatically preclude a person from involvement in youth ministry.
Are you using illegal drugs? YES NO
Have you ever gone through treatment for alcohol or drug abuse? YES NO
Will you consent to follow the ministry’s guidelines in regard to prohibiting alcohol
consumption while involved in a youth ministry event? YES NO
Have you ever been arrested and/or convicted of a crime? YES NO
If yes, please explain
As an adult, have you ever had sexual relations with a minor? YES NO
Have you ever been accused or convicted of any form of child abuse? YES NO
Is there any reason you should not work with or be around children/youth? YES NO
Have you ever been the subject of a child abuse investigation? YES NO
Are you willing to be finger printed for state criminal conviction clearing? YES NO
To your knowledge, do you have any communicable diseases? YES NO
Volunteer Covenant for Student Ministry
The goal of the FCGY Student Ministries is to “See Christ in the lives of our students.” In an
effort to ensure that the church and the activities our students are involved in is a “safe place”,
some precautionary measures are taken to protect our students and volunteers. An initial
preventative step involves a screening process for those persons whom we entrust to care for and
teach our students. The following is a covenant for the ministry between volunteers and FCGY.
Please check the circles as you read.
o As a volunteer for this ministry, I realize that I am an example of Christ to the students & adults
with whom I interact. I will do my best to live a life worthy of such a calling.
o I understand that I should be early and prepared for ministry activities.
o I agree to attend any training offered by this ministry in an effort to increase my effectiveness as
a student ministry volunteer.
o I understand that a criminal background history check will be conducted by signing the consent
form on the last page of this application.
o I understand that it is my responsibility to distribute a minimum of 3 reference forms and to follow
up on their completion within 10 days of my application.
o I understand that if I suspect that a student has been physically or sexually abused or neglected,
that I am by law required to report this suspicion. I will not handle this situation myself, but will
notify a staff member of FCG with my concerns.
o As a volunteer of the FCGY Student Ministries, I certify that to my best knowledge, the
information given in this application is true and I have fully completed it.
o I acknowledge that I have received and will read the SM handbook of protection policies and
procedures and agree to abide by it.
Signature of Volunteer Date Signed
Please check your areas of interest:
___ Sunday School Teacher ___Special Event Helper/Fund Raising/Family Fun
___Substitute Sunday School Teacher
___Special Events Chaperone: Ski Trip, Summer Sunday’s, International Youth
Please list the three references you will ask to recommend you as a volunteer. It is your responsibility to
give your references the reference forms and ensure that they are completed within 10 days of your
application. Thank you.
Name Address, City, State, Zip Phone Relationship to Applicant
Consent for Criminal Background History Check
I hereby give my permission for First Church of God to obtain information relating to my
criminal history record. The criminal history record, as received from the reporting agencies, may
include juvenile offenses, arrest and conviction data, as well as plea bargains and deferred
adjudications. I understand that this information will be used, in part, to determine my eligibility
for an employment or volunteer position with this organization. I also understand that I will have
an opportunity to review the criminal history and a procedure is available for clarification, if I
dispute the record as received.
I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remise,
release and forever discharge and agree to indemnify First Church of God and the reporting
agency and their officers, directors, employees, and agents harmless from and against any and all
causes of actions, suits, liabilities, costs, debts, and sums of money, claims and demands
whatsoever, and any and all related attorney’s fees, court costs, and other expenses resulting
from the investigation of my background in connection with my application to become a
_________________ ____________ ___________ ______________
Last Name (print) First Middle Maiden Name
Former Name Date of Birth Circle one: Male Female
_________________ ____________ ___________ _______________
Street Address City State Zip Code
_______/_______/______ ___________________ _________
Social Security Number Drivers License Number State
Reference’s Name Phone Number
Address City, State, Zip
________________________is applying to become a volunteer in the FCGY Student
Ministries at the First Church of God and has given your name as a personal reference.
Please do the following: (1) complete the form, (2) sign at the bottom, (3) drop the form in
the student ministries treasure box or mail it in by _______________________.
(10 days from the date of the application)
This volunteer will be in close contact with students, and we want to ensure that these
relationships will be healthy ones. Your response will be confidential. Thank you.
This box to be filled our by prospective volunteer
1. How long have you known this person?
2. Describe your relationship with this person. ____________________________
Use the following chart to rate the applicant in the following areas.
1-low 2-below average 3-average 4-very good 5-excellent n/a-not observed
1 2 3 4 5 n/a
o o o o o o Ability to work as a healthy team member
o o o o o o Ability to relate to students
o o o o o o Ability to discipline students in a positive way
o o o o o o Ability to relate to parents or adults
o o o o o o Ability to follow through with commitments
o o o o o o Ability to respond well under supervision of a
o o o o o o Ability to be dependable and punctual
What are this applicant’s greatest strengths?________________________________________
Do you have any concerns regarding this person working with students?
O No O Yes If yes, please explain:______________________________________________
Thank you for taking the time to fill this out. If you have questions regarding this reference,
please contact the church office at (803) 905-5234.
I I certify that I have honestly completed this form to the best of my ability.
Return to: FCGY Student Ministries, First Church of God, 1835 Camden Road, Sumter SC 29153
Additional comments may be added on the back.