VOLUNTEER APPLICATION AND AUTHORIZATION FORM
First Christian Academy A Ministry of First Baptist Church
216 East Live Oak Avenue, DeFuniak Springs, FL 32435 Spiritual
Building Spiritual Strength and Academic Excellence
Voice 850-892-2722 Fax 850-892-2381
Return completed form to the First Christian Academy Director at the above address.
Driver’s license and social security numbers are required for a background check. Background checks expire after one year
from the date of the most recent background check. A new authorization form is required each school year.
Full Legal Name Date of Birth
Address Sex (Circle one): Male Female
City State Zip
Driver’s License # State Social Security #
Home Phone Work Phone
Mobile/Pager Email Address
Have you ever been charged with, indicted for, or pled guilty to an offense involving a minor? ( ) NO ( ) YES If yes, list all convictions:
Were you a victim of abuse or molestation while a minor? ( ) NO ( ) YES You may refuse to answer this question. You may prefer to
discuss your answer in confidence with the director or one of the ministers. Answering yes or leaving the question unanswered is not an
CHURCH AND SERVICE
Are you a member of First Baptist Church? ( ) NO ( ) YES—if yes, for how long have you been a member?
If no, list your church membership contact. List pastor, church address/phone number.
List the type of work involving children you have performed either at FCA, First Baptist Church, another school, or other church.
List two personal references (not former employers or relatives). (Give name, address, city/state/zip, and phone number.)
VOLUNTEER APPLICATION AND AUTHORIZATION FORM (page 2)
First Christian Academy seeks to create a safe sanctuary for students and staff,
free from crime, violence, drugs, and abuse.
Please read, initial each statement, and sign and date. Return this two-page completed form to Jennifer Wilkerson, First
Christian Academy Director.
All information contained in this application and authorization form is correct to the best of my knowledge.
I authorize references or churches listed in this application to provide information (including opinions) regarding my
character and fitness for working with children.
I release all such references from any liability for furnishing such evaluations, provided they do so in good faith.
I waive any right to inspect references provided on my behalf.
I agree to be bound by the bylaws and policies of First Baptist Church and First Christian Academy and to refrain from
unscriptural conduct in the performance of my services.
I have carefully read and understand this binding application and authorization agreement.
This authorization and consent for release of personal information acknowledges that First Christian Academy may
now or at any time obtain the criminal history record of prospective volunteers and conduct investigations whether the
records are of a public, private, or confidential nature. These investigations may include, but are not limited to, driving
records, educational reference, personal reference, name verification, social security verification, county civil court
records, county felony criminal history, misdemeanor or criminal history, federal civil court records, and criminal history
(statewide, federal, or extended).
I understand that these searches will be used to determine volunteer work assignment eligibility for First Christian
Academy. Therefore, I authorize and consent for full release of records to the authorized representatives of the school.
In addition, I release and discharge First Christian Academy and its agents and associates to the full extent permitted
by law from any claims, damages, losses, liabilities, expenses or any other charges or complaints filed with any agency
arising from retrieving and reporting this information. I understand that according to the Federal Fair Credit Act, I am
entitled to know whether volunteer services were denied based upon the information obtained and to receive, upon
written request, a disclosure of the background report if allowed by law.
Applicant Signature Date
Office Use Only