Registered Child and Youth Worker Application

Name

This field is for validation purposes and should be left unchanged.

Children and Youth Worker Confidential Application

This application is to be completed by all people wishing to serve in any position with the Community of Christ that involves direct contact with children or youth. The intent of this application is to help the church provide a safe and secure environment for young people who participate in ministry and to assist applicants and church leaders in identifying and utilizing gifts and skills of the applicant. Information input into this form is secure and is PII compliant with CCPA, GDPR, and other global privacy frameworks.

Date of Birth(Required)

Date of Application(Required)

Name(Required)

First Middle Last Other/Aliases

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Criminal Offenses; Investigations; Administrative Actions – If the applicant answers ‘Yes’ below, the applicant MUST provide a detailed description of the underlying circumstances. Marking “Yes” does not necessarily disqualify an applicant from consideration. However, if the applicant does not provide additional details, the review will cease until further information is provided. If needed, please upload files with additional details and any further explanation that is relevant.

Have you ever been convicted of a crime other than a minor traffic violation?(Required)

Yes

No

If yes, please explain (include date and nature of the offense).(Required)

Please upload additional files with details and any further explanation that is relevant to this question

Drop files here or

Max. file size: 128 MB.

Have you ever been or are you currently under investigation by any law enforcement or government agency for child abuse, neglect or any criminal activity involving a minor?(Required)

Yes

No

If yes, please explain (include date and nature of the issue).(Required)

Please upload additional files with details and any further explanation that is relevant to this question

Drop files here or

Max. file size: 128 MB.

Has your youth worker status with Community of Christ previously been removed?(Required)

Yes

No

If yes, please indicate the reason(s) why your status was changed.(Required)

Please upload additional files with details and any further explanation that is relevant to this question

Drop files here or

Max. file size: 128 MB.

Congregational Membership or Affiliation – Membership in Community of Christ is NOT necessary to be a youth worker. This section helps us understand how you’re connected to Community of Christ. If you’re not currently part of a Community of Christ congregation, please put ‘NA’ in the relevant fields.

Community of Christ congregation you have been associated with for the past 6 mo.(Required)

Current Pastor(Required)

Current Pastor Phone/Email(Required)

List any other churches or faith communities you have regularly attended or participated in during the past five years (include name & location):(Required)

References – At least three (3) references are required for applications to be processed. References must be age 18 or over, must not be a relative, must have known you, and should be able to speak to your ability to work with youth. Please provide accurate and complete information for each reference.

One of your references must also satisfy one of the following*:

(i) be a pastor or youth minister of the church;
(ii) be a Community of Christ member who has known the applicant; or
(iii) be a leader in the community (i.e. School Principal/Teacher, Supervisor from work; Staff member from an organization where you’ve previously volunteered, especially a youth-serving organization).

* Please indicate which reference satisfies one of the above criteria.

Reference #1:

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

This applicant satisfies the requirements.

Reference #2:

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

This applicant satisfies the requirements.

Reference #3:

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

This applicant satisfies the requirements.

Applicant’s Statement: I authorize any references, or any other person or organization, whether or not identified in this application, to provide any information they have to Community of Christ regarding my character and fitness for children and youth work. I release all references listed in this application from liability for any damage that may result from furnishing such information to Community of Christ, and I waive any right to inspect references provided on my behalf. I further authorize Community of Christ and its agents or assigns to conduct a background check for any criminal records and agree that I will fully cooperate in providing all information and signing all documents necessary to complete the background check.

I hereby attest and certify that I have never been convicted of nor pled guilty to: any type of child abuse, any type of rape, sodomy, sexual abuse or misconduct, child pornography, endangering the life or welfare of any child, gross sexual imposition, sexual imposition, voyeurism, public indecency, stalking, harassment, violation of a protection order, any offense of physical violence or assault, or any existing or former offense of any municipality, any state, United States, or any other nation that is substantially equivalent to any of the above offenses. (If you have been convicted of or pled guilty to any of the above offenses and wish to explain the circumstances thereof, please attach your explanation on a separate sheet.) I further certify that I have never resigned or been discharged from employment or a volunteer position because of any behavior described above.

Should my application be accepted, I agree to be bound by the rules, regulations and policies of Community of Christ, and to act in accordance with those, in the performance of my services on behalf of the church. I affirm that it is my responsibility to remain aware of any changes or updates in the rules and regulations of Community of Christ.

I hereby represent and warrant that the information contained in this application is correct and complete to the best of my knowledge. I understand that misrepresentations or omissions may disqualify my application or result in my immediate dismissal if I am already serving in a youth-related position. Should any of the information provided or attested in this statement change, I agree to update this application immediately or as requested by church leadership.

Applicant Signature – By signing, you affirm that you have read, understand and agree with the statements above.

“If applicant is under the age of eighteen (18), parental/guardian signature is required in addition to applicant signature.*

Disclosure & Authorization for a Background Check

Community of Christ is committed to providing safe, caring, and respectful environments for all individuals, especially children and youth. As part of this commitment, the church conducts background checks on all applicants for Child and Youth Worker positions or volunteer roles involving minors or vulnerable persons.

By signing this form, I understand and authorize Community of Christ, or its designated screening provider, to obtain and review information about my background that may include, but is not limited to:

Criminal history records (including state, provincial, federal, and international databases)

Records of sexual offenses and crimes against children or vulnerable persons

Court records and law enforcement agency reports

Verification of identity and residence history

These checks may include searches within the United States, Canada, and internationally, as required to confirm my eligibility to serve. I understand that this information will be used solely for the purpose of evaluating my suitability for service with Community of Christ and will be handled confidentially in accordance with applicable privacy laws and church policies.

I hereby release Community of Christ, its officers, employees, agents, and designated screening providers from any liability in connection with the retrieval, review, or use of such information.

This authorization shall remain valid for the duration of my service with Community of Christ unless revoked in writing.

Applicant or Parent/Guardian Signature(Required)