Volunteer Application (Confidential)

Basic Info

Church History

Are You a Member? *


Please give two (2) character references with whom you have had sufficient contact over the past five (5) years. Your references must be over the age of 18.

*Family members or paid West Lansing staff are not eligible for references.

Reference 1

Reference 2

Personal Background

Do you have any medical conditions that could prevent you from performing activities relevant to your area of interest? *
Have you ever been accused and/or convicted of domestic violence, pornography, child abuse, molestation or any other sexual or assaultive crime related to persons? *
Have you ever been counseled for any of the situations described above? *
Would you like a staff member or elder to call you to discuss your answers to the above questions? *

Applicant's Statement

The information contained in this application is correct to the best of my knowledge. I, the undersigned, give my authorization to West Lansing Church of Christ or its representatives to release any and all records and information relevant to working with minors. The church may also contact my references. I authorize any references listed to give you any information they may have regarding my character and fitness for work with minors. I release all such references from liability from any damage that may result from such evaluations to you, and I waive any right to inspect these references.

I authorize West Lansing Church of Christ to perform a criminal records check for arrests, convictions, or other information the Department of Corrections and any other local, state, or federal criminal enforcement agency may have regarding me and release such information to West Lansing Church of Christ.

I release West Lansing Church of Christ and the above mentioned agencies from any liability or damages resulting from the release of this information. I waive any present or future claims of privacy resulting from this information for qualifications of volunteer work at West Lansing Church of Christ.

I understand that by placing my name in the "digital signature" area, I am officially signing this document with my own hand. This signature is binding according to law in the same way my own written signature is.