Safe Sanctuary Application

1
NamePlease enter your name so we can get started with training.
First Name
Last Name
2
Which SUMC staff member invited you to complete this application?* This field is required.
Lesli Wood
Andy Morris
Katy Tevepaugh (Volunteers only)
Susan Curran
Cari Treece
3
Watch "The Rules" Training Video
4
What background check does Shandon United Methodist Church do on all volunteers that wish to work with children?* This field is required.
a. Social Security Number verification
b. Sled Check
c. National Registry Check
d. All of the above
Other
5
How many months must you be active in the life of SUMC before you can be a volunteer with children?* This field is required.
a. One
b. Three
c. Five
d. Six
Other
6
What is this Policy’s “Two Adult Rule”?* This field is required.
a. Two adults are good with any number of children
b. Two adults per 8 children
c. Two parents on all day trips
d. Two unmarried, unrelated, policy certified adults must be in a room before one child may enter
Other
7
What grade must a child be in, to be dropped off from a car or unescorted anywhere at church?* This field is required.
a. Third
b. Fourth
c. Fifth
d. Sixth and up
Other
8
Who can pick up your child from a church function?* This field is required.
a. Only the parent, or legal guardian
b. The parent or an adult member of the church
c. Any family member
d. Only the parent or an adult or youth (6th grade & up) arranged in advance by the parent
Other
9
Children and Youth can only be in rooms with* This field is required.
a. Chairs and tables sized for their age.
b. Rooms with two exits.
c. Rooms with adjacent bathrooms.
d. Rooms with uncovered glass windows in the doors.
Other
10
Diaper changing and restroom help for infants and toddlers must be* This field is required.
a. Done only by the parent.
b. Done before the child is dropped off.
c. Done in private.
d. Announced to another adult.
Other
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How old must an adult be to volunteer with children or youth?* This field is required.
a. 39 and holding
b. Over the hill
c. Old enough to know better but too young to care
d. At least 18 years of age, and 5 years older than the age assisted
Other
12
Social media postings on ministry pages* This field is required.
a. Will be monitored by designated social media representatives for the church.
b. Will not include specific details for locations of events nor the names of individuals pictured.
c. Will have tagging disabled.
d. All of the above
Other
13
Electronic communication from adult workers directly with children (5th graders and younger) is* This field is required.
a. Difficult to track.
b. Difficult to read.
c. Difficult to understand.
d. Strictly prohibited.
Other
14
What content or images are prohibited from all electronic communication for ministry?* This field is required.
a. Content that is sexually suggestive.
b. Content that is disrespectful or abusive.
c. Content that is discriminatory or insensitive.
d. All of the above.
Other
15
Abused children* This field is required.
a. Are abused only by strangers.
b. Are abused only by adults.
c. Are abused only at home.
d. Are most often abused by people they know and trust.
Other
16
As a volunteer with children or youth at SUMC, you hear about or suspect a child has been abused. Whom should you contact?* This field is required.
a. The parents
b. The child and verify the story
c. The suspected abuser and verify the story
d. Shandon UMC clergyperson or staff director of the relevant program
Other
17
Please read the Safe Sanctuary PolicyA copy will be emailed to you upon completion of this process.
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I have reviewed the Safe Sanctuary Policy and Social Media and Electronic Communication Policy and I will abide by them.* This field is required.
I agree
19
Legal Name (as it appears on your identification)* This field is required.
Prefix
First Name
Middle Name
Last Name
Suffix
20
What name do you prefer to be called?* This field is required.
21
Print all other names that have been used by applicant - including full name prior to marriage. (if none, please type N/A)* This field is required.
22
Date of Birth* This field is required.
Date
Year
Month
Day
23
Social Security Number* This field is required.
24
Driver's License Number * This field is required.
25
State issuing Driver's License
26
Driver's License Expiration Date* This field is required.
Date
Year
Month
Day
27
Gender* This field is required.
Please Select
Please Select
Male
Female
28
Email* This field is required.
example@example.com
29
Mobile Phone Number* This field is required.
Area Code
Phone Number
30
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
31
Have you lived at your current location for 5 or more years?* This field is required.
YESNO
32
Previous address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
33
Current Occupation/Position* This field is required.
34
Current Employer* This field is required.
35
Previous work experience* This field is required.
36
Previous volunteer experience at Shandon UMC and elsewhere* This field is required.
37
Special interests, hobbies and skills* This field is required.
38
Would you like to work with children and/or youth?* This field is required.
39
Have you ever been charged, arrested, convicted of, or pled guilty to a crime, either a misdemeanor or a felony (including but not limited to drug-related charges, child abuse or neglect, other crimes of violence, theft, or any of the crimes listed on page 6 in section V. A. of the Child and Youth Abuse Prevention Policy of Shandon United Methodist Church)?* This field is required.
YESNO
40
Do you have any traits or tendencies that could pose any threat to children, youth, or others?* This field is required.
YESNO
41
Is there any reason why you should not work with children, youth, or others?* This field is required.
YESNO
42
Reference 1 - Name* This field is required.
First Name
Last Name
43
Reference 1 - Email* This field is required.
example@example.com
44
Reference 1: Phone Number* This field is required.
Area Code
Phone Number
45
Reference 1: Relationship to applicant* This field is required.
46
Reference 2 - Name* This field is required.
First Name
Last Name
47
Reference 2 - Email* This field is required.
example@example.com
48
Reference 2: Phone Number* This field is required.
Area Code
Phone Number
49
Reference 2: Relationship to applicant* This field is required.
50
Reference 3 - Name* This field is required.
First Name
Last Name
51
Reference 3 - Email* This field is required.
example@example.com
52
Reference 3: Phone Number* This field is required.
Area Code
Phone Number
53
Reference 3: Relationship to applicant* This field is required.
54
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Disclosure Regarding Background Investigation: Shandon United Methodist Church, the "Company," may obtain information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a" consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history (including income), or other background checks. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by Verified First, Phone: 888-670-9564, Fax: 208-266-2310, Mailing Address:, 1550 STech Lane Suite 200 Meridian, ID 83642. To the extent permitted by law, the Company may obtain consumer reports from any outside organization throughout the course of your employment.* This field is required.
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and certify that I have read and understand this document.
56
Please verify that you have completed the training by signing below.* This field is required.
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