VBS Volunteer Registration and Background Check Acknowledgement * This application is to be completed by all applicants for any volunteer position. This is not an employment application form. The information that is collected in this form is used for the screening of the applicant (you), which helps allow Joshua Campaign International Worship Center (JCIWC) to provide a safe and secure environment for any minors taking part in any of our events, being held on or off our premises. By typing your FULL name below and submitting the form below you knowingly and willingly give JCIWC authorization to request LexisNexis to release any and all information in its files regarding any record of criminal convictions or charges. These can reflect convictions or charges on the local, state, or federal level, including, but not limited to accusations and convictions for crimes against minors. By typing your FULL name and submitting the form below, you, the applicant, release agency from any and all liability that may result from such a disclosure made in response to this request. I have read and understand the statement above. Have you gone by any other names? If yes, please list them. Male or Female? Male Female Date of Birth MM DD YYYY Birth Place Social Security Number Address Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone (###) ### #### Email * How long have you attended jciwc? How would you rate your experience working with children? Much Experience Little Experience No Experience Date MM DD YYYY Thank you! TAP FOR DIRECTIONS
