Child/Youth Protection Policies

St Mark's Episcopal Church
Irving, Texas

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EPISCOPAL DIOCESE OF DALLAS POLICIES

FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE

1630 North Garrett Avenue

Dallas, Texas, 75206

214-826-8310

Diocesan Office FAX 214-826-5968

Office of the Bishop FAX 214-826-4753

[page 2].....I. CODE OF CONDUCT FOR PROTECTION OF

CHILDREN AND YOUTH

[page 3].....II. GENERAL DEFINITIONS

[page 3].....A. Church Personnel

[page 3].....B. Children and youth

[page 3].....C. Regularly or Occasionally Work

With or Around Children or Youth

[page 4].....D. Types of abuse

[page 5].....III. SAFEGUARDS FOR CHILDREN AND YOUTH

[page 5].....A. Screening and Selection

[page 6].....B. Education and Training Requirements

[page 6].....C. Monitoring and Supervision of Programs

[page 7].....D. General Conduct for the Protection of Children and Youth

[page 9].....IV. RESPONDING TO PROBLEMS

[page 9].....A. Reporting Inappropriate Behaviors

or Policy Violations with Children or Youth

[page 10].....B. Reporting Suspected Abuse of Children or Youth

[page 11].....V. APPENDIX

[page 11].....A. Guidelines for Appropriate Affection

[page 12].....B. Confidential Notice of Concern

[page 13].....C. Sample Paid Employee Application Form, Code of Conduct,

and Acknowledgment, Release and Signature

[page 17].....D. Sample Volunteer Application Form, Code of Conduct,

and Acknowledgment, Release and Signature

[page 20].....E. Texas Child Abuse Reporting Statute Website

[page 20].....F. Texas State Criminal Records and Sex Offenders Registry Information

[page 20]….G. Criminal Background Check Information

May 1, 2009

I. CODE OF CONDUCT FOR PROTECTION OF CHILDREN AND YOUTH

Relationships among people are at the foundation of Christian ministry and as such are central to the life of the church. Defining healthy and safe relationships through policies and codes of conduct is not meant, in any way, to undermine the strength and importance of personal interaction in our ministries. Rather, it is to assist in more clearly defining behaviors and practices that allow the church to more fully demonstrate its love and compassion for children and youth in sincere and genuine relationships. Relationships in ministry should always be experienced as caring and without intention to do harm or allow harm to occur. These Policies and Codes of Conduct have been adopted by The Episcopal Diocese of Dallas to help the church create safe environments for children and youth and for those who minister to them. All Church Personnel are asked to carefully consider each statement in the Code and within the Policies for the Protection of Children and Youth from Abuse before agreeing to adhere to the statements and continue in service to the church.

Code of Conduct for protection of children and youth:

� Church Personnel agree to do their best to prevent abuse and neglect among children and youth involved in church activities and services.

� Church Personnel agree to not physically, sexually or emotionally abuse or neglect a child or youth.

� Church Personnel agree to comply with the policies for general conduct with children and youth as defined in these Policies for the Protection of Children and Youth from Abuse.

� All Church Personnel agree to comply with the Guidelines for Appropriate Affection with children and youth.

� In the event that Church Personnel observe any inappropriate behaviors or possible policy violations with children or youth, church personnel agree to immediately report their observations to their supervisor or to the appropriate legal authority.

� All Church Personnel acknowledge their obligation and responsibility to protect children and youth and agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with these policies.

� Church Personnel understand that the church will not tolerate abuse of children and youth and agree to comply wholeheartedly with this position.

Please reference sections IV A and B.

II. GENERAL DEFINITIONS

A. CHURCH PERSONNEL

For the purposes of this policy, the following are included in the definition of Church Personnel when they are functioning in their respective roles for the church:

1. All clergy whether stipendiary, or non-stipendiary, or otherwise, who are engaged in ministry or service to the church.

2. All paid personnel whether employed in areas of ministry or other kinds of services by the diocese, its congregations, schools or other agencies. For example: sextons, nursery workers, choir directors, or organists.

3. Those who contract their services to the diocese, its congregations, schools or other agencies.

4. Volunteers, including any person who enters into or offers him or herself for a church related service, or who actually assists with or performs a service, whether or not they have been selected or assigned to do so. Volunteers include members of advisory boards, vestries, and boards of directors. For example: volunteer nursery workers, volunteer choir directors or special program leaders, such as Vacation Bible School or Pageant volunteers.

B. CHILDREN, YOUTH AN ADULTS

A child is defined as anyone under the age of 12 years.

A youth is defined as anyone who is at least 12 years old, but not yet 18 years old. A youth may also be an individual who is 18 years old or older, but still in high school.

For the purposes of these guidelines, an adult is defined as a person who is 18 years of age and one year out of high school.

C. DEFINITIONS OF WORK WITH OR AROUND CHILDREN OR YOUTH

For the purpose of this policy, the following are included in the definition of Church Personnel who “Regularly Work With or Around Children or Youth:”

1. All clergy whether stipendiary, non-stipendiary, or otherwise who are engaged in ministry or service to the church.

2. All paid or volunteer Church Personnel whose work regularly takes them throughout the facility or grounds or who has keys giving them access to the buildings on the grounds.

3. All persons who supervise or assist with supervising children or youth in ministries, programs or activities more often than occasionally.

4. All persons who provide transportation to children or youth without other adults in the vehicle more often than occasionally.

5. Any paid personnel whose living quarters are on the grounds of the church, school or other related agency, programs or activities for children or youth.

Examples of Church Personnel who REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH: include, but are not limited to:

Church School teachers

Children’s or youth choir directors

Organists who work with children or youth

Lay youth ministers

Volunteer youth directors

All Church Personnel who work or assist in the nursery more than four times a year

All Church Personnel who work in the nursery if they are the only person over 18 present at any time

All staff, whether volunteer or paid, at church camps

Adults who participate in overnight activities with children or youth.

For the purpose of this policy, the following are included in the definition of Church Personnel who OCCASIONALLY WORK WITH OR AROUND CHILDREN OR YOUTH:

1. All persons who supervise or assist with supervising children or youth in ministries, programs or activities infrequently, generally no more than three times a year or for one program or activity during a year that lasts less than a month (i.e. assisting with preparation for the Christmas pageant, or substituting in a Church school class.

2. All persons who provide transportation to children or youth without other adults in the vehicle at least four times a year.

3. All persons who work or assist in the nursery four or fewer times a year, whether on an emergency basis or as a substitute.

D. TYPES OF ABUSE

1. Physical abuse is non-accidental injury, which is intentionally inflicted upon a child or youth.

2. Sexual abuse perpetrated by an adult is any contact or activity of a sexual nature that occurs between a child or youth and an adult. This includes any activity, which is meant to arouse or gratify the sexual desires of the adult, child or youth.

3. Sexual abuse perpetrated by another child or youth is any contact or activity of a sexual nature that occurs between a child or youth and another child or youth when there is no consent, when consent is not possible, or when one child or youth has power over the other child or youth. This includes any activity which is meant to arouse or gratify the sexual desires of any of the children or youth.

4. Emotional abuse is mental or emotional injury to a child or youth that results in an observable and material impairment in the child or youth’s growth, development or psychological functioning.

5. Neglect is the failure to provide for a child or youth's basic needs or the failure to protect a child or youth from harm.

6. Economic exploitation is the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a child or youth's belongings or money.

III. SAFEGUARDS FOR CHILDREN AND YOUTH

A. SCREENING AND SELECTION

1. Any and all Church Personnel who are paid employees or who REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH in overnight situations or long-term nursery care shall be screened and selected utilizing at least the following:

a. A STANDARD APPLICATION FOR AN EMPLOYEE or a STANDARD APPLICATION FOR A VOLUNTEER completed by the applicant that includes an authorization for the release of information for background checks and the CODE OF CONDUCT. (See Appendices C and D)

b. CRIMINAL RECORDS CHECK in any state where the applicant has resided during the past seven (7) years, and other states, if any, as determined by the church. (See Appendix G.)

c. SEXUAL OFFENDER REGISTRY CHECK in any state where the applicant has resided during the past seven (7) years). (See Appendix G.)

d. INDIVIDUAL INTERVIEW with the applicant.

e. If an employee, REFERENCE CHECKS with persons outside the congregation who know the applicant, preferably who know how the applicant works with children.

f. DRIVING OR MOTOR VEHICLE RECORDS CHECK if the person may be transporting children or youth.

2. Any and all Church Personnel who REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH shall be screened and selected utilizing at least the following:

a. A STANDARD APPLICATION FOR A VOLUNTEER completed by the applicant and the CODE OF CONDUCT.

b. SEXUAL OFFENDER REGISTRY CHECK in any state where the applicant has resided during the past seven (7) years).

c. INDIVIDUAL INTERVIEW with the applicant.

d. DRIVING OR MOTOR VEHICLE RECORDS CHECK if the person may be transporting children or youth.

3. Any and all Church Personnel who OCCASIONALLY WORK WITH OR AROUND CHILDREN OR YOUTH shall be screened and selected utilizing at least the following:

b. INDIVIDUAL INTERVIEW with the applicant.

c. If an employee, REFERENCE CHECKS with persons outside the congregation who know the applicant, preferably who know how the applicant works with children.

d. DRIVING OR MOTOR VEHICLE RECORDS CHECK if the person may be transporting children or youth.

4. All information gathered about an applicant will be carefully reviewed and evaluated to make a determination, in consultation with others as necessary, of whether or not the person is appropriate to work with children or youth.

5. Church Personnel who work with or around children or youth must have a personnel file that is kept where other church records are kept.

6. Criminal records checks and sexual offender registry checks will be conducted every five (5) years for Church Personnel who Regularly Work With or Around Children or Youth. (See Appendix G.)

7. Church Personnel who transfer within the Diocese of Dallas and apply for or are asked to or who do undertake a position working with children or youth are required to undergo the same screening and selection process in Section A above. This requirement may be met through a transfer of a copy of their personnel file to the new congregation, school, agency or program together with the completion of a new application, individual interview, and reference checks with the congregations, schools, agencies or other programs for which the applicant has worked with or around children or youth since the screening was last done as shown in the applicant’s file.

B. EDUCATION AND TRAINING REQUIREMENTS

1. Safe Church training in child abuse prevention is required of all CHURCH PERSONNEL WHO REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH before they start their work with children or youth. A grace period of 90 days may be granted by the Bishop’s Office in rare circumstances.

2. Safe Church training in child abuse prevention is required of all CHURCH PERSONNEL WHO OCCASIONALLY WORK WITH OR AROUND CHILDREN OR YOUTH within 90 days after they start their work with children or youth if not before.

3. Safe Church training must be renewed every three years.

C. MONITORING AND SUPERVISION OF PROGRAMS

1. Church Personnel who are responsible for screening, selection and supervision of others in programs for children and youth are required to keep adequate records in this area.

2.. The Diocese of Dallas will maintain a database record of all Church Personnel who have received Safe Church Training in child abuse prevention.

3. The minimum number of adults at any activity involving children or youth is two. It may be appropriate for a Sunday School class to have only one teacher so long as at least one other adult

can maintain visual contact with the teacher. The congregation, school, agency or program is responsible for ensuring that sufficient leadership is provided for all activities.

4. Older children or teens working with educational programs can do so in a leadership role under the supervision of and in the physical presence of an adult aged 18 or older.

5. Church Personnel are prohibited from being alone with a child or youth where other adults can not easily observe them.

6. An up to date list of approved congregation-sponsored programs for children or youth will be maintained in the church office or place where other church records are kept.

7. Church Personnel are not permitted to develop new activities for children or youth without approval from the rector or vestry. No event for children or youth shall take place in a private residence without prior approval from the rector or vestry. Requests to develop new activities should be submitted in writing to the rector or vestry who will consider whether the plan includes adequate adult supervision.

8. Each program will develop age-appropriate procedures to ensure the safety of children and youth using restrooms and showers or baths.

9. When supervising or assisting private activities such as dressing, bathing, or diapering infants or children, Church Personnel will remain in an area observable by other adults or work in pairs.

10. When both boys and girls are participating in an activity other than educational programs or under nursery care, male and female adults must be present.

D. GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH

These guidelines should be used to make decisions about interactions with children and youth in church sponsored and affiliated programs. They are not designed or intended to address interactions within families. When exceptions to these guidelines must be made, they should be reported to the supervisor of the Church Personnel making the exception as soon as possible.

1. All Church Personnel who work with children or youth must agree to comply with the Diocese of Dallas Guidelines for Appropriate Affection. (Appendix A)

2. No person will be allowed to volunteer to REGULARLY WORK WITH CHILDREN OR YOUTH until the person has been know to the clergy and congregation for at least six months.

3. Programs for infants and children under six (6) years old will have procedures to ensure that children are released only to their parents or legal guardians or those designated by them.

4. Church Personnel are prohibited from the use, possession, distribution or being under the influence of alcohol, illegal drugs, or the misuse of legal drugs while participating in or assisting with programs or activities specifically for children or youth.

5. Parents or guardians must complete written permission forms before Church Personnel transport children or youth for a church sponsored activity or for any purpose on more than an occasional basis.

6. Church Personnel will respond with respect, consideration and equal treatment, regardless of sex, race, religion, sexual orientation, culture or socio-economic status. Church Personnel will portray a positive role model for children and youth by maintaining an attitude of respect, patience, and maturity. They will avoid even the appearance of favoritism.

7. One-on-one counseling with children or youth will be done in open or public or other places where private conversations are possible but occur in full view of others.

8. Classrooms, meeting rooms, nurseries or offices where activities for children or youth take place should have doors with windows, “dutch” doors, or have their doors left open when children or youth are present.

9. Church Personnel are prohibited from dating or becoming romantically involved with a child or youth.

10. Church Personnel are prohibited from possessing any sexually oriented materials (magazines, cards, videos, CDs, films, clothing, etc.) on church property or in the presence of children or youth except as expressly permitted as a part of a pre-authorized educational program.

11. Church personnel are prohibited from using the internet to view or download any sexually oriented materials on church property or in the presence of children or youth.

12. Church Personnel are prohibited from discussing their own sexual activities, dreams and fantasies, or discussing their use of sexually oriented or explicit materials such as pornography, videos, CDs, or materials on or from the internet, with children or youth.

13. Church Personnel and the use of Electronic Communication.

a. Electronic Communication is here defined as any form of communication that uses text, image, or video transmitted, or "posted", electronically. This includes, but is not limited to: Cell phone "text messaging"; Email communication; Internet websites; Blogs; Online chat and discussion forums; Social Networking utilities (such as "Facebook" or "Myspace"); And all electronic forms of communication which may arise to serve the same purpose as the above named technologies.

b. Church Personnel will use Electronic Communication in a responsible manner which seeks to fulfill our baptismal covenant. This includes communicating in such a way as to: "Proclaim by word and example the Good News of God in Christ"; "Serve Christ in all persons, loving our neighbor as ourselves"; and "Respect the dignity of every human being".

This includes, but is not limited to:

- Remembering that there is no assumption of privacy in any electronic communication, and that anything communicated by electronic means may be publicly distributed to supervisors, parishioners, friends, and family;

- Seeking to make electronic contact (i.e. by becoming online "friends", "buddies", etc.) with only those you already have personal contact with, or who are introduced to you by other personal contacts;

- Not seeking to make electronic contact with those who you do not know and with whom you have no connection;

- Making your Electronic Communication as public as possible so that parents, parishioners, and supervisors can see your online "profile(s)", blog(s), and other internet means of communication publicly;

- When communicating with underage persons, making a reasonable attempt to alert their parent or legal guardian that you are in contact with them using Electronic Communication;

-Ceasing Electronic Communication with someone if you are asked to terminate communication by them (or by their parent or legal guardian, if they are under-age);

-Providing a clear way to terminate communication, or request termination of communication, in all your Electronic Communication (i.e. Make it clear how to “defriend” you on line, or how to unsubscribe from groups or mass emails);

- Using your legal name and current contact information in any Electronic Communication;

- When communicating "privately" through Electronic Communications (via messages, email, text messages, or other means), remembering that you have a duty to report communications which indicate that someone is planning to harm themselves or others;

- Posting nothing in text, image, or video format which promotes or condones activities that are illegal or against professional ethical standards, including but not limited to: Anything that promotes illegal drug use or underage drinking; Anything that could be considered pornographic; Anything that promotes fornication or underage sexual activity; Anything that promotes hatred, violence, or criminal activity;

- Posting nothing in text, image, or video format about anyone in your ministry, unless you have explicit permission to do so from them (if they are of legal age), or from their parent or legal guardian (if they are under-age);

- Using Electronic Communication in such a way as to insure your own safety and the safety of those with whom you communicate.

14. Church Personnel are prohibited from sleeping in the same beds, sleeping bags, tents, hotel rooms or other rooms with children or youth unless the adult is as immediate family member of all the children or youth in the bed, sleeping bag, tent, hotel room or other room. Is is acceptable to have multiple adults sleep in the same room as children or youth if there is one open space such as a church basement, parish hall or camp lodge.

15. Church Personnel are prohibited from dressing, undressing, bathing or showering in the presence of children or youth.

16. Church Personnel are prohibited from using physical punishment in any way for behavioral management of children or youth. No form of physical discipline is acceptable. This prohibition includes spanking, slapping, pinching, hitting, or any other physical force. Physical force may only be used to stop a behavior that may cause immediate harm to the individual or to a child, youth, or others.

17. Church Personnel are prohibited from using harsh language, degrading punishment, or mechanical restraint such as rope or tape for behavior management.

18. Church Personnel are prohibited from participating in or allowing others to conduct any hazing activities relating to children’s or youth ministry or camp activities.

IV. RESPONDING TO PROBLEMS

A. REPORTING INAPPROPRIATE BEHAVIORS OR POLICY VIOLATIONS WITH CHILDREN OR YOUTH

1. When Church Personnel observe any inappropriate behaviors, behaviors that are inconsistent with the GUIDELINES FOR APPROPRIATE AFFECTION, or which may violate any provision of this Policies for the Protection of Children and Youth from Abuse, the must immediately report their observations. Examples of inappropriate behaviors or policy violations would be seeking private time with children or youth, taking children or youth on over-night trips without other adults, swearing or making suggestive comments to children or youth, or selecting or using staff or volunteers without the required screening.

2. Such inappropriate behaviors or possible policy violations that relate to interactions with children or youth should be reported in one of the following ways:

a. A telephone call or meeting with the immediate supervisor of the person;

b. A telephone call or meeting with the rector, if the person is not the rector;

c. A telephone call or meeting with a church warden and the Bishop if the person is the rector;

d. Submit a signed NOTICE OF CONCERN (Appendix B) to the Bishop.

3. All reports of inappropriate behavior or policy violations with children or youth will be take seriously.

B. REPORTING SUSPECTED ABUSE OF CHILDREN OR YOUTH

1. All Church Personnel are required by law and this policy to report known or suspected abuse of children or youth to the appropriate state authorities.

2. Failure to report suspected abuse of children or youth may be a crime. Reports may be made confidentially or anonymously. Every state provides immunity from civil liability for persons required to report suspected abuse in good faith and without malice. Simply stated, “in good faith” means that the person submitting the report believes what he or she is reporting to be true.

3. In addition to reporting to the state authorities, Church Personnel are required to report any suspected or known abuse of children or youth that may have been perpetrated by Church Personnel directly to the rector of the parish for that immediate and proper steps may be taken to ensure the safety of alleged victims.

4. Reports of suspected or known abuse that involve Church Personnel may be reported to the Diocese of Dallas in the following ways:

a. A telephone call, meeting or fax to the Bishop

b. A telephone call, or meeting with the rector, if the rector is not the person being complained about.

c. Submit a signed NOTICE OF CONCERN (Appendix B) to the Bishop.

5. The Diocese of Dallas and all of its parishes, missions, schools, agencies, camps and programs will cooperate with any investigation by state authorities to the fullest extent appropriate and inform authorities that a concurrent internal investigation will be directed by the Diocese of Dallas.

V. APPENDIX

A. GUIDELINES FOR APPROPRIATE AFFECTION

The Diocese of Dallas and all of its parishes, missions, schools, agencies, camps and programs are committed to creating and promoting a positive nurturing environment for our children’s and youth ministries that protect our children and youth from abuse and our Church Personnel from misunderstandings. When creating safe boundaries for children and youth, it is important to establish what types of affection are appropriate and inappropriate, otherwise that decision is left to the individual. Stating which behaviors are appropriate and inappropriate allows Church Personnel to comfortably show positive affection in ministry, and yet identify individuals who are not maintaining safe boundaries with children or youth. These Guidelines are based, in large part, on avoiding behaviors known to be used by child molesters to groom children or youth and their parents for future abuse. The following Guidelines are to be carefully followed by all Church Personnel working with or around children or youth.

Love and affection are part of church life and ministry. There are many ways to demonstrate affection while maintaining positive and safe boundaries with children and youth.

Some POSITIVE and APPROPRIATE forms of affections are listed below:

• Brief hugs

• Pats on the shoulder or back

• Handshakes

• “High-fives” and hand slapping

• Verbal praise

• Touching hands, faces, shoulders and arms

• Arms around shoulders

• Holding hands while walking with small children

• Sitting beside small children

• Kneeling or bending down for hugs with small children

• Holding hands during prayer

• Pats on the head when culturally appropriate (For example, this gesture should typically be avoided in some Asian communities.)

• Meeting for a meal or coffee in a public setting. An example of this would be a youth minister meeting one-on-one with a student at McDonalds or Starbucks.

The following forms of affection are considered INAPPROPRIATE with children and youth in ministry settings because many of them are the behaviors that child molesters use to groom children or youth ad their parents for later molestation or can be, in and of themselves, sexual abuse.

• inappropriate or lengthy hugs

• Kisses on the mouth

• Holding children over three years old on the lap

• Touching bottoms, chests or genital areas other than for appropriate diapering or toileting of infants and toddlers

• Showing affection in isolated areas such as bedrooms, closets, staff-only areas or other private rooms

• Occupying a bed with a child or youth

• Touching knees or legs of children or youth

• Wrestling with children or youth

• Tickling children or youth

• Piggyback rides

• Any type of massage given by a child or youth to an adults

• Any type of massage given by an adult to a child or youth

• Any form of unwanted affection

• Comments or compliments (spoken, written or electronic) that relate to physique or body development. Examples would be, “You sure are developing,” or “You look really hot in those jeans.”

• Snapping bras or giving wedgies or similar touching of underwear whether or not it is covered by other clothing.

• Giving gifts or money to individual children or youth

• Private meals in private settings with individual children or youth.

B. CONFIDENTIAL NOTICE OF CONCERN

Individual(s) of Concern:

Date of Occurrence:

Time of Occurrence:

Type of Concern:

[ ] Inappropriate behavior with a child or a youth

[ ] Policy violation with a child or a youth

[ ] Possible risk of abuse

[ ] Other concern:

Describe the situation: What happened, where it happened, when it happened, who was involved, who was present, who was notified? If reported to the State, what was their recommendation about investigating? Attach additional sheets if needed.

Has this situation ever occurred previously? Attach additional sheets if needed.

What action was taken? How was the situation handled, who was involved, who was questioned, were police called? Attach additional sheets if needed.

What is the follow-up plan? Does anyone else need to be notified? Will the situation need monitoring? Would you like someone else to call you to discuss this situation? Attach additional sheets if needed.

Submitted by: (Please print)

Telephone number:

Location and address

Church or agency:

Signature:

Date:

Reviewed by:

Once completed, please fax to the Bishop’s confidential fax line 214-826-4753

C. SAMPLE PAID EMPLOYEE APPLICATION FORM, CODE OF CONDUCT AND ACKNOWLEDGEMENT, RELEASE AND SIGNATURE

INSTRUCTIONS Please complete all of the questions accurately and fully. Attach additional sheets if needed.

Today’s date:

PERSONAL DATA:

Name:

Street Address:

City:

State: Zip:

How long at current address?

Mailing address:

Home phone:

Cell phone:

Best time to contact you:

Email address:

Drivers license number: State:

Social Security Number:

Are you eligible to work in this country? [ ] Yes [ ] No

Note: If you are chosen for a paid position, you will be required to show documents verifying your employment eligibility and identify to complete INS Form I-9 as required by the Immigration Reform and Control Act.

Please list your addresses in the past five (5) years:

For what position are you applying?

What interests you about the position for which you are currently applying?

What has prepared you for the position for which you are currently applying?

EMPLOYMENT HISTORY:

Please complete with your employers for the past ten (10) years:

CURRENT EMPLOYER Company Name

Address:

City: State: Zip:

Immediate supervisor name:

Immediate supervisor phone number:

Position held:

Dates of employment: from to

Reason for leaving position:

PREVIOUS EMPLOYER Company Name:

Address:

City: State: Zip:

Immediate supervisor name:

Immediate supervisor phone number:

Position held:

Dates of employment: from to

Reason for leaving position:

PREVIOUS EMPLOYER Company Name:

Address:

City: State: Zip:

Immediate supervisor name:

Immediate supervisor phone number:

Position held:

Dates of employment: from to

Reason for leaving position:

PREVIOUS EMPLOYER Company Name:

Address:

City: State: Zip:

Immediate supervisor name:

Immediate supervisor phone number:

Position held:

Dates of employment: from to

Reason for leaving position:

PREVIOUS EMPLOYER Company Name:

Address:

City: State: Zip:

Immediate supervisor name:

Immediate supervisor phone number:

Position held:

Dates of employment: from to

Reason for leaving position:

VOLUNTEER EXPERIENCE

Include all experience working with children and youth

Organization:

Contact:

Phone:

Duties:

Dates: from to

Organization:

Contact:

Phone:

Duties:

Dates: from to

Organization:

Contact:

Phone:

Duties:

Dates: from to

Organization:

Contact:

Phone:

Duties:

Dates: from to

EDUCATIONAL HISTORY

Name of School

Address:

City: State: Zip:

Type of School:

Name of program or degree:

Program completed?

Name of School

Address:

City: State: Zip:

Type of School:

Name of program or degree:

Program completed?

PROFESSIONAL/CIVIC REFERENCES

Name:

Address:

City: State: Zip:

Daytime phone:

How long have you known this person?

Relationship to you:

Name:

Address:

City: State: Zip:

Daytime phone:

How long have you known this person?

Relationship to you:

Name:

Address:

City: State: Zip:

Daytime phone:

How long have you known this person?

Relationship to you:

Name:

Address:

City: State: Zip:

Daytime phone:

How long have you known this person?

Relationship to you:

FAMILY REFERENCES:

Name:

Address:

City: State: Zip:

Daytime phone:

How long have you known this person?

Relationship to you:

Have you ever been accused of physically, sexually, or emotionally abusing a child or an adult?

[ ] Yes [ ] No

If yes, please explain.

CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH

Read and initial each item to signify your agreement to comply with the statement.

_____ I agree to do my best to prevent abuse and neglect among children and youth involved in church activities and services.

_____ I agree not to physically, sexually or emotionally abuse or neglect a child or youth.

_____ I agree to comply with the policies for GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN defined in the Episcopal Diocese of Dallas Polices for the Protection of Children and Youth from Abuse.

_____ I agree to comply with the GUIDELINES FOR APPROPRIATE AFFECTION with children and youth.

_____ In the event that I observe any inappropriate behaviors or possible policy violations with children or youth, I agree to immediately report my observations.

_____ I acknowledge my obligation and responsibility to protect children and youth and to agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with the POLICIES FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE.

_____ I understand that the church will not tolerate abuse of children and youth and I agree to comply in spirit and in action with this position.

ACKNOWLEDGMENT, RELEASE AND SIGNATURE

To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, driving record, criminal record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize _______________________ [Parish, agency, school] to request and receive such information.

discretion and without prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without without prior notice at the option of ____________________ [Parish, agency, school] or myself. Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contract between myself and ____________________ [Parish, agency, school] for either employment or volunteering or the provision of any benefit. I HAVE READ AD UNDERSTAND THE ABOVE PROVISIONS.

SIGNATURE __________________________________________________DATE___________________

D. SAMPLE VOLUNTEER APPLICATION FORM, CODE OF CONDUCT AND ACKNOWLEDGEMENT, RELEASE AND SIGNATURE

INSTRUCTIONS Please complete all of the questions accurately and fully. Attach additional sheets if needed.

Today’s date:

PERSONAL DATA:

Name:

Street Address:

City:

State: Zip:

How long at current address?

Mailing address:

Home phone:

Cell phone:

Place of Employment:

Address:

City: State: Zip:

Work Phone:

Best time to contact you:

Email address:

Drivers license number: State:

For what position are you applying?

What interests you about the position for which you are currently applying?

What has prepared you for the position for which you are currently applying?

VOLUNTEER EXPERIENCE

Include experience working with children and youth, including Sunday School, Youth Sponsor, Boy Scouts, Soccer coaching, etc

Organization:

Duties:

Dates: from to

Organization:

Duties:

Dates: from to

Organization:

Duties:

Dates: from to

Organization:

Duties:

Dates: from to

Have you ever been accused of physically, sexually, or emotionally abusing a child or an adult?

[ ] Yes [ ] No

If yes, please explain.

CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH

Read and initial each item to signify your agreement to comply with the statement.

_____ I agree to do my best to prevent abuse and neglect among children and youth involved in church activities and services.

_____ I agree not to physically, sexually or emotionally abuse or neglect a child or youth.

_____ I agree to comply with the policies for GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN defined in the Episcopal Diocese of Dallas Polices for the Protection of Children and Youth from Abuse.

_____ I agree to comply with the GUIDELINES FOR APPROPRIATE AFFECTION with children and youth.

_____ In the event that I observe any inappropriate behaviors or possible policy violations with children or youth, I agree to immediately report my observations.

_____ I understand that the church will not tolerate abuse of children and youth and I agree to comply in spirit and in action with this position.

For those to be involved in overnight activities with children or youth or who will be serving in long-term or regular Nursery care, please complete the following:

ACKNOWLEDGMENT, RELEASE AND SIGNATURE

If hired or chosen, I agree to be bound by _________________ [Parish’s, agency’s, school’s] policies and procedures, including but not limited to the Episcopal Diocese of Dallas POLICIES FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE and CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH. I understand that these may be changed, withdrawn, added to or interpreted at any time at the ______________________ [Parish’s, agency’s, school’s] sole discretion and without prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without without prior notice at the option of ____________________ [Parish, agency, school] or myself. Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contract between myself and ____________________ [Parish, agency, school] for either employment or volunteering or the provision of any benefit. I HAVE READ AD UNDERSTAND THE ABOVE PROVISIONS.

SIGNATURE __________________________________________________DATE___________________

E. TEXAS STATE CHILD ABUSE REPORTING WEBSITE

www.tdprs.state.tx.us

F. TEXAS STATE CRIMINAL RECORDS AND SEX OFFENDERS REGISTRY INFORMATION

Texas Department of Public Safety

Crime Records Division

P. O. Box 4143

Austin, Texas 78765

https://records.txdps.state.tx.us/DPS_WEB/SorNew/index.aspx

G. BACKGROUND CHECK SITES:

Publicdata.com

Oxforddoc.com

Familywatchdog.us

Webmasters: Sherece Johnson & Sherry Johnson