Volunteer Background Check Form

Release Authorization:
1. In connection with my future involvement as a staff member or a volunteer working with children, I understand that Wiley Union Church will conduct a background check to determine my ability to minister in this role. It may include information concerning my character, work habits, performance and any court records that may have a bearing on my job responsibilities.

2. I acknowledge that a telephonic facsimile (fax) or photographic copy shall be as valid as the original.

3. I hearby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, church or non-profit organization, reference, or insurance company contacted by Wiley Union Church to furnish this information described above.

4. I understand that if any of those records contains information which is used to deny my involvement in ministering at Wiley Union Church, that I will be notified of my rights and where I can obtain a copy of the information.

5. If a background check reveals a prior sexual misconduct related offense that I will be permanently ineligible to be involved in any way with minors.

Applicant's Info



Personal Interview




If you prefer, you may refuse to answer this question and discuss your answer in confidence with the Pastor rather than answering it on this form.  Answering "Yes" or refusing to answer will not automatically disqualify an applicant for children or youth ministries.

Church Involvement


Unless otherwise approved by Wiley's Board of Elders, there is a three month waiting period before new church attendees are allowed to volunteer or interact with minors.



Youth & Children Service History

Personal References

(not former employees or relatives)

Applicant's Statement of Acknowledgement & Agreement

I waive or do not waive, as indicated below, any right that I may have to inspect any information provided about me by any person or organization identified by me in this screening form.

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give any information (including opinions) that they may have regarding my character and fitness for work with youth and children to Wiley Union Church or its representative. In consideration of the receipt and evaluation of this application by Wiley Union Church, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization, excepting only the communication of knowingly false information.
As a volunteer or paid worker for Wiley Union Church, I agree to abide by the child protection policy and to refrain from unbiblical conduct in the performance of my services and duties on its behalf.

I have received and read the Wiley Union Church Child Abuse Policy and Procedure document and agree to follow the same in handling any child abuse situations that may arise.

I further acknowledge that I have carefully read and understand the contents of this application and I sign this authorization of my own volition.

Submit