Safety Team Application


Name *
Name
Date of Birth *
Date of Birth
Current Address *
Current Address
Cell Phone *
Cell Phone
Home Phone
Home Phone
Spouse Name
Spouse Name
Are You A Member of the Church of Christ *
Have you even been arrested for, charged with, accused or suspected of or questioned about any crime other than a traffic offense? *
Do you have any issue (not limited to physical or mental) that would limit your participation in this program? *
Have you ever been questioned about any inappropriate conduct around any child or children? *
Reference with phone number who attends Sunset, not related to you: *
Reference with phone number who attends Sunset, not related to you:
Phone 2 *
Phone 2
Reference with phone number who attends Sunset, not related to you: *
Reference with phone number who attends Sunset, not related to you:
Phone 3 *
Phone 3
Reference with phone number who does not attend Sunset, not related to you: *
Reference with phone number who does not attend Sunset, not related to you:
Phone 4 *
Phone 4
Reference with phone number who does not attend Sunset, not related to you: *
Reference with phone number who does not attend Sunset, not related to you:
Is there anything you need to inform the Safety Committee of that might affect their decision to include you on the Safety Team? *
Do you give assurance the information in this application is correct to the best of your knowledge and do you understand that any omission, misinformation or inaccurate information is grounds for your removal from the safety team? *
Do you give permission for the Sunset Church of Christ to conduct a background investigation as deemed necessary including (but not limited to) contacting your references and others who may know you? *
Today's Date *
Today's Date