Child/Youth Work Application Form Full Name*Todays Date* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Age*What type of Child/Youth work do you prefer?*Have you any physical handicap or conditions preventing you from performing certain types of activities relating to youth or children’s work?* Yes No If yes, please explain. Have you ever been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor?* Yes No Have you ever entered a “no contest” plea to a charge of sexual molestation of a minor or what otherwise might be considered a “sex crime”?* Yes No If yes, please explain. Name of church of which you are a member or regular attender.*List other churches you have attended regularly during the past five years.* List previous church, school or ministry work involving youth (identify church and type of work) Personal References: (Not former employers or relatives)Reference Name*Reference Phone*Email* Reference NameReference PhoneEmail 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 you any information they may have regarded my character and fitness for child/youth work. Should applications be accepted, I agree to be bound by the Constitution & Bylaws and policies of Tulsa Bible Church, and to refrain from unscriptural conduct in the performance of my services on behalf of the Church.* I agree with the above statement. Upon clicking the submit button below, you will be redirected to the Tulsa Bible Church Background Screening form. This must also be filled out in order for you to be considered for any child/youth work.