ROCKFISH CHURCH VOLUNTEER APPLICATION

ROCKFISH CHURCH VOLUNTEER APPLICATION Please complete the entire form and return to the Welcome Center (in foyer) or church office in a sealed envelope addressed to Director of Ministry. If you have any questions please feel free to contact the church office at 910-875-5680 or email Office@RockFishChurch.com. 1 P a g e

General Information 9949 Fayetteville Road Raeford, NC 28376 RockFishChurch.com 910.875.5680 Volunteer Application (Confidential) Last Updated 9.26.13 First Name: Last Name: MI: DOB: (mm/dd/yyyy) Age: M / F Current Marital Status: If married, spouse s name: How many people currently live in your home? ZIP: Cell Phone: Home Phone: Work Phone: Email (required): Is there a specific ministry you are interested in? If interested in RockFish Kids, please check off your preference(s): 9:00 Sunday 10:30 Sunday 1:00 Sunday Wednesday Night Nursery Employment History Employer: Job Title: Supervisor: Length of Employment: ZIP: Phone: 2 P a g e

Previous Employer: Job Title: Supervisor: Length of Employment: ZIP: Phone: Personal Information The following questions are designed to help us provide a safe and loving environment for ministry and those utilizing the ministries of RockFish Church. Answering yes or no to questions in this section will not necessarily disqualify you from participating in the ministry of RockFish Church. You may be asked to participate in a confidential meeting with the ministry s oversight to determine whether certain issues may have a bearing on your ability to work in those areas. Have you ever been arrested? Are you currently under a charge or have you ever been convicted or pleaded guilty to child abuse or a crime involving actual or attempted sexual misconduct or molestation of a minor? Have you ever been a victim of any form of child abuse? If you answered yes to the previous questions, are you willing to discuss this with a leader of RockFish Church? Have you struggled with any addiction such as alcohol, drugs, gambling, or pornography in the past five years? If you answered yes to the previous question, are you willing to discuss this with a leader of RockFish Church? Have you been involved in any form of sexual immorality in the past five years, whether premarital, homosexual, or extramarital? If you answered yes to the previous questions, are you willing to discuss this with a leader of RockFish Church? 3 P a g e

Have you had any serious sickness or injuries? If so, please list details and age occurred: Current Medications: Physical Impairments: Do you have a history of mental illness? Have you ever been military or court ordered for anger management classes? Do you use drugs or alcohol? (even occasionally) Do you use tobacco products? Have you been convicted of a felony? Are you currently under a felony charge? Is there any other information we should know? Spiritual History and Background Have you completed all 4 classes of Pastor s Class 101? Are you a member of RockFish Church? (circle one) YES NO I Don t Know Which RockClimber Classes have you completed? (circle) NONE 201 301 401 501 How long have you been attending RockFish Church? Do you tithe or give on a regular basis? Is there anything that you feel would disqualify you from volunteering? 4 P a g e

Briefly describe your spiritual journey, including when you received Christ as your Savior: List all churches that you have regularly attended during the past five years: Church Name: Pastor s Name: Church Name: Pastor s Name: Church Name: Pastor s Name: References Please list three adults you have known for at least one year, who are not related to you, and who have definite knowledge of your character and abilities. Name: Nature of Association: Occupation: How long have you know this person? ZIP: Cell Phone: Home Phone: Email Address: 5 P a g e

Name: Nature of Association: Occupation: How long have you know this person? ZIP: Cell Phone: Home Phone: Email Address: Name: Nature of Association: Occupation: How long have you know this person? ZIP: Cell Phone: Home Phone: Email Address: List any special training or experience associated with the area you are applying for: 6 P a g e

Please read to following statement very carefully: I agree that the information contained in this application is correct to the best of my knowledge. I authorize any person or organization, whether or not identified in this application, to give any information (including opinion) regarding my character and fitness for volunteer services. I hereby release any individual, church, denominational agency or official of any other organization, including record custodians, both collectively and individually, and whether or not identified in this application, from any 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 attempt to comply with this authorization, excepting only to communication of false information. I further state that I HAVE READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEROF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding release which I have read and fully understand. I understand that I may consult my attorney before signing this document. I FURTHER UNDERSTAND THAT A CRIMINAL RECORDS CHECK MAY BE CONDUCTED ON ME, AND I CONSENT TO ANY SUCH CHECK. This space may be used to provide additional information relevant to your application: Signature: Date: Disclosure and Authorization 7 P a g e

Disclosure and Authorization for Access to Consumer Reports Authorization I hereby authorize, without reservation, the obtaining of consumer reports or investigative consumer reports by RockFish Church at any time after receipt of this authorization and throughout my employment or volunteer service, if applicable. I further authorize and request, without reservation, any present or former employer, school, police department, state or federal agency, financial situation, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about me to furnish SecureSearch or RockFish Church with any and all background information in their possession regarding me, so that my employment or volunteer qualifications may be evaluated and/or reassessed. I also agree that a fax or photocopy of this authorization with my signature should have the same authority as the original. By signing below, I certify: (1) that I have read and fully understand this disclosure and authorization; (2) that all the information I am providing is true, complete, correct and accurate; and (3) that I have reviewed the attached Summary of Your Rights under the Fair Credit Reporting Act (15 U.S.C. 1681 et seq.) The following information is required for RockFish Church to obtain a complete consumer report: First Name: Middle Name: Last Name: Date of Birth: Social Security Number: Please list any former names: (maiden, surname, etc.) ZIP: Driver s License Number: Issuing State: Signature: Date: 8 P a g e

Please list all counties and states that you have lived in since the age of 18: County: State: Name Used in County: Date From: Date To: County: State: Name Used in County: Date From: Date To: County: State: Name Used in County: Date From: Date To: County: State: Name Used in County: Date From: Date To: 9 P a g e

Disclosure In connection with your application for employment or volunteer service with RockFish Church (including any independent contract for services) or when deciding whether to modify or continue your ongoing employment (if hired) volunteer or paid service, RockFish Church may obtain a consumer report and/or an investigative consumer report on you from SecureSearch, a consumer reporting agency, or from any third party, in strict compliance with both state and federal law. A consumer report is a communication of information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used for purposes of serving as a factor in establishing your current and/or continuing eligibility for volunteer and employment purposes. An investigative consumer report is a report obtained through personal interviews with individuals who may have knowledge of your character, general reputation, personal characteristics, or mode of living. The consumer reports or investigative consumer reports may contain information regarding your credit history (if applicable to position), criminal records, driving history records, education records, previous employment history, social security traces, military records, professional licensure records, drug testing, government records, and other types of background information. Your further understand that these reports may contain information concerning the reason for termination of past employment. You are hereby notified that, prior to being denied employment or volunteer service based in whole or in part on the information obtained in the consumer report, you will be provided a copy of the report, the name, address and telephone number of the consumer reporting agency and a description in writing of your rights under the Fair Credit Reporting Act. Inquiries to SecureSearch should be directed to SecureSearch; Consumer Disputes; 558 Castle Pines Parkway. #b4-137, Castle Rock, CO 80108. 1 (866) 891-1954. MAINE AND NEW YORK APPLICANTS OR EMPLOYEES ONLY: You have the right to inspect and receive a copy of your investigative consumer report requested by RockFish Church by contacting the consumer reporting agency identified directly above. NEW YORK APPLICATION OR EMPLOYEES ONLY: By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law. MINNESOTA AND OKLAHOMA APPLICANT OR EMPLOYEES ONLY: Please check this box if you would like to receive a copy of a consumer report if one is obtained by Rockfish Church. CALIFORNIA APPLICANTS OR EMPLYEES ONLY: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by RockFish Church whenever you have a right to receive such a copy under California law. 10 P a g e

NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW RockFish Church intends to obtain information about you for employment purposes from an investigative consumer reporting agency or consumer credit reporting agency. Thus, you can expect to be the subject of investigative consumer reports and consumer credit reports obtained for employment purposes. Such reports may include information about your character, general reputation, personal characteristics and mode of living. With respect to any investigative consumer reports from an investigative consumer reporting agency (ICRA), RockFish Church may investigate the information contained in your employment application and other background information about you, including but not limited to obtaining a criminal record report, verifying references, work history, your social security number, your educational achievements, your licensure and certifications, your driving record, and other information about you, and interviewing people who are knowledgeable about you. The results of this report may be used as a factor in making employment decisions. The source of any investigative consumer report (as that term is defined under California law) will be SecureSearch; Consumer Disputes; 558 Castle Pines Parkway/ #b4-137, Castle Rock, CO 80108. 1 (866) 891-1954. The source of any credit report will be SecureSearch; Consumer Disputes; 558 Castle Pines Parkway/ #b4-137, Castle Rock, CO 80108. 1 (866) 891-1954. RockFish Church agrees to provide you with a copy of an investigative consumer report when required to do so under California law. Under California Civil Code section 1786.22, you are entitled to find out from an ICRA what is in the ICRA s file on you with proper identification as follows: in person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The ICRA may not charge you more than the actual copying costs for providing you with a copy of your file. A summary of all information contained in the ICRA s file on your that is required to be provided by the California Civil Code will be proved to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone calls is prepaid by or directly charged to you. By requesting a copy be sent to a specified addressee by certified mail. ICRA complying with requests for certified mailing shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICRA. Proper identification includes documents such as a valid driver s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the ICRA require addition information concerning your employment and personal or family history in order to verify your identity. The ICRA will provide trained personnel to explain any information furnished to you and will provide written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file in such person s presence. The following are my responses to questions about my criminal record history (if any) with descriptions to any question with a YES answer. Have you ever been convicted or pleaded guilty before a court of any federal, state, or municipal criminal offense (excluding minor traffic violations)? YES NO If YES, please explain: Have you ever received a deferred adjudication or similar disposition for any federal, state, or municipal criminal offense? YES NO If YES, please explain: 11 P a g e

Have you ever received probation or community supervision for any federal, state, or municipal criminal offense? YES NO If YES, please explain: Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States? YES NO If YES, please explain: As of the date of this authorization, do you have any pending criminal charges against you? YES NO If YES, please explain: Have you ever served in the US Military? YES NO If YES, please explain: If you answered YES to the above question, did you receive a DD214? YES NO If you answered YES, are you able to provide the document? YES NO If you answered YES to serving in the US Military, did you receive an honorable discharge? YES NO If NO, please explain: Signature: Date: 12 P a g e

Summary of Your Rights Under the Fair Credit Reporting Act A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus that gather and sell information about your creditworthiness to creditors, employers, landlords, and other businesses. The FCRA gives you specific rights, which are summarized below. You may have additional rights under state law. For more information, go to www.ftc.gov/credit, or write to: Consumer Response Center, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580. You must be told if information in your file has been used against you. Anyone who uses information from a consumer reporting agency to deny your application for credit, insurance, or employment or take another adverse action against you must tell you and give you the name, address, and phone number of the agency that provided the information. You can find out what is in your file. At any time, you may request and obtain your report from a consumer reporting agency. You will be asked to provide proper identification, which may include your Social Security number. In many cases the report will be free. You are entitled to free reports if a person has taken adverse action against you because of information in a report; if you are the victim of identify theft; if you are the victim of fraud; if you are on public assistance; or if you are unemployed but expect to apply for employment within 60 days. In addition, you are entitled to one free report every twelve months from each of the nationwide credit bureaus and from some specialized consumer reporting agencies. See www.ftc.gov/credit for details about how to obtain your free report. You have a right to know your credit score. Credit scores are numerical summaries of a consumer s creditworthiness based on information from consumer reports. For a fee, you may get your credit score. For more information, click on www.ftc.gov/credit. In some mortgage transactions, you will get credit score information without charge. You can dispute inaccurate information with the consumer reporting agency. If you tell a consumer reporting agency that your file has inaccurate information, the agency must take certain steps to investigate unless your dispute is frivolous. For an explanation of dispute procedures, go to www.ftc.gov/credit. Inaccurate information must be corrected or deleted. A consumer reporting agency or furnisher must remove or correct information verified as inaccurate, usually within 30 days after you dispute it. However, a consumer reporting agency may continue to report negative data that it verifies as being accurate. Outdated negative information may not be reported. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need as determined by the FCRA -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. 13 P a g e

Identity theft victims and active duty military personnel have additional rights. Victims of identity theft have new rights under the FCRA. Active-duty military personnel who are away from their regular duty station may file active duty alerts to help prevent identity theft. For more information, visit www.ftc.gov/credit. Your consent is required for reports that are provided to employers. A consumer reporting agency may not give out information about you to your employer, or potential employer, without your written consent. Blanket consent may be given at the time of employment or later. You may choose to remove your name from consumer reporting agency lists for unsolicited credit and insurance offers. These offers must include a toll-free phone number you can call if you choose to take your name and address off lists in the future. You may seek damages from violators. If a consumer reporting agency, a user of consumer reports, or, in some cases, a furnisher of information to a consumer reporting agency violates the FCRA, you may sue them in state or federal court. The FCRA gives several federal agencies authority to enforce the FCRA: TO COMPLAIN AND FOR INFORMATION: Consumer reporting agencies, creditors and others not listed below National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Federal credit unions (words "Federal Credit Union" appear in institution's name) State-chartered banks that are not members of the Federal Reserve System Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921 PLEASE CONTACT: Federal Trade Commission Consumer Response Center - FCRA Washington, DC 20580 1-877-382-4367 (Toll-Free) Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC 20219 800-613-6743 Federal Reserve Board Division of Consumer & Community Affairs Washington, DC 20551 202-452-3693 Office of Thrift Supervision Consumer Programs Washington, DC 20552 800-842-6929 National Credit Union Administration 1775 Duke Street Alexandria, VA 22314 703-518-6360 Federal Deposit Insurance Corporation Division of Compliance & Consumer Affairs Washington, DC 20429 800-934-FDIC Department of Transportation Office of Financial Management Washington, DC 20590 202-366-1306 Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC 20250 202-720-7051 14 P a g e