Touchstone Volunteer Application

This confidential application is to be completed by all applicants for any position involving contact with students or the representation of Touchstone in any official capacity.

Full Name*

First NameLast Name

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email*

example@example.com

Primary Phone*

Area CodePhone Number

Date of Birth*

MonthDayYear

Drivers License Number*

Occupation*

Employer*

Marital Status*

Do you have children/grandchildren?*

YesNo

If so, describe your relationship with them.

What makes you want to volunteer with Touchstone?*

Please identify any skills you have that may be useful to our work.*

Describe any experience you have as a teacher, counselor, social worker, pastor, youth worker or similar helping profession.*

Do you have any physical, emotional, or mental conditions that might affect your abiliity to work with students?*

YesNo

If yes, explain.

Are you contagious with any communicable disease such as TB, hepatitis, or HIV?*

YesNo

If yes, explain.

Have you ever been hospitalized for a psychiatric condition?*

YesNo

If yes, explain the condition, when you were hospitalized, and for how long.

Are you taking any medications that could cause physical or mental impairment?*

YesNo

If yes, list the medication and describe the impairment.

Have you ever been accused, investigated, indicted, or convicted of any misdemeanor or felony other than a minor traffic violaton?*

YesNo

If yes, explain.

Have you ever been convicted of a criminal offense that includes the sale or use of drugs?*

YesNo

If yes, explain.

Have you ever been accused, investigated, indicted or convicted of any sexual misconduct related to minors?*

YesNo

If yes, explain.

Did you experience trauma as a child or yough (e.g. parent's substance abuse, physical, emotional, or sexual abuse, loss of parent, etc.)?*

YesNo

If yes, explain.

If you experienced trauma, have you received professional help for this?

YesNo

If yes, explain.

If no, would you be willing to receive help?

YesNo

If you have worked with children or youth in any other context, please include under Youth Work References below.

Organization 1

Organization 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Org 1 Phone Number

Area CodePhone Number

Org 1 Start & End Dates

Org 1 Reference Name

First NameLast Name

Organization 2

Organization 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Org 2 Phone

Area CodePhone Number

Org 2 Start & End dates

Org 2 Reference Name

First NameLast Name

List the name, address, and phone number of two people who are not related to you who know you personally and have a definite knowledge of your character.

Personal Reference 1*

Personal Reference 2*

Touchstone Child Security Policy:

To prevent the actual occurrences of child abuse, or even allegations of child abuse, all leaders are to follow the guidelines listed below. Anyone who works with students for Touchstone Youth Resource Services, Inc./CiViL Groups is subject to the supervision and evaluation of the Touchstone program staff. Touchstone reserves the right to dismiss workers who fail to follow policies and guidelines.

Should leaders suspect a student has been abused by any adult, they must report the abuse to the State Department of Child Services 1-877-237-0004 as required by law.

Leader / Student Procedures:

Leaders should avoid being alone with any individual student.
When a one-on-one meeting is necessary, the classroom door window must remain uncovered.
Leaders should not give car rides to individual students of the opposite gender.
Physical contact with students should be minimal, age appropriate, gender appropriate, and done in the presence of other adults in an open area.
When transporting students, leaders MUST text designated director when the first student is picked up, and when the last student is dropped off. Please include the names of students you are transporting.
Leader must get prior approval for any involvement or activity with students who are affiliated with Touchstone/CiViL. If leader feels a student and his/her family is in need, the leader must bring this to the Touchstone/CiViL director’s attention so that the need is properly assessed. Leaders do not give gifts, money, or any other items to students without prior approval of director.

Touchstone Mission Statement: We inspire change by helping youth...

Envision a hopeful future,
Embrace positive options, and
Engage in real steps toward a better life.

Touchstone Beliefs

God has called us to use the resources he has provided to carry out His work on earth to individuals and groups in and outside the church
The Gospel of Jesus Christ as it is set forth in the Bible and in the basic tenets of Christianity expressed in the Apostle’s Creed and the Nicene Creed

Applicant's Statement: "I, the undersigned, declare that the information in this application is correct to the best of my knowledge. I affirm and agree to abide by the Touchstone Child Security Policy, the Touchstone Mission, and the Touchstone Beliefs. I authorize any references or organizations listed in this Volunteer Application to release all such references from liability for any damage that may result from furnishing such evaluations to Touchstone, and I waive any right that I may have to inspect references provided on my behalf. I hereby givbe Touchstone Youth Resource Services, Inc. permission to conatct my references and any parties necessary to do a background check. I understand and submit to temporary or permanent removal from volunteer placement at any time Touchstone leadership should deem it necessary."

Signature*

Signature Date*

MonthDayYear

Touchstone Volunteer Application

Youth Work References

Personal References