Background Check
  1. If you have a completed application on file with the office, it is not necessary for you to complete this online form. Application Form For Working with Children, Students or Vulnerable Adults Cornerstone Church Confidential (as provided in the Policy) This application is to be completed by all applicants for any position (volunteer or compensated) involving working with children, students or vulnerable adults. This is not an employment application form. It is being used to help Cornerstone provide a safe and secure environment for those in our care.
  2. First Name(*)
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  3. Middle Name(*)
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  4. Last Name(*)
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  5. Maiden Name or other Aliases
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  6. Please enter your address, city, zip code(*)
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  7. Phone(*)
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  8. Email
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  9. Please check one option(*)
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  10. Sex(*)
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  11. Date of Birth(*)
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  12. Have you lived outside of Michigan in the last 5 years?(*)
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  13. If yes, please specify address
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  14. Have you lived outside of Kent County in the last 5 years?(*)
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  15. If yes, please specify county
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  16. Criminal History
  17. Have you ever been convicted of or pled guilty to a crime?(*)
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  18. Do you have any pending charges against you?(*)
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  19. Have you ever been formally charged with any abuse or criminal sexual conduct?
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  20. If you are under 18, have you been charged with any crime in the Juvenile Court system?(*)
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  21. Have you been found guilty of violating a school rule?(*)
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  22. Please explain any "yes" answers.
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  24. How long have you attended Cornerstone Church?(*)
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  25. List name and address of other churches you have attended regularly in the past five years.
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  27. Were you a victim of abuse or molestation of any kind?
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  28. NOTE: If you prefer, you may OMIT answering this question, or you may discuss your answer in confidence with the Director of Kids’ Ministry, Pastor or Administrator rather than answering it on this form. Answering yes, or leaving the question unanswered, will not automatically disqualify an applicant from providing care for children, students or vulnerable adults.
  30. The information contained in this application is correct to the best of my knowledge. I understand that a background check will be conducted with the Michigan State Police and the National Sex Offenders Database using the information provided. If I have lived out of state in the past five years, that state could also be contacted. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for this work. In consideration of the receipt and evaluation of this application by Cornerstone Church, I hereby RELEASE any individual, church, 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 providing or complying or attempting to comply with this authorization. I have received and read the Cornerstone Church Protection and Abuse Prevention Policy (the “Policy”) and understand that this is a condition of my appointment as a Care Provider. Should my application be accepted, I agree to be bound by the rules and policies of Cornerstone Church, including the Policy.
  31. Type in your initials to indicate you agree(*)
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  32. Enter the Numeric Code
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