Russell Cave Reading Program Volunteer Application "*" indicates required fields 1Personal Information2Personal References Personal InformationName* First Last Email* 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 Home Phone*Daytime PhoneAre you a resident of Kentucky?* No Yes If no, in which state are you a resident, and how long have you resided there?* If yes, how long have you been a resident of Kentucky?* Are you 18 years of age or older?* No Yes If no, please give current age.* Do you attend this church?* Yes No Have you ever been convicted of or pled guilty or no contest to a crime other than a minor traffic violation, or are you now under charges for any criminal offense?*A criminal conviction will not necessarily disqualify you from consideration. No Yes If yes, please explain fully.*Background Check Authorization*I authorize First Alliance Church to request a police background check from law enforcement authorities in Kentucky or any other jurisdiction as deemed appropriate. I agree.* Personal ReferencesPlease include complete addresses. Do not use relatives or former employers.List four personal references who are well acquainted with you.*Please use references that have seen you interact with children if possible.NameEmail AddressPhysical Address Add RemoveReference Authorization*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 (including opinions) that they may have regarding my character and fitness for children’s or youth work. In consideration of the receipt and evaluation of this application by First Alliance Church, I hereby release any individual, church, youth 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 compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. I have read and understand the above provisions, and agree to them. I agree.*EmailThis field is for validation purposes and should be left unchanged.