TRBC Application for Supervision of Minors (Print out this form and present it to an elder, it is treated as confidential)
Personal Information
Applicant's Name:
Street Address:
City, State, Zipcode:
Phone Number:
Full explanation of any prior arrest or criminal convictions for sexual abuse, molestation, or related crimes:
Circle the type of work you are interested in:  Nursery, Youth Group, Other, explain:	Training or education in youth related work:
Description of Church membership over past 5 years:
Description of Church volunteer work over the past 5 years:
Description of any youth work (Church or other) over the past 5 years:
If you are not a member, please list two references:
Name:
Address:
Phone:
Signature
We appreciate your desire to serve in our church! Sign below to affirm that the previous information is true to the best of your knowledge and that you will notify an elder if there is any substantial change to the information given.
Signature of applicant:
Date: