Safety Team Volunteer Application If you are human, leave this field blank.Knox Safety Team Volunteer ApplicationFirst name *Last name *Current occupationAddress *CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityZip codeEmail *Preferred phone number *Preferred phone type *Home PhoneMobile PhoneOffice PhoneAlternate phone numberAlternate phone typeHome PhoneMobile PhoneOffice PhoneKnox Member *YesNoAttending Knox since (month-year):Have you served in other ministries at Knox?YesNoIf so, what was your experience? If you continue to serve in that ministry, does it conflict with being on the Safety Team?YesNoPlease note other church(es) you have attended in the past 5 years? (if applicable)Please list: Church name, pastor's name, and # of years attended QuestionsWhy would you like to serve on the Safety Team? *Are you able to commit to one Sunday a month?We recognize there are times when people need to be gone due to conflicts—vacations, illness, etc. YesNoWould you be able to be at church from 8:30 AM - 12:30 PM on your designated Sunday?YesNoIf you are married, does your spouse support your participation on the Safety Team?YesNoWhat qualities or skills do you have that would help you work with the public? *Do you have any special safety training or credentials that might support your participation on the Safety Team?YesNoIf yes, please describe:What safety or security related work or volunteer experience do you have, if any?Do you have any disabilities or conditions which would prevent you from carrying out safety-related duties, such as lifting or running? *YesNoIf yes, please explain: ReferencesInstructionsPlease provide three references (other than relatives) and their contact information. One reference should be someone who is not connected with Knox Church. Name of reference #1 *Email or street address of reference #1 *Phone number of reference #1Name of reference #2 *Email or street address of reference #2 *Phone number of reference #2Name of reference #3 *Email or street address of reference #3 *Phone number of reference #3Reference disclosureI understand that any release/disclosure of information carries with it the potential for an unauthorized redisclosure and the information may not be protected by Federal Confidentiality Laws. I understand that I have waived my right to inspect any information provided by my references and have released all individuals and organizations from any and all liability for damages in regard to their release of information about me. Agreement to reference disclosure *I agreeI do not agree Applicant AgreementI certify that the information I have provided in this application is correct to the best of my knowledge. I understand that this application will be kept strictly confidential. Applicant Agreement *I agreeI do not agreeIf there are any changes in the above information, the volunteer should inform the Safety Team Director. All applicants must complete a Knox Applicant Release and Agreement Form. If you have not completed this form in the past three years, please download and complete the form, and place in a sealed envelope in the Safety Team mailbox in the lower level workroom. For prompt processing of your application, please complete this form within two weeks of applying. After submitting this application you will be automatically redirected to the Applicant Release and Agreement Form. Thank you for your interest in the Knox Safety Team! Captcha *reCAPTCHA is required.Submit
