As we go through the volunteer process, we will need a copy of your driver's license or another photo identification. HSLC requires a valid driver’s license or photo id to be on file. If your current driver's license or photo id is expired, you will be contacted to provide another copy

Yes

Have you been convicted of, or pleaded guilty or no contest to, any crime? *

Yes

Have you ever been investigated by Child Protective Services or the Department of Social and Health Services for alleged child abuse or neglect? *

Yes

Have you ever been asked not to attend another church or to cease volunteering with any other organization? *

Yes

Is there any fact or circumstance in your background that would call into question the advisability of entrusting you with the supervision, guidance and care of young people? *

Yes

RELEASE AND AUTHORIZATION OF RELEASE OF INFORMATION I have applied for volunteer status at Holy Spirit Lutheran Church (the “Church”). I authorize the Church to contact any person or entity to obtain information concerning me, including, but not limited to, the employers, organizations, supervisors, governmental agencies, and references listed in my application. Without limiting the foregoing, I understand and agree that this release allows the Department of Social and Health Services, including, but not limited to, Child Protective Services, to release information concerning me. I hereby release and agree to hold harmless from liability any person or organization (whether listed in my application or not) who provides information or references about me to the Church or its officers, employees, volunteers, and agents. I also hereby release and agree to hold harmless the Church and its past, present, and future officers, employees, volunteers, and agents with respect to the obtaining of such information about me. I waive any right I might have to inspect the references provided on my behalf. A digital copy of this release shall be as effective as a signed original. I understand and agree that the Church may conduct a criminal background check on me upon an offer of volunteer status and that the Church may continue to conduct future background checks should I continue to volunteer. I have read this release and authorization of release of information and enter it freely and voluntarily. By signing I certify that the information given is true and complete to the best of my knowledge. *

Please type your name below as signature

Date *

YYYY

Thank you!

Don’t forget to fill out your Criminal Background Check Form (if you are 18 or older).

Holy Spirit Lutheran Church ELCA

10021 NE 124th Street | Kirkland, WA 98034 | 425-823-2727 | office@hslckirkland.org

Worship Times 8:00, 9:30 & 11:00 am

Sunday School 9:30 am

Office Hours Monday-Friday 9:00 am - 1:00 pm and by appointment 1:00 pm to 4:00 pm

OFFICE CLOSED Thursday, November 28 and Friday, November 29 in observance of the Thanksgiving holiday