Discipleship Training School Application Please enable JavaScript in your browser to complete this form.Discipleship Training School Application Form Thank you for applying for the Discipleship Training School in Liverpool. Please answer all the questions on this application form prayerfully and honestly. If you need more space to answer a question, please use a separate piece of paper. Married couples must complete separate applications forms. Please send any questions you have regarding this application or the Discipleship Training School to info@YWAMLiverpool.co.uk We require each of our applicants to have three confidential references. Please fill in the contact details for your church leader, employer/leader, and friend. We will send the appropriate reference forms. References from family members will not be accepted. Church Leader Reference - This must be filled out by your pastor. If you are unable to obtain a pastor’s reference, please contact us and we will discuss an acceptable alternative referenceEmployer/Leader Reference - This must be someone who has been in a leadership position over you, like a teacher or employer.Confidential Reference - This should be filled out by a friend or someone who has know you for longer than one year.CHURCH LEADERName *FirstLastEmail *NumbersEMPLOYER/LEADERName *FirstLastEmail *NumbersFRIENDName *FirstLastEmail *NumbersPERSONAL INFORMATIONTitleName *FirstLastEmail *AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDate of Birth *AgeGenderMaleFemale(FOR ACCOMMODATION PURPOSES)Place of BirthMarital StatusHAVE YOU EVER BEEN REFUSED A VISA TO ANY COUNTRY?Yes NoIF YES, PLEASE GIVE DETAILSDO YOU NEED A VISA TO WORK IN THE UK? YES (PLEASE GIVE PASSPORT DETAILS BELOW)NoPassport NumberNATIONALITYDATE OF ISSUEDATE OF EXPIRYPLACE OF ISSUEFULL NAME AS IT APPEARS IN PASSPORT:IF MARRIED, WILL YOUR SPOUSE BE ACCOMPANYING YOU?Yes NoPLEASE EXPLAIN BELOWPLEASE NOTE THAT WE DO NOT BELIEVE THAT FAMILIES SHOULD SEPARATED, AND AS SUCH WE ARE UNLIKELY TO ACCEPT AN APPLICANT WITHOUT THEIR SPOUSE AND CHILDREN ACCOMPANYING THEM.DOES YOUR SPOUSE NEED A VISA TO LIVE IN THE UK?Yes NoFULL NAME AS IT APPEARS IN PASSPORT (SPOUSE) Passport Number (SPOUSE)NATIONALITY (SPOUSE)PLACE OF ISSUE (SPOUSE)DATE OF ISSUE (copy)DATE OF EXPIRY (SPOUSE)WILL YOUR CHILDREN BE ACCOMPANYING YOU?YesNoNOT APPLICABLENAMES OF CHILDREN ACCOMPANYING YOU?DO THEY NEED A VISA TO LIVE IN THE UK? No YES (PLEASE GIVE PASSPORT DETAILS via email)Emergency ContactsContact's Name *FirstLastContact's NumberContact's AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryWHAT CHURCH DO YOU CURRENTLY ATTEND?DENOMINATIONCHURCH LEADER’S NAMESHOW LONG HAVE YOU BEEN ATTENDING THIS CHURCH?HAVE YOU MENTIONED TO YOUR CHURCH LEADER YOUR INTENTION OF SERVING WITH US?YesNoIF NO, PLEASE GIVE THE REASONIS YOUR CHURCH LEADER SUPPORTIVE OF YOUR INTENTION TO SERVE WITH US?YesNoIF NO, PLEASE GIVE THE REASON EDUCATION & QUALIFICATIONSUNIVERSITY/COLLEGE/HIGHER OR FURTHER EDUCATION (POST 16 YEARS OLD) DATES // LOCATION // QUALIFICATIONS RECEIVEDPRESENT OCCUPATION/CAREER DETAILS PLEASE LIST ALL CAREER DETAILS OTHER THAN YWAM FOR THE LAST 10 YEARS, BEGINNING WITH THE MOST CURRENT.DATES // EMPLOYER // JOB TITLE OR MAIN RESPONSIBILITIES COMPETENCIES WHAT LANGUAGES DO YOU SPEAK, IN ORDER OF FLUENCY?HOW WELL DO YOU SPEAK ENGLISH?VERY WELL WELLAVERAGEPOORLYPRACTICAL SKILLS AND ABILITIESOTHER TALENTS, SPECIAL INTERESTS, HOBBIESCRIMINAL OFFENSES HAVE YOU EVER BEEN CHARGED WITH, CAUTIONED OR CONVICTED IN RELATION TO ANY CRIMINAL OFFENCE NOT SUBJECT TO DBS (DISCLOSURE AND BARING SERVICE) FILTERING RULES; OR ARE YOU AT PRESENT THE SUBJECT OF A CRIMINAL INVESTIGATIONS/PENDING PROSECUTION?YESNOIF YES, PLEASE GIVE DETAILS INCLUDING THE NATURE OF THE OFFENCES AND THE DATES. PLEASE GIVE DETAILS OF THE COURT(S) WHERE YOUR CONVICTION(S) WERE HEARD, THE TYPE OF OFFENCE AND SENTENCE(S) RECEIVED. COULD YOU ALSO GIVE DETAILS OF THE REASONS AND CIRCUMSTANCES THAT LED TO THE OFFENCE(S). HAVE YOU EVER BEEN THE SUBJECT OF A POLICE INVESTIGATION IN ANY COUNTRY, WHICH DID NOT LEAD TO A CRIMINAL CONVICTION (NOT SUBJECT TO DBS FILTERING RULES)?YESNOIF YES, PLEASE GIVE DETAILS BELOW, INCLUDING THE DATE OF THE INVESTIGATION, THE POLICE FORCE INVOLVED, DETAILS OF THE INVESTIGATION AND THE REASON FOR THIS, AND DISPOSAL(S) IF KNOWN.TO YOUR KNOWLEDGE HAVE YOU EVER HAD ANY ALLEGATION MADE AGAINST YOU, WHICH HAS BEEN REPORTED TO, AND INVESTIGATED BY, SOCIAL SERVICES/SOCIAL WORK DEPARTMENT (CHILDREN’S OR ADULT SOCIAL CARE)?YESNOPLEASE PROVIDE DETAILS, WE WILL NEED TO DISCUSS THIS WITH YOUHAS THERE EVER BEEN ANY CAUSE FOR CONCERN, ANY DISCIPLINARY ACTION EVER BEEN TAKEN AGAINST YOU OR WRITTEN WARNING GIVEN TO YOU IN ANY COUNTRY, BY ANY EMPLOYER OR ANY CHARITABLE OR OTHER ORGANIZATION OR BODY WORKING WITH CHILDREN OR YOUNG PEOPLE IN RELATION TO YOUR BEHAVIOUR WITH CHILDREN OR YOUNG PEOPLE? YESNOPLEASE PROVIDE DETAILS, WE WILL NEED TO DISCUSS THIS WITH YOU (copy)YWAM ENGLAND AND WALES, AS AN AGENCY WORKING WITH CHILDREN AND YOUNG PEOPLE, IS EXEMPT FROM THE UK REHABILITATION OF OFFENDERS ACT (1974) AND THEREFORE APPLICANTS MUST DECLARE ALL PREVIOUS CONVICTIONS. POLICE RECORD CHECKS CAN BE MADE BY YWAM TO VERIFY INFORMATION.FINANCES STAFF IN YWAM ARE RESPONSIBLE FOR PROVIDING THEIR OWN FEES AND PERSONAL LIVING EXPENSES. WE ASK THAT SINGLE STAFF COME WITH AT LEAST £350 A MONTH COMMITTED SUPPORT. PLEASE CONTACT US FOR MINIMUM AMOUNTS FOR COUPLES AND FAMILIES. HOW WILL YOU RAISE THE REQUIRED FINANCES?COMMITTED FROM YOUR CHURCH PER MONTHCOMMITTED FROM FRIENDS/RELATIVES PER MONTHOTHEROTHER (SPECIFYDO YOU HAVE DEBTS OR OTHER FINANCIAL OBLIGATIONS?YesNoLIABILITIES MAY INCLUDE DOCTORS’ BILLS, COURSE FEES, LOANS FROM BANKS, CREDIT CARD DEBT ETC. LIST ANY FINANCIAL OBLIGATIONS YOU CURRENTLY HAVE, AND WHEN AND HOW YOU EXPECT TO FULFILL THEMYES (PLEASE LIST BELOW)BACKGROUND QUESTIONS Please describe how you came to know Jesus personally:How did God lead you to apply for this particular school?Please describe your present personal relationship with the Lord:Which areas of your character that you are seeking to further develop and improve?Do you feel that God is leading you or have a specific interest in any particular area of ministry (children, arts, music, teaching, sports, administration, hospitality, maintenance, etc.)?Do you feel that you can live in possibly unfamiliar conditions: i.e. mixed cultures & races, different food, limited living space, no running water? If not, please share:Please describe your involvement with your local church. Are they supportive of your participation in YWAM?How would you describe your relationship with your family? Are they supportive of your participation in YWAM?Do you feel that the Lord has called you into full-time ministry?Is there anything else you would like to share with us about yourself?Are there any past experiences (i.e. drug or alcohol addiction, homosexuality, extramarital activity etc.) which we should know about as we consider your application?Please give relevant history if you have been divorced, separated or remarried:Are you still receiving help in any of the above areas? Would you appreciate counsel should you be accepted?DO YOU HAVE ANY HEALTH PROBLEMS, DIETARY RESTRICTIONS OR ANY DISABILITIES THAT MAY AFFECT YOUR DAY-TODAY FUNCTIONING? IF YES, PLEASE OUTLINE HOW YOUR FUNCTIONING MAY BE LIMITED.IS THERE ANYTHING ELSE YOU THINK WE SHOULD KNOW ABOUT YOURSELF OR YOUR FAMILY? (E.G. CURRENT PERSONAL ISSUES, HEALTH OF YOURSELF AND CHILDREN, CHILDREN’S EDUCATIONAL NEEDS, DEPENDENT CLOSE RELATIVES)DECLARATIONSI UNDERSTAND THAT: • YOUTH WITH A MISSION (YWAM) REQUIRES LONG-TERM STAFF TO HAVE SUCCESSFULLY COMPLETED A DISCIPLESHIP TRAINING SCHOOL (DTS). • ACCEPTANCE ON STAFF IS CONDITIONAL, SUBJECT TO A 3 MONTH MUTUAL EVALUATION PERIOD. BY THE END OF THIS TIME WE WILL AIM TO HAVE A MUTUAL REVIEW TO DETERMINE IF THIS IS THE RIGHT PLACE FOR YOU. • IF I AM ACCEPTED I WILL COMPLY WITH THE VALUES AND ETHOS OF YWAM. • AS A VOLUNTEER WITH YWAM ENGLAND, I AM CLASSIFIED AS SELF-EMPLOYED AND I UNDERSTAND IT IS MY RESPONSIBILITY TO REGISTER WITH HMRC WITHIN 90 DAYS OF ENTERING THE UK. I UNDERSTAND THAT IF I FAIL TO DO THIS, I WILL BE RESPONSIBLE FOR ANY FINES OR CONSEQUENCES RELATING TO THIS. • IN ACCORDANCE WITH THE UK DATA PROTECTION ACT (1998), THE INFORMATION PROVIDED ON MY STAFF APPLICATION FORM WILL BE HELD SECURELY, CONFIDENTIALLY AND WILL NOT BE KEPT FOR LONGER THAN IS NECESSARY TO ACHIEVE THE STATED PURPOSED OF RECRUITMENT, SELECTION, SUPPLEMENTARY PERSONAL DETAILS AND STATISTICS, OR THAT REQUIRED BY LAW OR OUR INSURANCE COMPANY. YES, I GIVE YWAM PERMISSION TO SAVE MY CONTACT DETAILS FOR THE PURPOSES STATED IN THE PRIVACY POLICY, FOUND ON OUR WEBSITE, WWW.YWAMLIVERPOOL.CO.UK YesNoThough every effort is made to provide a safe environment, Youth With A Mission, their agents, employees and volunteer assistants are insured against loss or injury through their negligence. In the absence of any negligence or other breach of duty by Youth With A Mission, participation in a Youth With A Mission organised programme, event or outreach is entirely at the participants own risk. Participants are required to have adequate health and accident insurance for all phases of their involvement with Youth With A Mission. YesNoI/we do hereby agree to the performance of such treatment, anaesthetics and operations as in the opinion of the attending physician are deemed necessary. YesNoCONSENT FOR TREATMENT – AN EMERGENCY PROVISION IN THE EVENT THAT I AM UNABLE TO SIGN A CONSENT FORM DUE TO INCAPACITY, I HEREBY GIVE MY CONSENT FOR ANY TREATMENT/MEDICAL INTERVENTION DEEMED NECESSARY BY THE ATTENDING HEALTH CARE PROFESSIONALS. WHILST YWAM WILL MAKE EVERY EFFORT TO CONTACT MY NEXT OF KIN/EMERGENCY CONTACTS, THERE MAY BE SITUATIONS WHERE THIS IS NOT POSSIBLE. I, THEREFORE, GIVE PERMISSION FOR YWAM TO ACT IN MY BEST INTERESTS. I RECOGNIZE THAT IN AN EMERGENCY SITUATION IT IS STANDARD OPERATING PROCEDURE TO ALWAYS ACT IN THE INTEREST OF PRESERVING LIFE.= RELEASE OF LIABILITY THOUGH EVERY EFFORT IS MADE TO PROVIDE A SAFE ENVIRONMENT, YOUTH WITH A MISSION LIMITED, THEIR AGENTS, EMPLOYEES AND VOLUNTEER ASSISTANTS ARE INSURED AGAINST LOSS OR INJURY CAUSED BY THE NEGLIGENCE OF YOUTH WITH A MISSION LIMITED. IN THE ABSENCE OF ANY NEGLIGENCE OR OTHER BREACH OF DUTY BY YOUTH WITH A MISSION LIMITED, PARTICIPATION IN A YOUTH WITH A MISSION LIMITED ORGANISED PROGRAMME, EVENT OR OUTREACH IS ENTIRELY AT THE PARTICIPANT’S OWN RISK. ACCORDINGLY PARTICIPANTS ARE REQUIRED TO HAVE ADEQUATE MEDICAL INSURANCE FOR ALL PHASES OF THEIR INVOLVEMENT WITH YOUTH WITH A MISSION LIMITED. SAFEGUARDING DECLARATION IF NEEDED, I CONSENT TO A CRIMINAL RECORDS CHECK IF APPOINTED TO THE POSITION FOR WHICH I HAVE APPLIED. I AM AWARE THAT DETAILS OF PENDING PROSECUTIONS, PREVIOUS CONVICTIONS, CAUTIONS, OR BINDOVERS AGAINST ME MAY BE DISCLOSED ALONG WITH ANY OTHER RELEVANT INFORMATION, WHICH MAY BE KNOWN TO THE POLICE. IF NEEDED, I UNDERSTAND THAT, IF I AM A UK RESIDENT, A CHECK WILL BE MADE WITH THE DISCLOSURE AND BARRING SERVICE (DBS) AND THAT IT IS AN OFFENCE FOR ANY PERSON TO COMMENCE REGULATED ACTIVITY WITHOUT FIRST PROVIDING A VALID DBS DISCLOSURE. IF I AM AN OVERSEAS RESIDENT, I UNDERSTAND THAT I WILL NEED TO PROVIDE A POLICE CHECK FROM MY HOME NATION IF THE POSITION I AM APPOINTED TO REQUIRES IT. I AGREE TO INFORM THE PERSON WITHIN THE YWAM BASE/TEAM RESPONSIBLE FOR PROCESSING APPLICATIONS FOR DISCLOSURE AND BARRING SERVICE CHECKS IF I AM CONVICTED OF AN OFFENCE AFTER I TAKE UP ANY POST WITHIN YWAM ENGLAND. I UNDERSTAND THAT FAILURE TO DO SO MAY LEAD TO THE IMMEDIATE SUSPENSION OF MY WORK WITH CHILDREN OR VULNERABLE ADULTS AND/OR THE TERMINATION OF MY WORK/TRAINING ASSOCIATION WITH YWAM. I AGREE TO INFORM THE PERSON WITHIN YWAM RESPONSIBLE FOR PROCESSING APPLICATIONS FOR THE DISCLOSURE AND BARRING SERVICE IF I BECOME THE SUBJECT OF A POLICE AND/OR A SOCIAL SERVICES/(CHILDREN’S SOCIAL CARE OR ADULT SOCIAL SERVICES)/SOCIAL WORK DEPARTMENT INVESTIGATION. I UNDERSTAND THAT FAILURE TO DO SO MAY LEAD TO THE IMMEDIATE SUSPENSION OF MY WORK WITH CHILDREN OR VULNERABLE ADULTS AND/OR THE TERMINATION OF MY WORK/TRAINING AND ASSOCIATION WITH YWAM. DUE TO THE NATURE OF THE WORKING AND LIVING ENVIRONMENT FOR MOST OF OUR YWAM TEAMS, WITH STAFF AND FAMILIES WITH SMALL CHILDREN LIVING IN CLOSE PROXIMITY, WE NEED TO ALSO ASK YOU TO SIGN THIS STATEMENT. I CONFIRM THAT I AM NOT BARRED FROM WORKING WITH CHILDREN/VULNERABLE ADULTS I HAVE READ AND AGREE WITH THE DECLARATIONS, CONSENT FOR TREATMENT AND RELEASE OF LIABILITY ABOVE, AND I DECLARE THAT I HAVE COMPLETED THIS APPLICATION TRUTHFULLY, TO THE BEST OF MY KNOWLEDGE.Printed NameDateSignatureClear SignatureSubmit