Phone number *
Phone type Mobile Home Work Other
Are you an active member of Bread? *
Please select any/all that relate to you, select no if none apply
Which Bread Kids program(s) do you want to become involved with? *
Please select all that apply.
Why do you want to work with kids at Bread? *
Are you a part of any other volunteer teams at Bread? *
Select all teams you actively volunteer on
What other children/youth work experience do you have? *
Organization / Program (role) / Dates / Contact Name & Email
References *
Please provide at least two references (other than relatives). NOTE: Bread will email a form link to your references, please let them know to look check their inboxes upon completion of your application. Name / Relationship / Email address / Phone
Been subject to any disciplinary action, complaint, or allegation that you violated any employerâs or organizationâs policy concerning sexual misconduct? *
Been arrested, charged, indicted, or convicted of any criminal offense (misdemeanor or felony) other than a traffic violation? *
Had your driverâs license suspended or restricted for any reason? *
Engaged in, or been accused of, any child molestation, exploitation, or abuse? *
Been hospitalized or treated for alcohol or substance abuse? *
Been the subject of a Department of Social Services complaint? *
Been the subject of a Juvenile and Domestic Relations Court petitions of abuse and neglect? *
Been the subject of a Juvenile and Domestic Relations Court petitions for Protective Orders or Restraining Orders? *
Having any traits or tendencies that could pose any threat to children, you, or others? *
Any reason why you should not work with children, youth, or others? *
We need to run a formal background/criminal record check on all applications. Please check this box to finish the application. Upon completion, Bread will send you a "Request for Criminal Records Check and Authorization" form to complete and return. You may return the filled out form via: a new form thru planning center; email; in-person. All digital documentation will be printed to hard copy and stored safely at the church office. The digital documentation, thereafter, will be disposed of properly.
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