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CENTERING PRAYER INFORMATION!!!
EPISCOPAL DIOCESE OF
POLICIES FOR THE PROTECTION OF
CHILDREN AND YOUTH FROM ABUSE
INTRODUCTION
The Church Pension Group, in partnership with The Nathan Network, is
pleased to provide these Model Policies for the Protection of Children
and Youth from Abuse to the Episcopal Church.
HISTORY OF MODEL POLICIES FOR THE PROTECTION
OF CHILDREN AND YOUTH FROM ABUSE
The Committee on Sexual Exploitation ("COSE") was created by resolution
of the 70th General Convention in 1991 to address issues of sexual
misconduct in the Episcopal Church. It continued its work through the
74th General Convention in 2003. In 1999 in preparation for the 73rd
General Convention in 2000, it conducted a survey of 100% of the
domestic dioceses on how dioceses were dealing with issues of sexual
misconduct. The survey indicated, among other things, that a conference
for those who work on issues of sexual misconduct in the church
was needed.
As a result, in June 2001 COSE and the Office of Pastoral Development
sponsored the first national Pastoral Standards Conference. An extraordinary
gathering of one hundred twenty-five bishops, chancellors, clergy
and laity from 70 dioceses attended and unanimously called for review
of existing sexual misconduct policies and development of the "next
generation" of policies.
COSE gathered and reviewed policies submitted by 70 dioceses with
the intention of circulating as model policies those that incorporated
and reflected current best practices based on the Church's experience
in the area of sexual misconduct over the past decade. COSE concluded
that none of the policies gathered was a truly state-of-the-art, "next
generation" policy that could serve as a model for those dioceses planning
on revising and updating their current policies. COSE determined
that it did not have the time or resources to create new state-of-the-art,
next generation policies.
Encouraged to do so by COSE, with requests from a number of dioceses
to do so, to support prevention efforts, and based on its own perception
of the need, The Church Pension Group undertook to develop
model child sexual abuse prevention and response policies.
Just prior to the meeting of the House of Bishops in March 2003, 47
bishops attended a training session on What Every Bishop Should
Know About Pedophiles and Preventing Child Sexual Abuse in the
Church put on by the Office of Pastoral Development and The Church
Pension Group. Out of this training session came a Mind of the House
Resolution presented by the 47 bishops in attendance that was
approved unanimously by the House of Bishops.
Among other resolves, the resolution called for development of a statement
of general expectations of behavior in this church by clergy, lay
employees, and volunteers, when engaged in ministry with children and
youth. The resolution stated that these expectations should be specific
enough to serve as clear directions and guidelines, but general enough
that each diocese would expand upon or develop the specific content
of policies and procedures and implementation according to
the particularities of each diocese. The Bishops unanimously committed
to reviewing current diocesan policies, and revising them as needed. In
addition, the Bishops committed to working together to provide appropriate
training, education, and materials to support each diocese in the
five identified areas.
The Bishops also committed to putting forth a resolution to the 74th
General Convention in 2003 as the statement of general expectations
called for by the March 2003 House of Bishops Mind of the House
Resolution. Resolution B008, Protection of Children and Youth from
Abuse, was submitted and passed at that General Convention.
This History section was drawn, in large part, from the Explanation
section of Resolution B008 as submitted to the 74th General
Convention in 2003
CHILDREN'S CHARTER AND SAFE CHURCH MINISTRY
AT THE BEGINNING OF THE 21ST CENTURY
Resolution B008 and these Model Policies for the Protection of Children
and Youth from Abuse call the church to respond in new and intentional
ways to care for, be responsible to, and create safe space for children.
Foundational to Resolution B008 and the work of the Church Pension
Group’s partnership with The Nathan Network is the Children’s Charter
for the Church (General Convention Resolutions 1997 - B005 and 2000 -
D045). The Children's Charter holds advocacy for children as central to
the mission and ministry of the church. The Charter calls the Church to
love, shelter, protect, and defend children within its own community and
in the world, especially those who are abused, neglected, or in danger.
CODE OF CONDUCT FOR PROTECTION
OF CHILDREN AND YOUTH
Relationships among people are at the foundation of Christian ministry
and as such are central to the life of the church. Defining healthy and
safe relationships through policies and codes of conduct is not meant,
in any way, to undermine the strength and importance of personal interaction
in our ministries. Rather, it is to assist in more clearly defining
behaviors and practices that allow the church to more fully demonstrate
its love and compassion for children and youth in sincere and genuine
relationships.
Relationships in ministry should, ideally, always be experienced as caring
and without intention to do harm or allow harm to occur. This Code of
Conduct has been adopted by _________________________ [Parish] to help the church
create safe environments for children and youth and for those who minister
to them. All Church Personnel are asked to carefully consider each
statement in the Code and within the Policies for the Protection of
Children and Youth from Abuse before agreeing to adhere to the statements
and continue in service to the church.
CODE OF CONDUCT FOR PROTECTION
OF CHILDREN AND YOUTH
Church Personnel agree to do their best to prevent abuse and neglect
among children and youth involved in church activities and services.
- Church Personnel agree to not physically, sexually or emotionally
abuse or neglect a child or youth.
- Church Personnel agree to comply with the policies for general conduct
with children and youth as defined in these Policies for the
Protection of Children and Youth from Abuse.
-
Appropriate Affection with children and youth.
- In the event that Church Personnel observe any inappropriate behaviors
or possible policy violations with children or youth, church personnel
agree to immediately report their observations.
-
to protect children and youth and agree to report known or suspected
abuse of children or youth to appropriate church leaders and state
authorities in accordance with these policies.
- Church Personnel understand that the church will not tolerate abuse
of children and youth and agree to comply in spirit and in action with
this position.
GENERAL DEFINITIONS
A. CHURCH PERSONNEL For the purposes of this policy,
the following are included in the definition
of Church Personnel when they are functioning in their respective
roles for the church:
1. All clergy whether stipendiary, non-stipendiary, or otherwise who are
engaged in ministry or service to the church.
2. All paid personnel whether employed in areas of ministry or other
kinds of services by the diocese, its congregations, schools or other
agencies.
3. Those who contract their services to the diocese, its congregations,
schools or other agencies.
4. Volunteers, including any person who enters into or offers him or
herself for a church related service, or who actually assists with or
performs a service, whether or not they have been selected or
assigned to do so. Volunteers include members of advisory boards,
vestries, Bishop’s Committees, and boards of directors.
B. CHILDREN AND YOUTH A child is defined as anyone under the age of 12 years.
A youth is defined as anyone who is at least 12 years old, but not yet
18 years old. A youth may also be an individual who is 18 years old or older, but still in high school.
C. REGULARLY OR OCCASIONALLY WORK WITH OR AROUND CHILDREN OR YOUTH
for the purpose of this policy, the following are included in the definition of CHURCH PERSONNEL WHO REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH:
1. All clergy whether stipendiary, non-stipendiary, or otherwise who are
engaged in ministry or service to the church.
2. All paid or volunteer Church Personnel whose work regularly takes
them throughout the facility or grounds or who has keys giving them
access to the buildings on the grounds.
3. All persons who supervise or assist with supervising children or
youth, other than church school teachers, in ministries, programs or
activities more often than occasionally.
4. All persons who provide transportation to children or youth without
other adults in the vehicle more often than occasionally.
5. Any paid personnel whose living quarters are on the grounds of the
church, school or other related agency.
6. All vestry members or other members of similar decision-making
groups who have the authority to approve the creation of ministries,
programs or activities for children or youth.
Examples of Church Personnel who REGULARLY WORK WITH OR AROUND
CHILDREN OR YOUTH: include, but are not limited to:
- Children’s or youth choir directors
- Organists who work with children or youth
- Lay youth ministers
- Volunteer youth directors
-
times a year
-
over 21 present at any time
- All staff, whether volunteer or paid, at church camps
- Adults who participate in overnight activities with children or youth
more than twice a year
For the purpose of this policy, the following are included in the definition
of Church Personnel who OCCASIONALLY WORK WITH OR AROUND CHILDREN
OR YOUTH:
1. Church school teachers.
2. All persons who supervise or assist with supervising children or youth
in ministries, programs or activities infrequently, generally no more
than three times a year or for one program or activity during a year
that lasts less than a month (i.e. assisting with preparation for the
Christmas pageant, or teaching one "unit" of
month).
3. All persons who provide transportation to children or youth without
other adults in the vehicle infrequently, generally no more than three
times a year.
4. All persons who work or assist in the nursery four or fewer times a
year, whether on an emergency basis or otherwise.
5. Adults who participate in overnight activities with children or youth
once or twice a year.
D. TYPES OF ABUSE
1. Physical abuse is non-accidental injury, which is intentionally
inflicted upon a child or youth.
2. Sexual abuse perpetrated by an adult is any contact or activity of a
sexual nature that occurs between a child or youth and an adult.
This includes any activity, which is meant to arouse or gratify the sexual
desires of the adult, child or youth.
3. Sexual abuse perpetrated by another child or youth is any contact
or activity of a sexual nature that occurs between a child or youth
and another child or youth when there is no consent, when consent is
not possible, or when one child or youth has power over the other
child or youth. This includes any activity which is meant to arouse or
gratify the sexual desires of any of the children or youth.
4. Emotional abuse is mental or emotional injury to a child or youth
that results in an observable and material impairment in the child or
youth’s growth, development or psychological functioning.
5. Neglect is the failure to provide for a child or youth's basic needs or
the failure to protect a child or youth from harm.
6. Economic exploitation is the deliberate misplacement, exploitation,
or wrongful temporary or permanent use of a child or youth's belongings
or money.
SAFEGUARDS FOR CHILDREN AND YOUTH
A. SCREENING AND SELECTION
1. Any and all Church Personnel who REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH shall be screened and selected utilizing at least the following:
a. A STANDARD APPLICATION completed by the applicant that includes an authorization for the release of information to conduct background checks (YOU MUST USE RELEASE AND DISCLOSURE FORMS PROVIDED IN TAB C) and the CODE OF CONDUCT STATEMENT (appendix C).
b. CRIMINAL RECORDS CHECK in any state where the applicant has resided during the past seven (7) years, and other states, if any, as determined by the church.
c. SEXUAL OFFENDER REGISTRY CHECK in any state where the applicant has resided during the past seven (7) years.
d. INDIVIDUAL INTERVIEW with the applicant.
e. REFERENCE CHECKS of persons outside the congregation who know the applicant, preferably who know how the applicant works with children.
f. DRIVING OR MOTOR VEHICLE RECORDS CHECK if the person may be transporting children or youth.
2. Any and all Church Personnel who OCCASIONALLY WORK WITH OR AROUND CHILDREN OR YOUTH shall be screened and selected utilizing at least the following:
a. A STANDARD APPLICATION completed by the applicant that includes an acknowledgment for the release of information to conduct background checks and the CODE OF CONDUCT (Appendix C).
b. INDIVIDUAL INTERVIEW with the applicant.
c. AT LEAST ONE REFERENCE CHECK of a person or persons outside the congregation who know the applicant, preferably who know how the applicant interacts with children.
d. DRIVING OR MOTOR VEHICLE RECORDS CHECK if the person will be transporting children or youth.
3. All information gathered about an applicant will be carefully reviewed and evaluated to make a determination, in consultation with others as necessary, of whether or not the person is appropriate to work with children or youth.
4. Church Personnel who work with or around children or youth must have a personnel file that is kept where other church records are kept.
5. Criminal records checks and sexual offender registry checks will be conducted every five (5) years for Church Personnel who Regularly Work With or Around Children or Youth.
6. To the extent possible, no person will be permitted to supervise an immediate family member when working with or around children or youth. For the purpose of this policy, immediate family member is defined as spouse, partner, child, parent, sister, brother, similar in-law relationship, stepchild, stepparent, stepsibling, grandparent, or co-habitant.
7. Church Personnel who transfer within the Diocese of Milwaukee and apply for or are asked to or who do undertake a position working with or around children or youth are required to undergo the same screening and selection process in Section A above. This requirement may be met through a transfer of a copy of their personnel file to the new congregation, school, agency, or program together with completion of a new application, individual interview and reference checks with the congregations, schools, agencies or other programs for which the applicant has worked with or around children or youth since the screening was last done as shown in the applicant's personnel file.
B. EDUCATION AND TRAINING REQUIREMENTS
1. Three hours of child abuse prevention education and training is required for all CHURCH PERSONNEL WHO REGULARLY WORK WITH OR AROUND CHILDREN OR YOUTH before they start their work with children or youth or, if that is not possible, one hour of child abuse awareness training before they start their work and the rest of the training within three months of starting.
2. One hour of child abuse awareness education and training is required for all CHURCH PERSONNEL WHO OCCASIONALLY WORK WITH OR AROUND CHILDREN OR YOUTH before they start their work with children or youth.
3. Church Personnel who are responsible for screening, selection and supervision of others in programs for children and youth are required to complete an additional three (3) hours of specialized education and training in screening, selection and monitoring every two years.
C. MONITORING AND SUPERVISION OF PROGRAMS
The monitoring and supervision of programs and activities involving
children or youth is important for safeguarding children and youth and
involves several aspects. One aspect involves having structural guidelines
or standards for the programs and activities for children and youth.
These include such things as who approves new programs, how many
adults need to be present and the like. In addition to setting structural
guidelines and standards, church leaders must make sure the structural
safeguards are followed. Programs and activities have to be monitored
and supervised to do that.
Another aspect of monitoring and supervision is that supervisory personnel
and others monitor and supervise the behavior of adults, youth
and other children with children and youth so that inappropriate behaviors
and interactions can be detected and stopped. Some behaviors
and interactions are potentially harmful to children or youth in and of
themselves. Examples include providing alcohol or drugs to children or
youth or actually having sexual contact with a child or youth. Other
behaviors and interactions are not necessarily harmful in and of themselves
but are the same behaviors and interactions known to be used
by those who abuse children or youth to "groom" them or their parents
for eventual abuse or which provide the privacy child molesters need in
order to abuse children or youth. Examples of those behaviors and
interactions include holding children over the age of three on the lap,
transporting a child or youth alone, and the like.
The structural guidelines and standards are covered in both this
MONITORING AND SUPERVISION section and in the following section,
GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH.
The behaviors and interactions of persons with children and youth that need to be
monitored and supervised are covered in the section on GENERAL
CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH and in the
GUIDELINES FOR APPROPRIATE AFFECTION.
1. Every program for children and youth must have established ratios for
adults and children. Compliance with the established ratio is required
at all times, including activities that occur off church premises.
2. Church Personnel are prohibited from being alone with a child or
youth or multiple children or youth where other adults cannot easily
observe them.
3. Church Personnel over the age of 21 must directly supervise Church
Personnel under the age of 18 and be physically present during all
activities.
4. An up to date list of approved congregation-sponsored programs for
children and youth will be maintained in the church office or other
place where church records are kept.
5. Church Personnel are not permitted to develop new activities for children
and youth without approval from the rector or canonical equivalent.
Requests to develop new activities should be submitted in writing
to the rector. The rector will consider whether the plan for a new
activity includes adequate adult supervision.
6. Each program will develop age-appropriate procedures to ensure the
safety of children and youth using restrooms and showers or baths.
7. When supervising or assisting private activities such as dressing,
showering or diapering infants or children, Church Personnel will
remain in an area observable by other adults or work in pairs.
8. At least two unrelated Church Personnel must supervise activities.
When both boys and girls are participating, male and female adults
must be present.
D. GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH
The following guidelines are intended to assist Church Personnel in monitoring
and supervising behaviors and interactions with children and
youth to identify and stop those that may be inherently harmful to children
or youth, that are the type used by child molesters to groom children,
youth and their parents, or that may create the conditions where
abuse can occur more easily. These guidelines should also be used to
make decisions about interactions with children and youth in church
sponsored and affiliated programs. They are not designed or intended to
address interactions within families. When exceptions to these guidelines
must be made, they should be reported to the supervisor of the Church
Personnel making the exception as soon as possible.
1. All Church Personnel who work with children or youth must agree to
comply with the ______________________________ [Parish] Guidelines for
Appropriate Affection (Appendix A).
2. No person will be allowed to volunteer to REGULARLY WORK WITH
CHILDREN OR YOUTH until the person has been known to the clergy and
congregation for at least six months.
3. Programs for infants and children under six (6) years old will have
procedures to ensure that children are released only to their parents
or legal guardians or those designated by them.
4. Church Personnel are prohibited from the use, possession, distribution,
or being under the influence of alcohol, illegal drugs, or the misuse
of legal drugs while participating in or assisting with programs or
activities specifically for children or youth.
5. Parents or guardians must complete written permission forms before
Church Personnel transport children and youth for a church sponsored
activity or for any purpose on more than an occasional basis.
6. Church Personnel will respond to children and youth with respect,
consideration and equal treatment, regardless of sex, race, religion,
sexual orientation, culture or socio-economic status. Church Personnel
will portray a positive role model for children and youth by maintaining
an attitude of respect, patience, and maturity. They will avoid
even the appearance of favoritism.
7. One-to-one counseling with children or youth will be done in an open
or public or other place where private conversations are possible but
occur in full view of others.
8. Church Personnel are prohibited from dating or becoming romantically
involved with a child or youth.
9. Church Personnel are prohibited from having sexual contact with a
child or youth.
oriented materials (magazines, cards, videos, films, clothing etc.)
on church property or in the presence of children or youth except
as expressly permitted as part of a pre-authorized educational
program.
11.Church Personnel are prohibited from using the Internet to view or
download any sexually oriented materials on church property or in
the presence of children or youth.
activities, including dreams and fantasies, or discussing their use of
sexually oriented or explicit materials such as pornography, videos or
materials on or from the Internet, with children or youth.
13.Church Personnel are prohibited from sleeping in the same beds,
sleeping bags, tents, hotel rooms or other rooms with children or
youth unless the adult is an immediate family member of all children
or youth in the bed, sleeping bag, tent, hotel room or other room. It
is acceptable to have multiple adults sleep with all the children or
youth participating in one open space such as a church basement
or camp lodge.
14.Church Personnel are prohibited from dressing, undressing, bathing,
or showering in the presence of children or youth.
any way for behavior management of children and youth. No form of
physical discipline is acceptable. This prohibition includes spanking,
slapping, pinching, hitting, or any other physical force. Physical force
may only be used to stop a behavior that may cause immediate
harm to the individual or to a child, youth or others.
punishment, or mechanical restraint such as rope or tape for
behavior management.
to conduct any hazing activities relating to children’s or youth ministry
or camp activities.
RESPONDING TO PROBLEMS
A. REPORTING INAPPROPRIATE BEHAVIORS OR POLICY VIOLATIONS WITH CHILDREN OR YOUTH
1. When Church Personnel observe any inappropriate behaviors,
behaviors that are inconsistent with the GUIDELINES FOR APPROPRIATE
AFFECTION, or which may violate any provision of these Policies the
for Protection of Children and Youth from Abuse, they must immediately
report their observations. Examples of inappropriate behaviors
or policy violations would be seeking private time with children or
youth, taking children or youth on over-night trips without other
adults, swearing or making suggestive comments to children or
youth, or selecting or using staff or volunteers without the required
screening.
2. Such inappropriate behaviors or possible policy violations that relate
to interactions with children or youth should be reported in one of
the following ways:
a. A telephone call or meeting with the immediate supervisor
of the person,
b. A telephone call or meeting with the rector, if the person is not
the rector;
c. A telephone call or meeting with a church warden if the person
is the rector;
d. A telephone call, meeting or fax to the bishop;
e. Submit a NOTICE OF CONCERN (Appendix B), signed or unsigned,
to the bishop.
3. All reports of inappropriate behavior or policy violations with children
or youth will be taken seriously.
B. REPORTING SUSPECTED ABUSE OF CHILDREN OR YOUTH
1. All Church Personnel are required by this policy to report known or suspected
abuse of children or youth to the appropriate state authorities. SEE REPORTING
CONTACT INFORMATION LISTED BY
2. Failure to report suspected abuse of children or youth may be a
crime. Reports may be made confidentially or anonymously. Every
state provides immunity from civil liability for persons required to
report suspected abuse in good faith and without malice. Simply
stated, "in good faith" means that the person submitting the report
believes what he or she is reporting to be true.
3. In addition to reporting to the state authorities, Church Personnel are
required to report any suspected or known abuse of children or
youth that may have been perpetrated by Church Personnel directly
to the rector of ________________________ Parish so that immediate and proper steps
may be taken to ensure the safety of alleged victims.
4. Reports of suspected or known abuse that involve Church Personnel
may be reported to the Diocese of Milwaukee in the following
ways:
a. A telephone call, meeting or fax to the bishop;
b. A telephone call or meeting with the rector, if the rector is not
the person being complained about.
c. Submit a NOTICE OF CONCERN (Appendix B), signed or unsigned,
to the bishop.
5. The Diocese of
with any investigation by state authorities to the fullest extent
appropriate and inform authorities that a concurrent internal investigation
will be directed by the Diocese of Milwaukee,
APPENDIX
A. GUIDELINES FOR APPROPRIATE AFFECTION
The Diocese of Milwaukee and ___________________________ Parish are committed to creating and promoting a positive, nurturing environment for our children’s and youth ministries that protect our children and youth from abuse and our Church Personnel from misunderstandings. When creating safe boundaries for children and youth, it is important to establish what types of affection are appropriate and inappropriate, otherwise that decision is left to each individual. Stating which behaviors are appropriate and inappropriate allows Church Personnel to comfortably show positive affection in ministry, and yet identify individuals who are not maintaining safe boundaries with children or youth. These Guidelines are based, in large part, on avoiding behaviors known to be used by child molesters to groom children or youth and their parents for future abuse. The following guidelines are to be carefully followed by all Church Personnel working around or with children or youth.
1. Love and affection are part of church life and ministry. There are many ways to demonstrate affection while maintaining positive and safe boundaries with children and youth.
Some POSITIVE and APPROPRIATE forms of affection are listed below:
- Brief hugs.
- Pats on the shoulder or back.
- Handshakes.
- "High-fives" and hand slapping.
- Verbal praise.
- Touching hands, faces, shoulders and arms of children or youth.
- Arms around shoulders.
- Holding hands while walking with small children.
- Sitting beside small children.
- Kneeling or bending down for hugs with small children.
- Holding hands during prayer.
- Pats on the head when culturally appropriate. (For example, this gesture
- should typically be avoided in some Asian communities).
2. The following forms of affection are considered INAPPROPRIATE with children and youth in ministry setting because many of them are the behaviors that child molesters use to groom children or youth and their parents for later molestation or can be, in and of themselves,
sexual abuse.
- Inappropriate or lengthy embraces.
- Kisses on the mouth.
- Holding children over three years old on the lap.
- Touching bottoms, chests or genital areas other than for appropriate
- diapering or toileting of infants and toddlers.
- Showing affection in isolated areas such as bedrooms, closets, staff
- only areas or other private rooms.
- Occupying a bed with a child or youth
- Touching knees or legs of children or youth.
- Wrestling with children or youth.
- Tickling children or youth.
- Piggyback rides.
- Any type of massage given by a child or youth to an adult.
- Any type of massage given by an adult to a child or youth.
- Any form of unwanted affection.
- Comments or compliments (spoken, written, or electronic) that relate
- to physique or body development. Examples would be, "You sure are
- developing," or "You look really hot in those jeans."
- Snapping bras or giving wedgies or similar touch of underwear
- whether or not it is covered by other clothing.
- Giving gifts or money to individual children or youth.
- Private meals with individual children or youth.
APPENDIX
B. CONFIDENTIAL NOTICE OF CONCERN
Individual(s) of Concern: ______________________________________________
______________________________________________
Date of occurrence: ___________________________________________________
Time of occurrence: ___________________________________________________
Type of Concern:
[ ] Inappropriate behavior with a child or youth
[ ] Policy violation with a child or youth
[ ] Possible risk of abuse
[ ] Other concern:
Describe the situation: What happened, where it happened, when it
happened, who was involved, who was present, who was notified? If
reported to the State, what was their recommendation about investigating?
Attach additional sheets if needed._____________________________________________
_________________________________________________________________________
_________________________________________________________________________
Has this situation ever occurred previously? Attach additional sheets if
needed.___________________________________________________________________
__________________________________________________________________________
What action was taken? How was the situation handled, who was
involved, who was questioned, were police called? Attach additional
sheets if needed.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
What is the follow-up plan? Does anyone else need to be notified? Will
the situation need monitoring? Would you like someone to call you to
discuss this situation?
Attach additional sheets if needed.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Submitted by: (Please print)___________________________________________________
Telephone number:__________________________________________________________
Location and address:________________________________________________________
Signature:______________________________________________Date______________
Reviewed by:______________________________________________________________
Once completed, please fax to the confidential fax line _____________________________
Attn Bishop of Milwaukee___________________________
APPENDIX
C: APPLICATION FORM, CODE OF CONDUCT AND ACKNOWLEDGMENT, RELEASE AND SIGNATURE
INSTRUCTIONS Please complete all of the questions accurately and fully.
Attach additional sheets if needed.
Today’s date: __________
PERSONAL DATA
Name: ____________________________________________________________________
Street address: ______________________________________________________________
City: ______________________________________________________________________
State: Zip: __________________________________________________________________
How long at current address: ___________________________________________________
Home phone: _____________________________
Work phone: _____________________________
Best time to contact you: _______________
Email address :__________________________
Driver license number:
Social Security number: _______________________________
Are you legally eligible to work in this country?
[ ] Yes [ ] No
Note: If you are chosen for a paid position, you will be required to show
documents verifying your employment eligibility and identity to complete
the INS Form I-9 as required by the Immigration Reform and Control Act.
Please list your addresses in the past five years:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
For what position are you applying? _____________________________________________
What interests you about the position for which you are currently applying?
__________________________________________________________________________
What has prepared you for the position for which you are currently applying?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
EMPLOYMENT HISTORY Please complete for your prior employers, covering the past TEN years.
CURRENT EMPLOYER Company name: ________________________________________
Address: ___________________________________________________________________
City: State: Zip: _____________________________________________________________
Immediate supervisor name: ___________________________________________________
Immediate supervisor phone number: ____________________________________________
Position held: _______________________________________________________________
Dates of employment: from to __________________________________________________
Reason for leaving position: ____________________________________________________
EMPLOYMENT HISTORY Please complete for your prior employers, covering the past TEN years.
PREVIOUS EMPLOYER Company name: ________________________________________
Address: ___________________________________________________________________
City: State: Zip: _____________________________________________________________
Immediate supervisor name: ___________________________________________________
Immediate supervisor phone number: ____________________________________________
Position held: _______________________________________________________________
Dates of employment: from to __________________________________________________
Reason for leaving position: ____________________________________________________
PREVIOUS EMPLOYER Company name: ________________________________________
Address: ___________________________________________________________________
City: State: Zip: _____________________________________________________________
Immediate supervisor name: ___________________________________________________
Immediate supervisor phone number: ____________________________________________
Position held: _______________________________________________________________
Dates of employment: from to __________________________________________________
Reason for leaving position: ____________________________________________________
PREVIOUS EMPLOYER Company name: ________________________________________
Address: ___________________________________________________________________
City: State: Zip: _____________________________________________________________
Immediate supervisor name: ___________________________________________________
Immediate supervisor phone number: ____________________________________________
Position held: _______________________________________________________________
Dates of employment: from to __________________________________________________
Reason for leaving position: ____________________________________________________
PREVIOUS EMPLOYER Company name: ________________________________________
Address: ___________________________________________________________________
City: State: Zip: _____________________________________________________________
Immediate supervisor name: ___________________________________________________
Immediate supervisor phone number: ____________________________________________
Position held: _______________________________________________________________
Dates of employment: from to __________________________________________________
Reason for leaving position: ____________________________________________________
VOLUNTEER EXPERIENCE Include all experience working with children or youth
Organization: ________________________________________________________________
Contact: ____________________________________________________________________
Phone: _____________________________________________________________________
Duties: _____________________________________________________________________
Dates: from to: _______________________________________________________________
Organization: ________________________________________________________________
Contact: ____________________________________________________________________
Phone: _____________________________________________________________________
Duties: _____________________________________________________________________
Dates: from to: _______________________________________________________________
Organization: ________________________________________________________________
Contact: ____________________________________________________________________
Phone: _____________________________________________________________________
Duties: _____________________________________________________________________
Dates: from to: _______________________________________________________________
Organization: ________________________________________________________________
Contact: ____________________________________________________________________
Phone: _____________________________________________________________________
Duties: _____________________________________________________________________
Dates: from to: _______________________________________________________________
EDUCATIONAL HISTORY
Name of school: __________________________________________
Address: _____________________________________________________________________
Type of school: _______________________________________________________________
Name of program or degree: _____________________________________________________
Program completed? ___________________________________________________________
Name of school: __________________________________________
Address: _____________________________________________________________________
Type of school: _______________________________________________________________
Name of program or degree: _____________________________________________________
Program completed? ___________________________________________________________
Name of school: __________________________________________
Address: _____________________________________________________________________
Type of school: _______________________________________________________________
Name of program or degree: _____________________________________________________
Program completed? ___________________________________________________________
PROFESSIONAL/CIVIC REFERENCES
Name: __________________________________________
Address: ______________________________________________________________________
Daytime phone: ________________________________________________________________
Relationship to you: _____________________________________________________________
Name: __________________________________________
Address: ______________________________________________________________________
Daytime phone: ________________________________________________________________
Relationship to you: _____________________________________________________________
PERSONAL REFERENCES
Name: ____________________________________________________
Address: ______________________________________________________________________
Daytime phone: Evening: ________________________________________________________
How long have you known this person? _____________________________________________
Relationship to you: _____________________________________________________________
Name: ____________________________________________________
Address: ______________________________________________________________________
Daytime phone: Evening: ________________________________________________________
How long have you known this person? _____________________________________________
Relationship to you:_____________________________________________________________
FAMILY REFERENCES
Name: _____________________________________________________
Address: _____________________________________________________________________
Daytime phone: Evening: ________________________________________________________
How long have you known this person? _____________________________________________
Relationship to you: _____________________________________________________________
Have you ever been accused of physically, sexually or emotionally abusing
a child or an adult?_____________________________________________________
[ ] Yes [ ] No
If yes, please explain.
CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH
Read and initial each item to signify your agreement to comply with the statement.
I agree to do my best to prevent abuse and neglect among children and youth involved in church activities and services.
I agree not to physically, sexually or emotionally abuse or neglect a child or youth.
I agree to comply with the policies for GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH defined in the Policies for the Protection of Children and Youth from Abuse.
I agree to comply with the GUIDELINES FOR APPROPRIATE AFFECTION with children and youth.
In the event that I observe any inappropriate behaviors or possible policy violations with children or youth, I agree to immediately report my observations.
I acknowledge my obligation and responsibility to protect children and youth and agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with the POLICIES FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE.
I understand that the church will not tolerate abuse of children and youth and I agree to comply in spirit and in action with this position.
ACKNOWLEDGMENT, RELEASE AND SIGNATURE
To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, credit history, driving record, criminal conviction record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize __________________________ [Parish] to request and receive such information.
If hired or chosen, I agree to be bound by ___________________________ [Parish’s] policies and procedures, including but not limited to its POLICIES FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE and CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH. I understand that these may be changed, withdrawn, added to or interpreted at any time at the ___________________________ [Parish’s] sole discretion and without prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without prior notice at the option of _____________________________ [Parish] or myself.
Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contract between myself and ______________________________ [Parish] for either employment, volunteering or the providing of any benefit.
I HAVE READ AND UNDERSTAND THE ABOVE PROVISIONS.
_______________________________________
Signature Date
appendix
D: STATE CHILD ABUSE REPORTING STATUTE WEBSITES
NEW