VOLUNTEER

Fill out the form below to find out how you can get involved with 2XSalt

Have you been at this address for 5 years or more?

Yes No

If no, please give us your previous address below:

What leadership or volunteer experience have you had with children/youth?

Is there any health related reason that would keeep you from effectively worknig with or cause any potential harm to children?

Yes No

If yes, please explain:

Personal References: (Must be 18 years old and not related to you.)

Reference 1:

Reference 2:

Reference 3:

Have you ever been convicted for the use of sale of drugs?

Yes No

Have you ever been hospitalized or treated for alcohol or substance abuse?

Yes No

Have you ever been arrested for a criminal offense excluding minor traffic violations?

Yes No

Have you ever been arrested or convicted of any sexually related crimes?

Yes No

Have you ever been denied participation in supervising youth activities in any organizations?

Yes No

By signing below, you acknowledge that you have read and comply with the Applicant's Statement above as well as the Child and Youth Protection Policy linked therein.

Please type your full name as your Signature

Date

Or print out the form below and send it to us at:

2XSalt Ministries
1900 Queen City Drive
Charlotte, NC 28208
704-393-3939

Download Form

Applicant's Statement

The information contained in this application is correct and complete to the best of my knowledge. I authorize any references, ministries, or other organizations listed in this application to give you any information they may have (including employer's opinions) regarding my character and fitness for working with children or youth and I hereby release all such references, ministries, or other organizations from liability for damages of whatever kind or nature that may result from furnishing such evaluations to you. I waive any right I may have to inspect any information provided about me by any person or organization identified by me in this application.

Should my application be accepted, I agree to follow the Child and Youth Protection Policy (link will open in a new window ontop of this one) and to refrain from inappropriate conduct in the performance of my services on behalf of the ministry. I understand that any violation of this Code of Conduct or misrepresentation of information that I have provided may result in termination of employment or volunteer service with children/youth.

I have not been convicted of a child or youth related sexual or physical abuse crime. I am not currently involved in any allegation of abuse of a child or youth.

I authorize that a Criminal and Civil Records Check may be conducted on me and that any information which pertains to any record of convictions contained in police files or any criminal or civil file maintained on me, whether state or local, be released to the ministry. In so authorizing, I release any law enforcement agencies, 2XSALT, Inc. or those individuals receiving the results of these check from any and all liability resulting from such disclosure.

I acknowledge that I have read the 2XSALT Child and Youth Protection Policy (link will open in a new window ontop of this one) and have received copies for my personal use.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT IN EXCHANGE FOR THE OPPORTUNITY TO SERVE AS A 2XSALT VOLUNTEER. This is a legally binding agreement, which I have read and understand. I understand that the personal information will be held confidential by the professional ministry staff.