PART 2 
Volunteer Staff Form * (Staff cannot be processed
unless ALL sections are complete)*

Section I Moral Conduct

As a result of concern for the safety and protection of children and youth, we require all potential volunteers to complete this form to protect the Adventurer/Pathfinder Club members from abuse and to protect the Seventh-day Adventist church organization from recommending any staff member who has a problem in this area.

Have you been (formally or informally) accused, charged, or disciplined for any questionable sexual conduct, child
abuse, and/or child sexual abuse?

0 NO 0 YES

If yes, please provide the following information and
documentation:
Date____________________

Place of incident_______________________________________

Type of Conduct_______________________________________

Explanation__________________________________________(use back page as needed)
! Legal documentation to clear or back-up above explanation
! Documentation from a professional as to your suitability to
serve as a Pathfinder staff/volunteer*

Section II Statement of Accuracy/Release
The above information is accurate to the best of my recollection. I authorize investigation of all statements contained in this application form if I am considered for service as Pathfinder leader, and hereby authorize personal references or any other person or persons to whom the Pathfinder organization or local entity may refer to give any and all information regarding my
employment or scholastic standing together with any other information, personal or otherwise, that may or may not be on
their records. I release those individuals/organizations from any damages as a result of furnishing the information requested. I understand this is strictly a volunteer position, and I will receive no remuneration for services and time volunteered.

For the purposes of this Authorization and Release, the undersigned gives permission to use a photocopy of his/her
signature on this form as an original signature.

This _____ day of _________________, 20___
Signature of Applicant:
____________________________________
Witness signature:
______________________________________

*Applicant Information: (please print)

First name: _______________Middle initial/name _______
Last name: __________________________

Address:________________________________________

Home phone: ___________________(wk)________________
Gender: Female 0  Male 0

Birth date: ____-____-_____

Church__________________________



Pathfinder Club name:__________________________________




Please return to:  Maritime Conference of SDA Church,  121
Salisbury Road,  Moncton, NB,  E1E 1A6.