Code of Ethics (Re Adult Background Checks)_Rev_3Mar2010 | Background Check | Leadership & Mentoring


Adults and older youth who are in leadership roles are in a position of stewardship and play a key role in fostering the spiritual development of both individuals and the community. Therefore, it is especially important that such persons be well qualified to provide the special nurture, care, and support needed to enable children and youth to develop a positive sense of self and a spirit of independence and responsibility. The relationship between youth and their leaders must be one of mutual respect if positive potential is to be realized. There are no more important areas of growth than those of self-worth and the development of a healthy identity as a sexual being. Adults play a key role in assisting children and youth in these areas of growth. Wisdom dictates that children, youth, and adults suffer damaging effects when leaders become sexually involved with young persons in their care; therefore leaders will refrain from engaging in sexual, seductive, or erotic behavior with children and youth. Neither shall they sexually harass or engage in behavior with youth that constitutes verbal, emotional or physical abuse. By signing below, the signer indicates s/he has been informed of this code and agrees to abide by it before assuming work with children and/or youth involved in District activities. In cases of violation of this code, appropriate action will be taken. Signed______________________________ Print Name ______________________________________ Role/Title ___________________________ Congregation____________________________________ Daytime telephone;_______________________________ Purpose of request: _____Youth conference or other youth event volunteer _____YAC member _____Requested to be on file in my home church - not district related (Note: church requesting background check will be billed for these services; applicant will also need to obtain a release of information form from the district before results can be shared.) REFERENCE AND BACKGROUND CHECK AUTHORIZATION FORM Below, please provide the names and contact information of three references (including at least one congregational leader or professional staff person) who have known you for at least three years and can recommend you as appropriate for a leadership role in programs for children and/or youth. (Please do not include relatives, partners, or other individuals applying for similar status.) 1) Name ___________________________________ Phone #______________________ Role ___________________________

Email Address _________________________________ Role ___________________________

2) Name ___________________________________

Phone #_______________________ Email Address _________________________________ 3) Name _____________________________________ Role __________________________ Phone #_______________________ Email Address _________________________________ I hereby authorize District staff to contact the above references and to conduct a criminal background and sexual offender check as conditions of my clearance to work with children and youth at NNED-sponsored events. Should my application be accepted, I agree to be bound by the protection requirements and policies set forth by the NNED regarding child care and youth workers (see “Safety” in Youth Pages at the NNED website: Signature _____________________________email:__________________________________ Address _____________________________________________________________________ Social Security # _______________________ Date of birth:_____________________ ______ REV 2/2/10 Do not write below this line; for office use only

Reviewed & Signed  Reference Checked  Background Check  Copy on File Rejected

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