Full Time or Part Time

Full Time (30+ hrs weekly and 51% income)

Part Time (less than 30hrs weekly and less than 51% income)

Date

MM

DD

YYYY

Associate’s Name

First Name

Last Name

Credentials

Locally Licensed

District Licensed

Ordained

California Background Check *

According to California law, any employee (whether or not they have access to minors) of a youth service organization must undergo a ‘Section 11105.3 Search’ (a.k.a. CA Live Scan or state background check) and must complete training in child abuse and neglect identification and training in child abuse and neglect reporting. Please Note: There is no current provision allowing a youth service organization to use the CA Live Scan performed by another entity (i.e. You must still perform a CA Live Scan on a teacher, even if they had one completed by the school district). Section 11105.3 Search (CA Live Scan) is limited to California records and does NOT include a search of the California or national sex offender registries. In addition to performing the Section 11105.3 Search, it is best practice to perform a nationwide database search and a search of the sex offender registries, at a minimum

I have read and understand the above statement.

AB506 Compliance *

Has the associate undergone AB506 compliant training in child abuse and neglect identification and reporting in the last 2 years?

Yes

No

Not yet, but it will be included in the onboarding process

Associate’s Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Associate’s Phone Number *

(###)

###

####

Lead Pastor’s Name

First Name

Last Name

Additional Paperwork *

I understand that I must email the associate's resume and a copy of the church's financial record(s) that verify the church is paying debts and denominational budgets to alberthung@norcal.org.