Safer Spaces Policy

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" rowspan="2" width=160 BGCOLOR="#FFFFFF" TEXT="#080000" background="04cc8c03.jpg"> <div> <IMG SRC="06e688d0.jpg" border=0 width="104" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div>  <A HREF="index.htm" TARGET="_top" TITLE="The United Church of Christ in North Ham">Home</A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Welcome">Welcome</A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="Church History">Church History</A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="Church Council">Church Council</A></div> <div> <A HREF="id88.htm" TARGET="_top" TITLE="Policies">Policies</A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="Programs">Programs</A></div> <div> <A HREF="id85.htm" TARGET="_top" TITLE="Announcements">Announcements</A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="Calendar">Calendar</A></div> <div> <A HREF="id42.htm" TARGET="_top" TITLE="Worship/Bulletins">Worship/Bulletins</A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="Lantern">Lantern</A></div> <div> <A HREF="id50.htm" TARGET="_top" TITLE="Members">Members</A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="Related Links">Related Links</A></div> <div> <A HREF="id56.htm" TARGET="_top" TITLE="Contact Us">Contact Us</A></div> <bR> <div> <I><B><IMG SRC="0ea8a6e0.jpg" border=0 width="138" height="110" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></I></div> <bR> </td> <td valign="top" colspan=2 height=110 style=" border-bottom: 1px solid #CCCCCC;" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>The United Church of Christ</B></div> <div> <FONT SIZE="6" COLOR="#FF0000" FACE="Lucida Calligraphy" ><B>in North Hampton</B></FONT><B> </B> <FONT SIZE="5" COLOR="#000000" FACE="Black-Chance" >  </FONT><FONT SIZE="5" COLOR="#000000" FACE="Times New Roman" ><B>|</B></FONT><FONT SIZE="3" COLOR="#000000" FACE="Times New Roman" ><B>    </B></FONT><FONT SIZE="3" COLOR="#336600" FACE="Times New Roman" ><A HREF="index.htm" TARGET="_top" TITLE="The United Church of Christ in North Ham"><B>Home</B></A></FONT></div> <div> </div> </td> </tr><tr> <td valign="top" height=370 width="100%" colspan=2 BGCOLOR="#FFFFFF" TEXT="#080000"> <div>  <A NAME="safer_spaces_policy"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Safer Spaces Policy</div> <bR> <div> <FONT SIZE="3" COLOR="#FF0000" FACE="Times New Roman" ><B>back to:</B></FONT> <A HREF="id88.htm" TARGET="_top" TITLE="Policies">Policies</A></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="id34.htm" TARGET="_top" TITLE="ByLaws">By-Laws</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id82.htm" TARGET="_top" TITLE="Church Use Policies">Church Use Policies</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id86.htm" TARGET="_top" TITLE="Sacrament of Holy Baptism">Sacrament of Holy Baptism</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id80.htm" TARGET="_top" TITLE="Wedding Policies">Wedding Policies</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><B>Safer Spaces Policy</B><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id108.htm" TARGET="_top" TITLE="Annual Report">Annual Report</A></div> <bR> <bR> <div> <I><B> <A NAME="safer_spaces_policy_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></I><FONT SIZE="5" COLOR="#0000FF" FACE="Times New Roman" ><I><B>SAFER SPACES POLICY</B></I></FONT></div> <bR> <div> UCC North Hampton, NH</div> <div> Committee “C” Members:</div> <div> Bill Boesch</div> <div> <I>Bob Kinsman</I></div> <div> <I>Colleen Ridge</I></div> <div> <I>Dick Tharp</I></div> <div> <I>Approved by Council on January 8, 2003</I></div> <div> <I> <A NAME="table_of_contents"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>Table of Contents</I></div> <div> <A HREF="#i__biblical_basis" TITLE="Safer Spaces Policy">I. Biblical Basis</A></div> <div> <A HREF="#ii__statement_of_policy" TITLE="Safer Spaces Policy">II. Statement of Policy</A></div> <div> <A HREF="#ii__statement_of_policy" TITLE="Safer Spaces Policy">A. Prohibition of Sexual Exploitation and All Forms of Harassment (See definitions.)</A></div> <div> <A HREF="#b__ministerial_conduct__see" TITLE="Safer Spaces Policy">B. Ministerial Conduct (See definitions.)</A></div> <div> <A HREF="#c__youth_protection_policy" TITLE="Safer Spaces Policy">C. Youth Protection Policy</A></div> <div> <A HREF="#iii__definitions" TITLE="Safer Spaces Policy">III. Definitions</A></div> <div> <A HREF="#iv__procedures_for_handling_complaints" TITLE="Safer Spaces Policy">IV. Procedures for Handling Complaints</A></div> <div> <A HREF="#iv__procedures_for_handling_complaints" TITLE="Safer Spaces Policy">A. Safer Spaces Committee</A></div> <div> <A HREF="#b__submitting_and_reviewing_complaints" TITLE="Safer Spaces Policy">B. Submitting and Reviewing Complaints</A></div> <div> <A HREF="#c__actions_to_be_taken_in_response_to" TITLE="Safer Spaces Policy">C. Actions to be taken in Response to Complaint may include:</A></div> <div> <A HREF="#v__screening_guidelines" TITLE="Safer Spaces Policy">V. Screening Guidelines</A></div> <div> <A HREF="#vi__review_and_update_of_policy" TITLE="Safer Spaces Policy">VI. Review and Update of Policy</A></div> <div> <A HREF="#appendix_a___forms" TITLE="Safer Spaces Policy">Appendix A – Forms</A></div> <div> <A HREF="#appendix_a___forms" TITLE="Safer Spaces Policy">United Church of Christ in North Hampton Disclosure Form</A></div> <div> <A HREF="#anchor" TITLE="Safer Spaces Policy">Criminal History Record Cover Letter</A></div> <div> <A HREF="#n_h_dept_safety" TITLE="Safer Spaces Policy">Criminal Record Release Authorization Form</A></div> <div> <A HREF="#nh_reduced_fee_request" TITLE="Safer Spaces Policy">Reduced Fee Request Form</A></div> <bR> <bR> <div> <I> <A NAME="i__biblical_basis"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>I. Biblical Basis</I></div> <div> Psalm 46 (RSV) – Psalm 46 begins “God is our refuge and strength, a very present help</div> <div> in trouble. Therefore we will not fear though the earth should change, though the</div> <div> mountains shake in the heart of the sea; though its waters roar and foam, though the</div> <div> mountains tremble with its tumult.” Psalm 46 goes on to say that God makes violence</div> <div> come to an end in the world and ends with “The Lord of hosts is with us; the God of</div> <div> Jacob is our refuge.”</div> <div> It means we know God’s presence among us when our community is absent of fear</div> <div> though the world may be changing around us. It means that we know God’s presence</div> <div> when violence among us ends. As the people of God, we are charged with the task of</div> <div> creating paths for God’s will to be done on earth.</div> <div> So that people may know that the presence of God is present at the United Church of</div> <div> Christ in North Hampton, we seek that God who is a safe place, who provides a place</div> <div> absent of fear, and who ends the violence among us.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="ii__statement_of_policy"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>II. Statement of Policy</I></div> <div> <I>A. Prohibition of Sexual Exploitation and All Forms of Harassment</I></div> <div> <I>(See definitions.)</I></div> <div> The United Church of Christ in North Hampton is committed to creating and maintaining a</div> <div> worship and work community in which members, friends, staff, and volunteers can worship and</div> <div> work together in an atmosphere free of all forms of discrimination, harassment, exploitation, or</div> <div> intimidation. Specifically, all persons associated with the United Church of Christ in North</div> <div> Hampton should be aware that the church is strongly opposed to sexual exploitation and all forms</div> <div> of harassment and that such behavior is prohibited by church policy. It is the intention and</div> <div> responsibility of the church to take whatever action may be needed to prevent and correct</div> <div> behavior which is contrary to this policy and, if necessary, to discipline those persons who violate</div> <div> this policy.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="b__ministerial_conduct__see"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>B. Ministerial Conduct (See definitions.)</I></div> <div> All persons engaged in the ministry of the United Church of Christ in North Hampton (including</div> <div> elected or appointed leaders, employees, volunteers, and authorized ministers) are responsible</div> <div> for knowing the possible impact of their words and actions in ministering to the emotional, mental,</div> <div> and spiritual needs of persons who come to them for help or over whom they have any kind of</div> <div> authority. All forms of harassment or sexual exploitation of parishioner(s) or other individual(s) by</div> <div> anyone engaged in the ministry of United Church of Christ in North Hampton is unethical and</div> <div> unprofessional behavior and will not be tolerated within this congregation.</div> <div> Because ministers (including elected or appointed leaders, employees, volunteers, and</div> <div> authorized ministers) often deal with individuals who are emotionally and psychologically fragile</div> <div> or otherwise personally vulnerable, it is imperative that those engaged in the ministry of this</div> <div> church maintain their own psychological, emotional, and spiritual health and that they have</div> <div> adequate preparation and education for helping those individuals they seek to serve in ministry.</div> <div> It is the policy of United Church of Christ in North Hampton to encourage its leaders, authorized</div> <div> ministers, employees, and volunteers to nurture safety within ministerial relationships by being</div> <div> attentive to self-care, education, and the importance of referring those in need to supportive and</div> <div> helpful resources. It is also expected that those engaged in providing ministry will complete and</div> <div> submit a disclosure document in a form substantially similar to that of the one accompanying this</div> <div> policy (See Appendix.)</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="c__youth_protection_policy"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>C. Youth Protection Policy</I></div> <div> The United Church of Christ in North is committed to creating a safe and healthy environment in</div> <div> which young people can learn about and experience God’s love. In order to ensure this, we</div> <div> expect that all people applying to be volunteers who work with minors will have been members for</div> <div> at least six months or friends of the United Church of Christ in North Hampton for one year. It is</div> <div> the policy of the church to provide adequate supervision for all youth activities. We also expect all</div> <div> employees or volunteers who work with minors to complete and submit a disclosure document in</div> <div> a form substantially similar to that of the one accompanying this policy.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="iii__definitions"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>III. Definitions</I></div> <div> <B>Minister</B>: a person engaged by the church to carry out its ministry. Minister includes elected or</div> <div> appointed leaders of the church, employees, and volunteers, as well as authorized ministers.</div> <div> <B>Authorized minister</B>: a person who holds ordained ministerial standing or has been</div> <div> commissioned or licensed by an association of the United Church of Christ.</div> <div> <B>Ministerial relationship</B>: the relationship between one who carries out the ministry of the church</div> <div> and the one being served by that ministry.</div> <div> <B>Harassment: </B>tormenting by repeated attacks, either physical or psychological. Verbal or written</div> <div> communications can constitute harassment when the content or delivery style results in</div> <div> humiliation, embarrassment, or fear. Any repeated behavior toward a person which results in</div> <div> humiliation, embarrassment, or fear is also considered harassment.</div> <div> <B>Sexual Exploitation</B>: sexual activity or contact (not limited to sexual intercourse) in which a</div> <div> minister engaged in the work of the church takes advantage of the vulnerability of a participant by</div> <div> causing or allowing the participant to engage in sexual behavior with the minister.</div> <div> Sexual harassment: repeated or coercive sexual advances toward another person contrary to his</div> <div> or her wishes. It includes behavior directed at another person’s sexuality or sexual orientation</div> <div> with the intent of intimidating, humiliating, or embarrassing the other person, or subjecting the</div> <div> person to public discrimination. Unwelcome sexual advances, requests for sexual favors, and</div> <div> other verbal or physical conduct of a sexual nature constitute sexual harassment when:</div> <div> ? Submission to such conduct is made either explicitly or implicitly a term or condition or</div> <div> circumstance of instruction, employment, or participation in any church activity;</div> <div> ? Submission to, or rejection of, such conduct by an individual is used as a basis for</div> <div> evaluation in making personnel or church-related decisions affecting an individual; or</div> <div> ? Such conduct has the purpose or effect of unreasonably interfering with an individual’s</div> <div> performance or participation in church activities or creating an intimidating, hostile, or</div> <div> offensive work or church environment.</div> <div> Prohibited sexual harassment includes unsolicited and unwelcome contact that has sexual</div> <div> overtones, particularly:</div> <div> ? Written contact, such as sexually suggestive or obscene letters, notes or invitations;</div> <div> ? Verbal contact, such as sexually suggestive or obscene comments, threats, slurs, epithets,</div> <div> jokes about gender-specific traits or sexual orientation, sexual propositions;</div> <div> ? Physical contact, such as intentional touching, pinching, brushing against another’s body,</div> <div> impeding or blocking movement, assault, coercing sexual intercourse; and</div> <div> ? Visual contact, such as leering or staring at another’s body, gesturing, displaying sexually</div> <div> suggestive objects or pictures, cartoons, posters, or magazines.</div> <div> Sexual harassment also includes continuing to express sexual interest after being informed</div> <div> directly that the interest is unwelcome – and using sexual behavior to control, influence, or affect</div> <div> the career, salary, work, learning, or worship environment of another. It is impermissible to</div> <div> sugest, threaten, or imply that failure to accept a request for a date or sexual intimacy will affect a</div> <div> person’s job prospects, church leadership, or comfortable participation in the life of the church.</div> <div> For example, it is forbidden either to imply or actually withhold support for an appointment, or</div> <div> promotion, or change of assignment, to suggest that a poor performance report will be given</div> <div> because a person has declined a personal proposition; or to hint that benefits, such as</div> <div> promotions, favorable performance evaluations, favorable assigned duties or shifts,</div> <div> recommendations or reclassifications, will be forthcoming in exchange for sexual favors.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="iv__procedures_for_handling_complaints"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>IV. Procedures for Handling Complaints</I></div> <div> <I>A. Safer Spaces Committee</I></div> <div> A Safer Spaces Committee (SSC) consisting of three (3) former church council members, in</div> <div> addition to the Minster of Family Life, and/or the Youth Leader, will be established by the Church</div> <div> Council at the United Church of Christ in North Hampton each year at the Annual Meeting.</div> <div> The committee shall be supported by the Denominational Correspondent Task Group Leader.</div> <div> The Task Group Leader shall be a liaison to other Seacoast Area Churches, New Hampshire</div> <div> Conference UCC and the United Church of Christ, Cleveland.</div> <div> This action is taken in preparation for the possibility of hearing complaints under its adopted</div> <div> statement of policy. The Committee (SSC) will familiarize itself with the terms of the policy as</div> <div> well as the established procedures of the United Church of Christ in North Hampton for dealing</div> <div> with complaints of alleged discrimination, exploitation, harassment or intimidation against any</div> <div> employee(s) or volunteer(s) in leadership positions.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="b__submitting_and_reviewing_complaints"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>B. Submitting and Reviewing Complaints</I></div> <div> 1. Submitting Complaints.</div> <div> a. New Hampshire state law, RSA 169-C, the Child Protection Act, states that any</div> <div> person who has reason to suspect that a child under the age of 18 has been</div> <div> abused and/or neglected must make a report to the Division for Children, Youth,</div> <div> and Families (DCYF). Contact information for DCYF: 1-800-894-5533, 603-271-</div> <div> 6556, Monday through Friday 8:00 am to 4:30 pm.</div> <div> b. A written notice of the complaint is given to a member of the Safer Spaces</div> <div> Committee.</div> <div> 2. Reviewing Complaints</div> <div> a. The Safer Spaces Committee meets to review the complaint and forward the</div> <div> complaint to the accused. If an authorized minister is involved in the complaint,</div> <div> the Pastoral Relations Committee will be informed of the complaint.</div> <div> b. The accused, in writing, answers the complaint.</div> <div> c. The Safer Spaces Committee meets to discuss the charges and/or gather</div> <div> statements or other information from the individuals involved in the complaint</div> <div> and/or others who may have pertinent information to determine the appropriate</div> <div> response.</div> <div> d. The appropriate response will depend upon whether or not there is a vi olation of</div> <div> the Safer Spaces Policy and will include reporting to the Church Council when</div> <div> appropriate.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="c__actions_to_be_taken_in_response_to"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>C. Actions to be taken in Response to Complaint may include:</I></div> <div> 3. Dismiss the charges if appropriate.</div> <div> 4. Conduct a meeting to hear verbal presentations by both sides. The meeting shall be held</div> <div> in such a manner that does not allow for cross discussion between the complainant and</div> <div> the accused. Each side shall simply state the facts and what they personally</div> <div> experienced.</div> <div> 5. If there has been a violation of Safer Spaces Policy, the following may occur:</div> <div> ? A formal reprimand with defined expectations for changed behavior, including</div> <div> possible public notification.</div> <div> ? Recommending or requiring rehabilitation that may include education and/or</div> <div> counseling.</div> <div> ? Reporting the incident to the police or proper authority.</div> <div> ? Suspension or dismissal from employment or volunteer leadership position, and, in</div> <div> extreme cases, affiliation with, or membership in, the church.</div> <div> ? Probation, with the terms of probation clearly defined.</div> <div> ? If the accused employee or volunteer is an authorized minister (i.e., holds ordained</div> <div> ministerial standing or has been commissioned or licensed by an association of the</div> <div> United Church of Christ) the SSC shall inform the appropriate body of the wider</div> <div> United Church of Christ (i.e., conference minister, association committee on the</div> <div> ministry) of the allegation. The United Church of Christ in North Hampton will</div> <div> cooperate fully in any procedures of the United Church of Christ related to the</div> <div> person’s ministerial authorization while retaining the right and responsibility to employ</div> <div> or designate leadership within the United Church of Christ in North Hampton as it</div> <div> determines best.</div> <div> 6. A written summary of the Safer Spaces Committee proceedings and documents will be</div> <div> kept in a locked file in the Church Office. Access to the locked file limited to the</div> <div> Chairperson of the Safer Spaces Committee and the Church Council Moderator(s).</div> <div> 7. The totality of circumstances is considered when judging the validity of complaints.</div> <div> 8. Any person bringing a discrimination, harassment, exploitation or intimidation complaint</div> <div> or assisting in investigating such a complaint will not be adversely affected in terms and</div> <div> conditions of employment, church membership or affiliation, or otherwise discriminated</div> <div> against or discharged.</div> <div> 9. If the complainant(s) or accused person(s) is not satisfied with the disposition of the</div> <div> matter by the Safer Spaces Committee, he or she has the right to appeal to the</div> <div> Moderator(s) who may refer the matter to the Church Council. Appeals must be made in</div> <div> writing and include specific justification for the appeal based upon the following: (1) bias,</div> <div> (2) procedural error, (3) decision contrary to fact or (4) new evidence.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="v__screening_guidelines"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>V. Screening Guidelines</I></div> <div> Everyone completing an “Employment/Authorized Volunteer Application and Disclosure Form” will</div> <div> also submit a notarized “Criminal Record Release Authorization Form.” The Office Manager will</div> <div> forward the “Criminal Record Release Authorization Form” to the New Hampshire State Police.</div> <div> For volunteers working with children or youth, the completed “Employment/Authorized Volunteer</div> <div> Application and Disclosure Form,” any references and criminal history record will be reviewed by</div> <div> Ministry of Family Life. The Church Council Moderators will review that information if the</div> <div> applicant is for the Pastor or Ministry of Family Life positions. The Pastor will review that</div> <div> information for all others.</div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#safer_spaces_policy_1" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <I> <A NAME="vi__review_and_update_of_policy"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>VI. Review and Update of Policy</I></div> <div> The Safer Spaces Policy will be reviewed annually by the Safer Spaces Committee, with a report</div> <div> submitted to the Church Council regarding the policy’s implementation and suggested</div> <div> improvements.</div> <DIV ALIGN="LEFT"></DIV> <div> <B>-------------------------------------</B></div> <bR> <div> <I> <A NAME="appendix_a___forms"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></I><I>Appendix A – Forms</I></div> <div> <A HREF="#the_united_church_of_christ_in_north" TITLE="Safer Spaces Policy"><I>United Church of Christ in North Hampton Disclosure Form</I></A></div> <div> <A HREF="#anchor" TITLE="Safer Spaces Policy"><I>Criminal History Record Cover Letter</I></A></div> <div> <A HREF="#n_h_dept_safety" TITLE="Safer Spaces Policy"><I>Criminal Record Release Authorization Form</I></A></div> <div> <A HREF="#nh_reduced_fee_request" TITLE="Safer Spaces Policy"><I>Reduced Fee Request Form</I></A></div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="#table_of_contents" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <B>-------------------------------------</B></div> <bR> <bR> <div> <B> <A NAME="the_united_church_of_christ_in_north"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>The United Church of Christ in North Hampton</B></div> <div> <B>Employment/Authorized Volunteer Application and Disclosure Form</B></div> <div> Name _______________________________________________________________________________________________</div> <div> Last First Middle</div> <div> Address _____________________________________________________________________________________________</div> <div> Street</div> <div> ____________________________________________________________________________________________</div> <div> City State Zip Code</div> <div> Daytime Phone ________________________ Evening Phone _____________________</div> <div> Name of Church where I am currently a friend or member _________________________</div> <div> My previous experience in the past five years (paid or volunteer) related to the ministry I am seeking to fill includes:</div> <div> (Attach additional page(s) as necessary.)</div> <div> Agency Name _______________________________________________________________________________________</div> <div> Address ____________________________________________________________________________________________</div> <div> City, State, Zip ______________________________________________________________________________________</div> <div> Contact Person ____________________________________________Phone ____________________________________</div> <div> Agency Name _______________________________________________________________________________________</div> <div> Address ____________________________________________________________________________________________</div> <div> City, State, Zip ______________________________________________________________________________________</div> <div> Contact Person ____________________________________________Phone ____________________________________</div> <div> Agency Name _______________________________________________________________________________________</div> <div> Address ____________________________________________________________________________________________</div> <div> City, State, Zip ______________________________________________________________________________________</div> <div> Contact Person ____________________________________________Phone ____________________________________</div> <div> I have been a member of this church since _____. I have been a friend of this church since _____.</div> <div> I have never been found guilty, or pled guilty or no contest, to a criminal charge. __ True __Not True</div> <div> If not true, give a short explanation of the charge. (Please indicate the date, nature, and place of the incident leading to the charge;</div> <div> where the charge was filed; and the precise disposition of the charge.)</div> <div> ____________________________________________________________________________________________________</div> <div> ____________________________________________________________________________________________________</div> <div> ____________________________________________________________________________________________________</div> <div> No civil lawsuit alleging actual or attempted sexual discrimination, harassment, exploitation, or misconduct; physical abuse; child</div> <div> abuse; or financial misconduct has ever resulted in a judgement being entered against me, been settled out of court, or been dismissed</div> <div> because the statute of limitations was expired. __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>True __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>Not True</div> <div> If not true, give a short explanation of the lawsuit. (Please indicate the date, nature, and place of the incident leading to the</div> <div> lawsuit; where the lawsuit was filed; and the precise disposition of the lawsuit.)</div> <div> ____________________________________________________________________________________________________</div> <div> ____________________________________________________________________________________________________</div> <div> ____________________________________________________________________________________________________</div> <bR> <div> I have never terminated my employment, professional credentials, or service in a volunteer position or had my</div> <div> professional credentials, or authorization to hold a volunteer position terminated for reasons relating to allegations of</div> <div> actual or attempted sexual discrimination, harassment, exploitation, or misconduct; physical abuse; child abuse; or</div> <div> <FONT SIZE="2" COLOR="#000000" FACE="TimesNewRomanPSMT" >financial misconduct. __</FONT> <FONT SIZE="2" COLOR="#000000" FACE="TimesNewRomanPSMT" >True __</FONT> <FONT SIZE="2" COLOR="#000000" FACE="TimesNewRomanPSMT" >Not True</FONT></div> <div> If not true, give a short explanation. (Please indicate the date of termination; name, address, and telephone number of employer or</div> <div> volunteer supervisor; and nature of the incidents(s) leading to your termination.)</div> <div> ____________________________________________________________________________________________________</div> <div> ____________________________________________________________________________________________________</div> <div> ____________________________________________________________________________________________________</div> <div> Do you have a valid driver’s license? . __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>True __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>Not True</div> <div> State where license is issued __________________ Driver’s license number _____________________</div> <div> With respect to my driving record, I have not had my license suspended or revoked within the last five years due to reckless driving or</div> <div> driving while under the influence of a controlled substance. __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>True __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>Not True</div> <div> Is there any other factor or circumstance involving you or your background that would call into question your being entrusted with the</div> <div> responsibilities of your volunteer position? __<FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" > </FONT>True  __Not True</div> <div> If yes, please provide a brief explanation.</div> <div> _____________________________________________________________________________________________________</div> <div> _____________________________________________________________________________________________________</div> <div> _____________________________________________________________________________________________________</div> <div> The covenants between persons seeking sanctioned volunteer positions in the church require honesty, integrity, and truthfulness for</div> <div> the health of the church. To that end, I attest that the information set forth in this application is true and complete. I understand that</div> <div> any misrepresentation or omission may be grounds for rejection of consideration for, or termination of, the volunteer position I am</div> <div> seeking to fill. I acknowledge that it is my duty in a timely fashion to amend the responses and information I have provided if I come</div> <div> to know that the response or information was incorrect when given or, though accurate when given, the response of information is no</div> <div> longer accurate.</div> <div> Beginning such relationships with an open exchange of relevant information builds the foundation for a continuing and healthy</div> <div> covenant between volunteers and the church they seek to serve. To that end, I authorize The United Church of Christ in North</div> <div> Hampton and/or its agents to make inquiries regarding all statement I have set forth above. I also authorize all entities, person, former</div> <div> employers, supervisors, courts, law enforcement, and other public agencies to respond to inquiries concerning me, to supply</div> <div> verification of the statement I have made, and to comment on and state opinions regarding my background and character. To</div> <div> encourage such persons and entities to speak openly and responsibly, I hereby release them from all liability arising from their</div> <div> responses, comments and statements made in good faith and without malice.</div> <div> The United Church of Christ’s authorized volunteer recruitment process involves the distribution of information regarding applicants</div> <div> with those persons in a position to recruit, secure, and supervise the position I am seeking to fill. To that end, I authorize The United</div> <div> Church of Christ and its agents to circulate, distribute, and otherwise share information gathered in connection with this application to</div> <div> such persons for these stated purposes. I understand that The United Church of Christ in North Hampton will share with me</div> <div> information it has gathered about me, if I request it to do so.</div> <DIV ALIGN="LEFT"></DIV> <div> (Signature) ________________________________________</div> <div> (Parent’s or guardian’s signature for applicants under <FONT SIZE="3" COLOR="#000000" FACE="TimesNewRomanPSMT+1" >1</FONT>8) __________________________________________</div> <DIV ALIGN="LEFT"></DIV> <div> (Date) _________________________________________</div> <bR> <bR> <div> <A HREF="#table_of_contents" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <div> <B>------------------------------------</B></div> <div> <B> <A NAME="anchor"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> <B><IMG SRC="0f6e8f30.png" border=0 width="744" height="755" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <A HREF="#table_of_contents" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <bR> <div> <B>-----------------------------------</B></div> <div> <B> <A NAME="n_h_dept_safety"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B><IMG SRC="0f803f40.png" border=0 width="771" height="1268" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <A HREF="#table_of_contents" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <bR> <div> <B>-----------------------------------</B></div> <div> <B> <A NAME="nh_reduced_fee_request"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> <B><IMG SRC="0fa04160.png" border=0 width="772" height="1046" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>-----------------------------------</B></div> <bR> <bR> <div> <A HREF="#safer_spaces_policy" TITLE="Safer Spaces Policy"><B>(Back to Top)</B></A></div> <bR> <div> <FONT SIZE="3" COLOR="#FF0000" FACE="Times New Roman" ><B>back to:</B></FONT> <A HREF="id88.htm" TARGET="_top" TITLE="Policies">Policies</A></div> <bR> <div> <A HREF="id34.htm" TARGET="_top" TITLE="ByLaws">By-Laws</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id82.htm" TARGET="_top" TITLE="Church Use Policies">Church Use Policies</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id86.htm" TARGET="_top" TITLE="Sacrament of Holy Baptism">Sacrament of Holy Baptism</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id80.htm" TARGET="_top" TITLE="Wedding Policies">Wedding Policies</A><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><B>Safer Spaces Policy</B><FONT SIZE="3" COLOR="#000000" FACE="Symbol" >   ·   </FONT><A HREF="id108.htm" TARGET="_top" TITLE="Annual Report">Annual Report</A></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="0dad84f0.jpg" border=0 width="216" height="79" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> If there are any problems with the Web Site or Comments about the Site please e-mail: <FONT SIZE="2" COLOR="#0000FF" FACE="Times New Roman" ><A HREF="mailto: webmaster@UCCNorthHampton.org" TARGET="_top" TITLE="mailto: webmaster@UCCNorthHampton.org">webmaster@UCCNorthHampton.org</A></FONT></div> <bR> </td> </tr></table></body>