Contact information
Name *
Name
Date of Birth *
Date of Birth
Address *
Address
Phone *
Phone
Background Information
I am an available driver.
Name of Spouse
Name of Spouse
Previous Addresses (last five years)
Address 1 (most recent)
Address 1 (most recent)
Address 2
Address 2
Address 3
Address 3
In order to help our church provide a safe and secure environment for those children and youth who attend our events and use our facility, all servants ministering in this area are required to complete the following information and submit to a criminal background screening.
If your answer is yes, please provide specific details and dates below. Information will be held in strict confidence.
If your answer is yes, please provide specific details and dates below. Information will be held in strict confidence.
If your answer is yes, please provide specific details and dates below. Information will be held in strict confidence.
PLEASE PROVIDE THREE PROFESSIONAL REFERENCES THAT KNOW YOUR SKILLS WITH CHILDREN AND YOUTH, AND CAN ATTEST TO YOUR SPIRITUAL JOURNEY:
Name, Address, E-mail, Relationship
Name, Address, E-mail, Relationship
Name, Address, E-mail, Relationship
In the following section, your decision to type your initials or name where requested will serve as your acknowledgement and agreement.
Please type your initials below to indicate your acknowledgement and agreement.
Please type your initials below to indicate your acknowledgement and agreement.
Please type your name below to indicate your acknowledgement and agreement.
Date of Signature *
Date of Signature