Central Avenue
I'M NEW
WHO WE ARE
WHO WE ARE
WHAT WE BELIEVE
OUR LEADERSHIP
HOW WE GROW
SMALL GROUPS
FAMILY MINISTRIES
ReCharge Retreat
WORSHIP & MEDIA
CONNECTIONS
HOSPITALITY
MESSAGES
VENUE
GIVE
FORWARD
ABOUT
TRANSFORM
PLANT
REACH
TEACH
GIVE
I'M NEW
/
WHO WE ARE
/
WHO WE ARE
WHAT WE BELIEVE
OUR LEADERSHIP
HOW WE GROW
/
SMALL GROUPS
FAMILY MINISTRIES
ReCharge Retreat
WORSHIP & MEDIA
CONNECTIONS
HOSPITALITY
MESSAGES
/
VENUE
/
GIVE
/
FORWARD
/
ABOUT
TRANSFORM
PLANT
REACH
TEACH
GIVE
Central Avenue United Methodist Church
Servant Leader Application
I'M NEW
/
WHO WE ARE
/
WHO WE ARE
WHAT WE BELIEVE
OUR LEADERSHIP
HOW WE GROW
/
SMALL GROUPS
FAMILY MINISTRIES
ReCharge Retreat
WORSHIP & MEDIA
CONNECTIONS
HOSPITALITY
MESSAGES
/
VENUE
/
GIVE
/
FORWARD
/
ABOUT
TRANSFORM
PLANT
REACH
TEACH
GIVE
SERVANT LEADER APPLICATION
Contact information
Name
*
Name
First Name
Last Name
Date of Birth
*
Date of Birth
MM
DD
YYYY
Address
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
Phone
(###)
###
####
Email Address
*
Background Information
I am an available driver.
(mark box if yes)
Driver's License #
State of Driver's License
Occupation
*
Employer
Marital Status:
*
Single
Married
Divorced
Widowed
Name of Spouse
Name of Spouse
First Name
Last Name
Alias Names (other names I have been known under):
Previous Addresses (last five years)
Address 1 (most recent)
Address 1 (most recent)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Address 2
Address 2
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Address 3
Address 3
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
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.
Have you ever been charged with or convicted of a felony?
*
If your answer is yes, please provide specific details and dates below. Information will be held in strict confidence.
YES
NO
Have you ever been charged with or convicted of any drug charges?
*
If your answer is yes, please provide specific details and dates below. Information will be held in strict confidence.
YES
NO
Have you ever been charged with or convicted of any sex charges?
*
If your answer is yes, please provide specific details and dates below. Information will be held in strict confidence.
YES
NO
If you answered "yes" to any of the above, please explain:
PLEASE PROVIDE THREE PROFESSIONAL REFERENCES THAT KNOW YOUR SKILLS WITH CHILDREN AND YOUTH, AND CAN ATTEST TO YOUR SPIRITUAL JOURNEY:
Reference #1
*
Name, Address, E-mail, Relationship
Reference #2
*
Name, Address, E-mail, Relationship
Reference #3
*
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.
Central Avenue United Methodist Church may obtain information about you from reporting agencies for volunteer purposes. The report may contain information bearing on your character, general reputation, personal characteristics, or mode of living, including but not limited to criminal and driving records, education, prior employment verification, and workers' compensation claims. The report may be obtained for public or private sources. You have a right to request disclosure of the nature and scope of any investigative consumer report.
*
Please type your initials below to indicate your acknowledgement and agreement.
I acknowledge receipt of the Notice Regarding Backround Investigation and certify that I have read and understand this text. I hereby authorize Clear Investigative Advantage to request and obtain the above-referenced reports at any time during the application process or during my volunteer service or employment and as often as the company deems necessary.
*
Please type your initials below to indicate your acknowledgement and agreement.
The information in this application is correct to the best of my knowledge.
I authorize any personal references listed in this application to provide you any information (including opinions) that they might have regarding my character and fitness for work with children or teens. In consideration of the receipt and evaluation of this application by Central Avenue United Methodist Church, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including legal and record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which might at any time result to me, my heirs or family, on account of compliance, or any attempts to comply, with this authorization.
I hereby give my consent for information regarding past violations of law to be released and authorize Central Avenue United Methodist Church to contact local, state, and national law enforcement officials and courts for such release. Should my application be accepted, I agree to sign a covenant and be bound by the policies of Central Avenue United Methodist Church, and to refrain from unscriptural conduct in the performance of my services on behalf of the church.
Falsification of information or noncompliance with the rules and covenant might, in the discretion of Central Avenue United Methodist Church, be determined to show me unfit to serve and might result in the withdrawal of servant status and admission to events.
I also waive and release the use of my photograph or likeness for the church website, in-house, or promotional use.
I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act.
*
Please type your name below to indicate your acknowledgement and agreement.
Date of Signature
*
Date of Signature
MM
DD
YYYY
Thank you!
