Date

MM

DD

YYYY

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Which area(s) would you like to serve in: *

Kids Crew

Host Crew

Social Media

Coffee Crew

Audio / Visual

Worship

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please check any of the following circumstances that apply to you: *

In order to provide a safe and secure environment for our children, youth and vulnerable persons we believe it is necessary to include the following as part of our application process. All information will be kept strictly confidential. Answering “yes” may not necessarily preclude your involvement in ministry. A meeting will be arranged with a Pastor so that you may discuss the circumstances. Thank you in advance for your understanding.

Have been convicted of a criminal offense involving children, youth or vulnerable persons.

Have been convicted of a sexually related crime.

Have been convicted of an abuse related crime.

Have been hospitalized or treated for alcohol or substance abuse.

Have any communicable disease.

In treatment for any form of diagnosed mental illness.

None of the above

Name *

First Name

Last Name

Name

First Name

Last Name

By checking this box, I hereby acknowledge that the information contained in this application is correct to the best of my knowledge. I also agree to acquire a personal Vulnerable Sector Check for the purpose of my protection against any false allegations and for the protection of those I serve. I understand that the results will be kept in extreme confidentiality. I further agree to adhere to the Abuse Prevention Policy and Procedures as adopted by the Church. *

I acknowledge that all the information is correct, I will obtain a Vulnerable Sector Check, and will adhere to the Abuse Prevention Policy

I acknowledge that I agree to the Church's Statement of Faith, including its stances on Marriage, Gender, and the sanctity of Life.