Subject: * | |
E-mail Address: * | |
First Name * | |
Middle Name | |
Last Name * | |
Date | |
Present address * | |
City * | |
State * | |
Zip code * | |
Home phone number | |
Other phone number | |
How long have you been a Christian? | |
Give a brief testimony of how you became a Christian. | |
Are you a member of Harvest Time Bible Church? * | yes no |
How long? | |
List the names of other churches you have attended regularly during the past 5 years | |
List all previous church work you have done involving children or youth. (list church name, address/phone number, type of work and dates) | |
List all previous non-church related work you have done involving children or youth. (list organization name, address/phone number, type of work performed, dates) | |
List any gifts, calling, training, education or other factors that you feel have prepared you for work with children/youth. | |
Which type of ministry work do you prefer, children or youth? | children youth |
What age? | preschool elementary middle school high school |
Have you ever been formally charged, arrested or convicted of or plead guilty to a crime involving child abuse or child molestation, physical abuse of any kind, alcohol or illegal drug use, possession, sale or related offense? * | yes no |
If yes, explain. | |
Have you ever been a complainant or a subject of the Illinois Department of Children and Family Services (DCFS) investigation? * | yes no |
If so, what was the nature of the complaint? | |
What was the outcome? | |
Explain | |
Were you a victim of abuse or molestation as a minor? (If you prefer, you may refuse to answer this question. Answering yes, or leaving the question unanswered will not automatically disqualify you as an applicant for youth or childrens work.) | yes no prefer not to answer |
Do you have a current drivers license? * | yes no |
If yes, has your drivers license ever been suspended or revoked? * | yes no |
If so, for what reason? | |
Explain. | |
Drivers License Number | |
Type of license. | passenger CDL air breaks school bus |
Would you be willing to drive a bus or van for children/youth events? | yes no perhaps in future but not now |
Personal reference#1 as to your character (not former employees or relatives) – list name, address, phone number and relationship | |
Personal reference#2 as to your character (not former employees or relatives) – list name, address, phone number and relationship | |
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