Office Use Only

Background Check ____________

Call / Interview _______________
Placed ______________________

Children’s Ministry Volunteer Application

Application/Personal Information
Name ____________________________________________________________________________
Last First Middle
Phone(s) ________________________________ Email ____________________________________

Best time to contact you ______________________________________________________________

Marital Status __________ If Married, How long?_________ Spouse’s Name ___________________

Children’s Names and Ages ___________________________________________________________

Do you have a personal relationship with Jesus Christ? __________ Briefly Describe:_______________

__________________________________________________________________________________

How long have you attended First Assembly? ___________

Previous Church(es) with Telephone number(s)_____________________________________________

__________________________________________________________________________________

What skills, spiritual gifts, or talents do you have which might be useful in this position?

What training or experiences do you have which might be useful in this position?

Ministry Preferences
Age/Grade Preference(s)
□ Babies to 24 month □ 2 and 3 yr olds □ 4 and 5 yr olds/Kindergarten
□ Grades 1-5 □ Prefer to work with Adults
Ministry Time Preference(s)
□ Sunday 8:30 □ Sunday 10:30 □ Wednesday Night
□ Set Up/Tear Down □ Special Events □ Weekend Retreats
The following questions are part of the process to help provide a safe and secure
environment for our children. It is our desire to work with you to find a ministry that is
fulfilling and suited to your strengths and experiences.
Have you ever been accused or convicted of the use or sale of illegal drugs? _______
Have you ever used illegal drugs? _______
Have you ever been treated for, or struggled with alcohol or substance abuse? _______
Have you ever been charged with a misdemeanor or felony? _______
Do you have any health issues that could place the children of Kenosha First Assembly at risk? _______
Have you ever been denied legal custody of your children in any legal proceeding including
divorce decrees or settlements? _______
Has DCFS ever investigated you for any reason? _______

Kenosha First Assembly Leader’s Covenant

Are you willing to commit to orientation, training and supervision? Yes _____ No ______
Have you read our faith values? (Please see at back of application) Yes_____ No______
Are you in agreement with them? Yes _____ No _____

Personal and/or Pastoral References (not relatives)

Name ________________________________________ Relationship ____________________________

Phone _______________________________ Email___________________________________________

Name ________________________________________ Relationship ____________________________

Phone _______________________________ Email___________________________________________

Name ________________________________________ Relationship ____________________________

Phone _______________________________ Email___________________________________________

Permission to Obtain a Background Check
In the interest of safety and security I, the undersigned applicant (also known as “consumer”), authorize
Kenosha First Assembly through its independent contractor, LexisNexis, to procure background
information (also known as a “consumer report and/or investigative consumer report”) about me, prior to,
and at any time during, my service to the organization. This report may include my driving history,
including any traffic citations; a social security number verification; present and former addresses; criminal
and civil history/records; and the state sex offender records.

I understand that I am entitled to a complete copy of any background information report of which I am the
subject upon my request to Kenosha First Assembly, if such is made within a reasonable time from the date
it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit
Reporting Act.

Signature _____________________________________________ Date _________________________

Identifying Information for Background Information Agency

Print Name: ________________________________________________________________________
First Middle Last

Other Names Used (alias, maiden, nickname) _______________________________________________

Current Address: _____________________________________________________________________

Street /P. O. Box City State Zip Code Dates

Former Address: _____________________________________________________________________

Street /P. O. Box City State Zip Code Dates

Social Security Number: _____________________ Daytime Telephone Number: ___________________

Driver’s License Number: ___________________________________ State of Issuance: __________

Date of Birth: _____________ Gender________

I certify that all information provided in this application is true and complete. I
understand that any false information or omission may disqualify me from further
consideration, or that discovery of such information at a later date may result in my
removal.

Signature _____________________________________________ Date __________________________

 Faith Values
We Believe:
1. The Scriptures are Inspired by God and declare His design and plan for mankind.
2. There is only One True God–revealed in three persons...Father, Son, and Holy Spirit (commonly
known as the Trinity).
3. In the Deity of the Lord Jesus Christ., as God's son Jesus was both human and divine.
4. Though originally good, Man Willingly Fell to Sin–ushering evil and death, both physical and
spiritual, into the world.
5. Every Person Can Have Restored Fellowship with God Through 'Salvation' (accepting Christ's
offer of forgiveness for sin).
6. In practicing two ordinances—(1) Water Baptism by Immersion after repenting of one's sins and
receiving Christ's gift of salvation, and (2) Holy Communion (the Lord's Supper) as a symbolic
remembrance of Christ's suffering and death for our salvation.
7. The Baptism in the Holy Spirit is a Special Experience Following Salvation that empowers
believers for witnessing and effective service, just as it did in New Testament times.
8. The Initial Physical Evidence of the Baptism in the Holy Spirit is ‘Speaking in Tongues,’ as
experienced on the Day of Pentecost and referenced throughout Acts and the Epistles.
9. Sanctification Initially Occurs at Salvation and is not only a declaration that a believer is holy, but
also a progressive lifelong process of separating from evil as believers continually draw closer to God
and become more Christ like.
10. The Church has a Mission to seek and save all who are lost in sin. We believe 'the Church' is the
Body of Christ and consists of the people who, throughout time, have accepted God's offer of
redemption (regardless of religious denomination) through the sacrificial death of His son Jesus Christ.
11. A Divinely Called and Scripturally Ordained Leadership Ministry Serves the Church. The Bible
teaches that each of us under leadership must commit ourselves to reach others for Christ, to worship
Him with other believers, and to build up or edify the body of believers–the Church.
12. Divine Healing of the Sick is a Privilege for Christians Today and is provided for in Christ's
atonement (His sacrificial death on the cross for our sins).
13. In The Blessed Hope—When Jesus Raptures His Church Prior to His Return to Earth. At this
future moment in time all believers who have died will rise from their graves and will meet the Lord in
the air, and Christians who are alive will be caught up with them, to be with the Lord forever.
14. In The Millennial Reign of Christ when Jesus returns with His saints at His second coming and
begins His benevolent rule over earth for 1,000 years. At that time many in the nation of Israel will
recognize and accept Him as the Messiah, the Savior who died for them and all mankind.
15. A Final Judgment Will Take Place for those who have rejected Christ. They will be judged for their
sin and consigned to eternal punishment in a punishing lake of fire.
16. And look forward to the perfect New Heavens and a New Earth that Christ is preparing for all
people, of all time, who have accepted Him. We will live and dwell with Him there forever following
His millennial reign on Earth. 'And so shall we forever be with the Lord!'

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