Thanks for wanting to help kids discover the Good News of Jesus Christ!

This form is to be completed by an applicant for any volunteer position within The Northern Collective Church involving the supervision or custody of minors or the developmentally disabled, and for any paid staff member, regardless of his/her job responsibilities. It is being used to help church leaders provide a secure environment for those children, youth and developmentally disabled persons who participate in our programs and use our facilities.

Please read the Norther Collective Church’s “Abuse Protection Plan” before filling out this form.

(INFORMATION RECEIVED IS STRICTLY CONFIDENTIAL)

Dates and Description of Ministry

First Name

Last Name

Gender

Present Address

Phone

(###)

###

####

Social Insurance Number

Drivers License

Date of Birth

Marital Status

Spouse's Name

Occupation and/or Employer

Hobbies, Interest or Skills

Spiritual History

How long have you attended The Northern Collective Church (NCC)?

Are you a formal member of NCC?

When did you accept Christ as your Saviour?

CHRISTIAN EDUCATION BACKGROUND

Have you completed any Christian Education Teacher Certificate courses? If yes, give details:

List any courses or training you have taken that would particularly equip you for Christian Ministry:

CHURCH ATTENDANCE BACKGROUND

1. Name of Church

Church Phone

(###)

###

####

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Attended

Member or Adherent

2. Name of Church

Church Phone

(###)

###

####

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Attended

3. Name of Church

Church Phone

(###)

###

####

Church Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Attended

Member or Adherent

PRESENT AND PREVIOUS MINISTRY EXPERIENCE

1. Name of Church

Dates and Description of Ministry

Pastor or Ministry Supervisor

Phone (Pastor or Ministry Supervisor)

(###)

###

####

2. Name of Church

Dates and Description of Ministry

Pastor or Ministry Supervisor

Phone (Pastor or Ministry Supervisor)

(###)

###

####

3. Name of Church

Dates and Description of Ministry

Pastor or Ministry Supervisor

Phone (Pastor or Ministry Supervisor)

(###)

###

####

LIFESTYLE

In order to provide a safe and secure environment for our children, we believe it is necessary to include the following questions as part of our application process. All information will be kept strictly confidential. (Police may access this information under warrant, if requested.) Answering “yes” to any of the questions 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.

If any of the following circumstances apply to you, please indicate (yes or no)

• Have been convicted of a criminal offense involving children. • 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 mental illness.

Do you have any physical conditions that would prevent you from performing certain types of activities (lifting children, playing sports)? If so, explain:

MINISTRY PROFILE

What would you consider to be your strengths and giftings?