Background Check

Full Name*

PrefixFirst NameLast Name

Maiden Name or Other Names Used: if none put N/A*

Age*

Date of Birth*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail

What area of ministry do you prefer?*

On what date would you be available?*

Minimum length of commitment?*

Marital Status*

Do you have any handicaps or conditions preventing you from performing certain types of activities? (Yes or No)*

If yes to above question please explain.

Have you ever been convicted of child abuse or have you ever been convicted of a felony? (Yes or No)*

If yes to above question please explain.

List (name and address) other churches you have attended regularly during the past year.*

"2" Personal References "This must be completely filled in) No relatives or others who attend Refinery Church or Siloe, Adonai) Please Include Name, Address, and Phone Number for both references*

Reference #1 E-mail

Reference #2 E-mail

The information contained on this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for ministry. I release all such references from any liability for furnishing such evaluations to you, provided they do so in good faith and without malice. I waive any right that I may have to inspect references provided on my behalf.

Should my application be accepted, I agree to be bound by the Statement of Faith of the Assemblies of God and the Bylaws and policies of West McKinley Assembly of God. and to refrain from unscriptural conduct in the performance of my services on behalf of the church.

Electronic Signature*

First NameLast Name

i hereby authorize our church pastor in the area of requested employment or volunteering, and the office staff, to make an independant investigation of my background, references, character, past employment, education, criminal or police records, including those by both public and private organizations and all public records for the purpose of confirming the information contained on my application or volunteer forms, and/or obtaining other information which may be material to my qualifications for employment or as a volunteer now and, if applicable, during the tenure of my employment or as a volunteer with our church.

I release West McKinley Assembly of God and any person or entity which provided information pursuant to this authorization, from any and all liabilities, claim or lawsuits in regards to the information obtained from any and all the above referenced sources used.

the following is my true and complete legal name and all infromation is true and correct to the best of my knowledge.

I understand that this information will be kept confidential and will not be shared.

Full Name*

First NameLast Name

Gender*

Maiden Name or other names used

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Date of Birth*

Drivers License Number (if you don't have one put N/A)

Social Security Number/ITIN

*Note the above information is required for identification purposes only, and is in no manner used as qualifications for employment or placement.