Clearances Application

Personal Information

Name

Address

This address will receive a confirmation email

Phone

Birthdate

Maiden Name and/or or Alias (Write N/A if not applicable)

Social Security Number (Required if over 18, if under 18 write N/A)

Ministry Information

Ministry Area

Elder Diaconate Counseling Security Team Financial Team/Counting Ministry Leader Growth Group Host Other

If you have been attending Gospel Life Church for less than 5 years, please list any other churches (name, city, State) you have regularly attended during that time frame:

Personal History

Have you lived in Pennsylvania continuously in the past 10 years?

Yes No

Have you been convicted of a felony or sex crime within the previous 5 years?

Yes No

If yes, please explain (otherwise enter N/A):

Have you ever been accused and/or convicted of a crime of any nature?

Yes No

If yes, please explain (otherwise put N/A):

Do you have any communicable diseases, such as TB, Hepatitis B, AIDS, etc.? (Note: If in the future you do contract a communicable diseases please inform your ministry leader.

Yes No

If yes, please explain (otherwise put N/A):

Note: If you experienced any abuse or neglect as a child you may be aware that emotional ramifications sometimes occur in adulthood. The pastor and counselors at Gospel Life Church are available to counsel with you and/or direct you to additional Christian counseling services at any time that you feel a need for such help.

References

Please list three (3) non-family references, including their addresses and phone numbers.
If possible, please include at least one reference who has observed you in ministry.

Reference 1

Name

Phone

Reference 2

Name

Phone

Reference 3

Name

Phone

Applicant's Statement

The information contained in 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 serving. I understand that this application will be kept strictly confidential.

I agree to refrain from unscriptural conduct in the performance of my services on behalf of the church.

*Electronic Signature

*By entering my name in the above box, I am providing my digital signature on this form and stating that I have answered each question above truthfully to the best of my knowledge.

Date

Clearances Application

Description

Please Fix the Following