Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How long have you lived at that address?
*
Cell Phone
*
(###)
###
####
Home Phone
(###)
###
####
Work Phone
(###)
###
####
Birthday
MM
DD
YYYY
Marital Status
*
Spouse's Name
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
(###)
###
####
If you have children, how many?
Your children's ages
Do you have any medical training or are you CPR certified?
*
In which areas would you like to serve?
*
Are you a member of BOOM (DNA)
*
Have you completed the Purple Book Discipleship?
*
Have you accepted Christ as your Lord and Savior?
When?
*
Please describe how you came to faith in Jesus Christ
*
List any gifts, talents, training, skills, or education that have prepared you to work with children or preschoolers: (None is ok if God has prompted you)
Please list any other BOOM ministries in which you are involved
*
Why do you want to work with children or preschoolers at BOOM?
*
List any special gifts or ministry interests that you would like to use while working with children, such as art, music, games/recreation, Bible story time
*
Name
*
First Name
Last Name
How long have you known the reference?
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Relationship
Name
First Name
Last Name
How long have you known the reference?
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Relationship
Name
First Name
Last Name
How long have you known the reference?
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Relationship
Have you ever been convicted of a crime?
*
If yes, please explain
Have you ever been accused, arrested, or convicted of child abuse, neglect, or a crime involving actual or attempted sexual molestation of a minor or other sexually related crime?
*
If yes, please explain
Do you use illegal drugs?
*
Have you ever been convicted of or plead guilty to the use or sale of drugs?
*
Have you ever been hospitalized or treated for alcohol or substance abuse?
*
Is there any health-related reason that would keep you from effectively working with children or cause any potential harm to our children?
*
If yes, please explain condition
Are there any circumstances involving your lifestyle or background that would call into question your ability to work with children?
*
If yes, please explain
Have you had any painful experiences in your life that have better equipped you or that may hinder you from a productive ministry with children?
*
If so, would you like to talk to pastor regarding this circumstance?
