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Picnics
Our Story
Statement of Faith
Sermons
Sermons
Past Series
Blog
Connect
FAQ
Give
HLAC
Harvest Lane Alliance Church
Personal Information
Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
*
(###)
###
####
Email
*
Marital Status
*
Single
Married
Divorced
Other
Spouse's Name
First Name
Last Name
Children's Names and Ages
Church Involvement
How long have you attended Harvest Lane Alliance Church?
*
Are you a member?
*
Yes
No
Do you attend regularly (two or more services a month)?
*
Yes
No
Previous Experience
Please list all previous work involving children (church and non-church).
*
References
Please provide the following information for three references. References must be over the age of 18, have known you in some capacity for over a year, and have a definite knowledge of your character and fitness for working with children and youth.
Reference #1 Name
*
A friend or associate that is not a relative.
First Name
Last Name
Occupation
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Nature of Relationship
*
Length of Time Known
*
Reference #2 Name
A friend or associate that is not a relative.
First Name
Last Name
Occupation
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Nature of Relationship
*
Length of Time Known
*
Ministry Reference Name
*
A church staff member, small group or ministry leader
First Name
Last Name
Occupation
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Nature of Relationship
*
Length of Time Known
*
Areas of Interest
Please check all that apply.
Ministry Area
*
S.O.L.E. (grades 5 - 8)
Cohort (grades 9 - 12)
Ministry Interest
*
Teaching
Leading a small group
Games
Personal Situations
We strongly believe it is our responsibility to ensure that children entrusted to our care at HLAC are cared for in a safe, loving, and nurturing environment. Answer yes, or leaving any questions unanswered will not automatically disqualify any applicant but will require further explanation. Please answer the following questions accurately and honestly. Your application is completely confidential.
Have you ever been convicted or pleaded guilty to a crime? (other than minor traffic violations)
*
Yes
No
If yes, please explain.
Has there been any abuse (substance, emotional, physical, spiritual, verbal or sexual) in your background?
*
Yes
No
If yes, please explain.
Have you ever been accused, charged, alleged to have or have ever committed any act of neglecting, abusing, molesting or battering any child or adult?
*
Yes
No
If yes, please explain.
Have you ever been diagnosed or treated for a psychiatric disorder?
*
Yes
No
If yes, please explain.
Have you ever had or been concerned that you may have an addiction to alcohol, drugs, pornography or any other addiction; or has anyone ever suggested that you may have a problem with any of the above?
*
Yes
No
If yes, please explain.
Is there any circumstance or pattern in your life which would make it inappropriate for you or would make you unable to serve in youth ministry?
*
Yes
No
If yes, please explain.
Do you have any physical limitations or schedule limitations that may prevent you from serving in some capacity in youth ministry (e.g. work schedule, other ministry schedule, etc.)?
*
Yes
No
If yes, please explain.
Your Spiritual Journey
Please briefly share your spiritual journey. Include how and when you began your relationship with Christ, if and when you were baptized, what you are doing to grow spiritually, and how you live your faith out in daily life.
*
Please briefly share why you would like to serve in youth ministry.
*
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 working with children. In consideration of the receipt and evaluation of this application by Harvest Lane Alliance Church, I hereby release any individual or organization, church or otherwise, from any liability for damages of whatever kind or nature which may at any time result to me, my heir, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to act in accordance with and adhere to the conduct and security policies set forth by Harvest Lane Alliance Church. I further state that I have carefully read the previously stated release and know the contents thereof and sign this release as my own free act.
*
I agree.
I do now agree.
Applicant's Signature
*
Date
*
MM
DD
YYYY
Thank you!