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					                  Phoenix Dream Center Missionary / Volunteer Questionnaire



Last Name                   First                         Middle                 Date

Street Address                                                                      Contact Number

City                        State                         Zip Code               Home:
                                                                                 Cell:
                                                                                 Work:
Are you 18 years of age or older?      Yes           No

Email                                    Date of Birth
Are you currently affiliated with and organization, ministry or church? If so, what is your current
commitment?


Date available to start                       Please fill in the days and hours you able to volunteer
Sunday       Monday         Tuesday          Wednesday Thursday             Friday          Saturday



Note: Conviction of a crime will not necessarily disqualify you for a position as a volunteer
at the Phoenix Dream Center.

Have you ever been convicted of or plead guilty or no contest to a crime other than a minor traffic
violation? Yes_______ No_______

If Yes, please describe, including the disposition of your case:

Have you ever been accused of, investigated or charged with any type of abuse or violence?
Yes______No_______ If Yes, please explain:

Are you presently under charges of any criminal offense? Yes______No______
If Yes, please explain:




                                                  -1-                PDC-FORMS-REV0-42606-002
How did you hear about the Phoenix Dream Center (PDC)?


What do you think the purpose of the PDC is?


What would you like to do at the PDC as a Missionary / Volunteer?


What is your church and ministry history?


What are your life experiences that might be beneficial to the PDC?


What is your work history?


What are your strengths and weaknesses?


Give an example of a positive and a negative experience you have had in ministry. How did you
handle it?


What type of commitment are you willing to make to the PDC full-time / part-time?

Do you have transportation? ___Yes ___No What type of drivers license do you have
(Regular or CDL)?

Please provide the names and telephone numbers of three references (not a relative) you have
known for at least one year.

Name                                         Telephone




Thank you for your interest in the ministry of the Phoenix Dream Center. We will contact you as
the ministry need arises at the Phoenix Dream Center.


     Missionary / Volunteer Signature ______________________ Date _______________




                                               -2-            PDC-FORMS-REV0-42606-002
                           REQUEST FOR BACKGROUND INFORMATION

Last Name                                      First                        Middle
Maiden Name or Other Names Used
Social Security Number:                                               Date of Birth:
Driver’s License Number:                                              State Issued:


Have you ever been convicted of a felony or misdemeanor ?: Yes______ No_____



                                 BACKGROUND VERIFICATION AND DISCLOSURE

       As part of the volunteer process PHOENIX DREAM CENTER may obtain a Consumer
       Report and/or Investigative Consumer Report that may include legally obtainable
       criminal records. The Fair Credit Reporting Act as amended by the Consumer Reporting
       Reform Act of 1996 requires that we advise you that for purposes of employment only, a
       Consumer Report may be made which may include information about your credit
       standing, character, general reputation, personal characteristics, or mode of living. Upon
       written request, additional information as to the nature and scope of the report, if one is
       made, will be provided, in the event the Report contains information regarding your
       character, general reputation, personal characteristics, criminal history or mode of living.

                                   AUTHORIZATION TO RELEASE INFORMATION

       During the application process and at any time during any subsequent
       employment, I hereby authorize the Phoenix Dream Center to procure a
       Consumer Report which I understand may include information regarding my
       credit standing, character, general reputation, personal characteristics, criminal
       history, or mode of living. This report may be compiled with information from
       credit bureaus, court record repositories, departments of motor vehicles, past or
       present employers and educational institutions, governmental occupational
       licensing or registration entities, business or personal references, and any other
       source required to verify information that I have voluntarily supplied. I understand
       that I may request a complete and accurate disclosure of the nature and scope of
       the background verification; to the extent such investigation includes information
       bearing on my character, general reputation, personal characteristics, criminal
       history or mode of living.



       Signature __________________________ Date _________________________




                                                   -3-              PDC-FORMS-REV0-42606-002
                   ASSUMPTION OF RISK FORM MISSIONARY-VOLUNTEER
       I, _______________________ (name of volunteer), in consideration of my acceptance as a
       Missionary-Volunteer of The Dream Center, 3210 Northwest Grand Ave., Phoenix, AZ 85017,
       represent and agree that:

  1.   I am a Missionary-Volunteer and not an employee of The Dream Center; I am 18 years old or
       older.
  2.   As a Mission-Volunteer I am aware of the hazards and risk to my person and property associated
       with serving. Such hazards and risks include, but are not limited to, death or injury by accident,
       disease, war, terrorist acts, weather conditions, inadequate medical services and supplies, criminal
       activity, and random acts of violence. I accept my assignment as a Missionary-Volunteer with full
       awareness of these risks, and, subject to any insurance coverage that may or may not be available
       to me from any source, and I voluntarily assume all risks of death, injury, and illness associated
       with such risks, and any damage to my personal property, and I release and hold harmless The
       Dream Center and its agents, officers, directors, and employees from any liability whatever arising
       as a result of death, injury, or illness that I may suffer as a result of participation in the missions
       project. I further recognize that such risks have always been associated with serving in this
       capacity.
  3.   I attest and certify that I have no medical condition that would prevent me from performing my
       duties as a Missionary-Volunteer.
  4.   I expressly waive any defense to the enforcement of any provision of this commitment arising
       from a claim of lack of consideration and warrant that this commitment constitutes a legal valid
       and binding obligation upon me enforceable against me, and my heirs, in accordance with its
       terms.
  5.   I am aware of the hazards and risks to my person associated with participation in The Dream
       Center as a Missionary-Volunteer, as described above. I further understand that The Dream
       Center may not have any insurance coverage that would apply in the event of my death, illness,
       injury, or damage to my property that may occur during my participation as a Missionary-
       Volunteer, and if I desire insurance coverage, I am responsible for the cost of such insurance.
  6.   I expressly agree that this Assumption of Risk agreement is intended to be as broad and inclusive
       as permitted by law. I further agree that in keeping with 1 Corinthians 6:1-8, I will resolve any and
       all disputes which may arise between me and The Dream Center pursuant to and in accordance
       with the Rules of Procedure for Christian Conciliation, Institute for Christian Conciliation. If
       efforts to conciliate the dispute fail, both parties agree to submit themselves to the laws of the
       State of Arizona and to the personal jurisdiction of the courts of Arizona. Each party shall bear
       their own costs, including attorney’s fees, related to any mediation, or legal proceeding.
  7.   I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK AND
       UNDERSTAND ITS CONTENTS AND VOLUNTARILY SIGN THIS RELEASE AS MY
       OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I
       HAVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING
       IT.

  Date:                                    Signature_________________________________
  Address___________________________________________________________________________
  City_____________________________________State______________________Zip_____________




ASSUMPTION OF RISK FORM MISSIONARY-VOLUNTEER                             PDC-FORMS-REV0-42606-001
PERSONAL TESTIMONY

Please use the following space to give an account of your personal testimony: how you
have come to know Christ, how you are growing in your current relationship with the
Lord, and how you see yourself growing in Him in the future. This does not involve what
ministry or job you would like to participate in at the Dream Center.

				
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