For Office use only:

							Children’s Ministry Application                                                                  For Office use only:
                                                                                                 Date received:_________________
General Information                                                                              Clearance level:________________
Date:___________________
Name:__________________________________________________________________________________________________________
                (Last)                                (First)                                        (MI)
Current Address:___________________________________________________________________________City:__________________
State:____________ Zip :_________       Daytime Phone:__________________________ Evening Phone: ______________________
Date of Birth _____ /____ / _____ Are you:  Single  Married  Separated  Divorced  Widowed Are you:  Male  Female
Do you have children?  No  Yes If yes, how many, what age?______________________________________________________
Who referred you to Children’s Ministries? _____________________________________________________________________
Background Information
Do you regularly attend weekend services?  No  Yes, Since _________Mid week services?  No  Yes, Since ____________
What were the circumstances that brought you to Cornerstone? _______________________________________________________
________________________________________________________________________________________________________________
What is your church background? _________________________________________________________________________________
__________________________________________________________________________________________________________ ______
Have you accepted Jesus Christ as your Lord and Savior and are you committed to having the character of Jesus live
through you?  Not Yet  Yes
Have you been baptized as an adult?  No  Yes  Soon
Are you a Participating Member of Cornerstone? ?  No  Yes, Since ______________          Soon
Have you completed Cleansing Stream Ministries?       Yes    No Have you completed the Network Course? ?             Yes    No
What are your top three spiritual gifts? ______________________________________________________________________________
(Circle one) Are you   task-oriented     or     people-oriented?    Are you    unstructured     or      structured?
Why have you chosen to work in Children’s Ministry?
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
What specific position are you interested in? _________________________________________________________________________
Date you are available to begin: _________________________ Hours per week available: ___________________________________
Can you make a one-year commitment to this volunteer role?       Yes     No
Would you be available for periodic training sessions?  No  Yes, Best day and time for training: __________________________
What other ministries at Cornerstone are you currently involved in?______________________________________________________
How many hours a week do you spend working in these ministries?______________________________________________________
Are you involved with a small group?  No  Yes, which one __________________________________________________________

Employment History
Occupation: ________________________________________________ Employer: __________________________________________
Current Job responsibilities and schedule: ___________________________________________________________________________
Previous work experience:_________________________________________________________________________________________
________________________________________________________________________________________________________________
Special Interest, hobbies, and skills: _________________________________________________________________________________
________________________________________________________________________________________________________________

Spiritual Journey
Whether we are devoted believers or still in the process of investigation, we all have a spiritual history. Please take a few moments to
describe your journey thus far.

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

cmapp 3-6                                                                                                         7/27/2012
                                           REFERENCE INFORMATION
                                                   CORNERSTONE 04/2006

    Please list three personal references (people whom are not related to you by blood or marriage) and provide a
     complete address and phone information for each. References are confidential.

    Volunteers who have direct contact with children must include a reference from a Cornerstone attendee.

    Youth who serve in Children’s Ministry must include a reference from the Youth Pastor.

ALL INFORMATION IS NECESSARY

1.      Name: _____________________________________________________________________________

        Address:___________________________________________________________________________

        ___________________________________________________________________________________

        Daytime Phone: _____________________________________________________________________

        Evening Phone: _____________________________________________________________________

        Relationship to reference: ____________________________________________________________


2.      Name: _____________________________________________________________________________

        Address: ___________________________________________________________________________

        ___________________________________________________________________________________

        Daytime Phone: _____________________________________________________________________

        Evening Phone: _____________________________________________________________________

        Relationship to reference: ____________________________________________________________


3.      Name: _____________________________________________________________________________

        Address: ___________________________________________________________________________

        ___________________________________________________________________________________

        Daytime Phone: _____________________________________________________________________

        Evening Phone: _____________________________________________________________________

        Relationship to reference: ____________________________________________________________




                       Signature: ________________________________________Date: ________________




cmapp 3-6                                                                                       7/27/2012
                                                CHILD PROTECTION SCREENING FORM
                                                                           CONFIDENTIAL
THIS APPLICATION IS TO BE COMPLETED BY ALL APPLICANTS FOR ANY POSITION INVOLVING THE SUPERVISION OR CUSTODY OF MINORS. IT IS BEING USED TO PROTECT THE CHURCH AND
PROVIDE A SAFE AND SECURE ENVIRONMENT FOR THOSE CHILDREN AND YOUTH WHO PARTICIPATE IN PROGRAMS SPONSORED BY CORNERSTONE CHURCH. ONLY THOSE PERSONS
AUTHORIZED BY THE PASTORAL STAFF WILL HAVE ACCESS TO THIS INFORMATION.

                                                                                                       Date: ____________________________________
                                                                  PERSONAL INFORMATION
Name:___________________________________________________________________________________________________________
                     (Last)                              (First)                                    (MI)

Who referred you to our children / youth ministries? ___________________________________________________________________

List names and addresses of other churches you have attended regularly in the past five years?______________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

Previous volunteer experience with children and/or youth? _____________________________________________________________

_________________________________________________________________________________________________________________

Why would you like to volunteer with Cornerstone children or youth ministries? ___________________________________________

_________________________________________________________________________________________________________________

How were you parented as a child? _________________________________________________________________________________

_________________________________________________________________________________________________________________

How do you discipline your own children? ___________________________________________________________________________

_________________________________________________________________________________________________________________

                 YES ANSWERS BELOW REQUIRE DETAILS ABOUT WHAT HAPPENED AND WHEN, YOUR LIFE SITUATION THEN, YOUR SITUATION NOW,
             AND THE TYPE AND AMOUNT OF HEALING THAT HAS HAPPENED. YES ANSWERS WILL NOT AUTOMATICALLY NEGATE YOUR POTENTIAL APPROVAL


Have you ever been arrested, been convicted, or pleaded guilty to a crime?                         Yes      No ___________________________________

________________________________________________________________________________________________________

Have you ever been accused, charged, alleged to have or have you ever committed any act of neglecting, abusing, molesting or
battering any child or adult? Or have you had any kind of a relationship with a minor that has brought sexual gratification to
yourself?   Yes      No ___________________________________________________________________________________________

_________________________________________________________________________________________________________________

Have you ever been treated for a psychiatric disorder?                   Yes      No_____________________________________________________

_________________________________________________________________________________________________________________

Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography or any other addiction, or has
anyone ever suggested that you may have a problem with any of the above?    Yes     No ________________________________

_________________________________________________________________________________________________________________

Has there been any abuse in your family background with alcohol or drugs or that was emotional, physical or sexual
in nature?   Yes   No If yes, what steps have you taken to minimize the impact that these issues will create for you?
_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________


cmapp 3-6                                                                                                                             7/27/2012
                                                    WAIVER AND CONSENT:
I ________________________________, hereby certify that the information I have provided is true and correct. I authorize Cornerstone

Church to verify the information I have provided by contacting the references I have listed, by conducting a criminal records check, and

by contacting others whom I have not listed. I authorize the references I listed to give Cornerstone Church whatever information the

references may have regarding my character and fitness.

Signature :________________________________________________________________                 Date: _______________________________


Parent/Guardian Signature: _________________________________________________ Date: _______________________________
                                (if applicant is a minor)

Witness __________________________________________________________________                  Date:_______________________________




                     AUTHORIZATION AND REQUEST FOR CRIMINAL RECORDS CHECK
I hereby request the ______________________________ Police Department to release any information which pertains to any
                              (Leave Blank)
record or convictions contained in its files or in any criminal file maintained on me whether local, state, or national. I hereby
release said Police Department from any and all liability resulting from such disclosure.

Signature of Applicant:_____________________________________________________                Date: _______________________________

                                                              PLEASE PRINT
                          Name: ______________________________________________________________

                          Maiden Name: _______________________________________________________

                          All Aliases: ___________________________________________________________

                          Date of Birth: _________________________________________________________

                          Place of Birth: _________________________________________________________

                          Current Address ______________________________________________________

                          _____________________________________________________________________

                          Social Security Number: ________________________________________________

                          Driver’s License Number: _______________________________________________

                          State Issuing License: __________________________________________________

                          License Expiration Date: ________________________________________________


                                                               for office use only


Request sent to: ___________________________________________________________                Date: _______________________________

Address: ________________________________________________________________________________________________________




cmapp 3-6                                                                                                          7/27/2012