Request To Be Sent Screening Form

Note: This is not your background screening form.

This is a request to push through the actual screening form that will be sent to your personal email within 24/48 hours coming directly from our ministry database.

Email will be coming from: message@mobilizeministry.com
Subject: New Life Community Church Background Screening Form

Please be sure to check your junk/spam folder.

Date Date / MM / DD YYYY
Name Name First Middle Last
List Maiden Name (or any name used, including previous marriage):
Email
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous Address (If not applicable type in N/A) Previous Address (If not applicable type in N/A)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Birth Date Birth Date / MM / DD YYYY
What ministry will you be serving in? Please select ALL that apply.
(You must have been prescreened by the ministry leader(s) before submitting this form)

What ministry will you be serving in? Please select ALL that apply.
(You must have been prescreened by the ministry leader(s) before submitting this form) Children's Ministry Puente de Vida Kids (Midway ONLY) Youth Ministry Awana Security Team Offering/Counting Team
What ministry will you be serving in?
(You must have been prescreened by the ministry leader before submitting this form)

What ministry will you be serving in?
(You must have been prescreened by the ministry leader before submitting this form) Children's Ministry Puente de Vida Kids (Midway ONLY) Youth Ministry Awana Security Team Offering/Counting Team
Which New Life Location do you attend?
Home Phone Home Phone - ### - ### ####
Social Security Number
Social Security Number
Do you have a current driver's license?

Do you have a current driver's license? Yes No
Driver's License Number (If no type in N/A)
Driver's License State (If no type in N/A)
Have you ever been convicted of, or pled guilty to a crime?

Have you ever been convicted of, or pled guilty to a crime? Yes No
If yes, please explain. (If no type in N/A)
NOTE: The following question applies only to those serving with or around youth and children.

If you prefer, you may refuse to answer the following question, or you may discuss your answer in confidence with the senior pastor rather than answering it on this form. Answering yes or leaving the question unanswered, will not automatically disqualify an applicant for youth or children's work.

Were you a victim of abuse or molestation while a minor?

NOTE: The following question applies only to those serving with or around youth and children.

If you prefer, you may refuse to answer the following question, or you may discuss your answer in confidence with the senior pastor rather than answering it on this form. Answering yes or leaving the question unanswered, will not automatically disqualify an applicant for youth or children's work.

Were you a victim of abuse or molestation while a minor? Yes No
Church History and Prior Ministry Work Information:
Which New Life Location do you currently attend? If Spanish, please note "Nueva Vida" after your location name.
List of other churches you have attended regularly during the past five years:
List all previous church work (include church name, type of work, and dates):
Personal References

(no former employers or relatives)
Reference 1 Reference 1 First Last
Phone Phone - ### - ### ####
Reference 2 Reference 2 First Last
Phone 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. Additionally, I hereby authorize New Life Community Church to procure a comprehensive criminal background check as a part of this application. In consideration of the receipt and evaluation of this application by New Life Community Church, I hereby release any individual, church, organization, charity, or employer, including record custodians, both collectively and the result of me, my heirs, 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 be bound by the bylaws and policies of New Life Community Church and to refrain from unscriptural conduct in the performance of my services on behalf of the church.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.
Applicant's Signature
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Request To Be Sent Screening Form

Request To Be Sent Screening Form

Church History and Prior Ministry Work Information:

Personal References

Applicant's Statement