GENERAL INFORMATION
Name *
Name
Address *
Address
Phone *
Phone
Date of Birth
Date of Birth
Spouse Name (if applicable)
Spouse Name (if applicable)
Anniversary Date (if applicable)
Anniversary Date (if applicable)
Christian & ministry experience
Have you received Jesus Christ as your personal Lord and Saviour? *
Have you been baptized in water? *
Have you ever been involved serving in ministry? *
Do you have any limitations or conditions preventing you from performing certain types of activities relating to serving? *
Church Background
Do you regularly attend Church on the Rock? *
Is your spouse in agreement with you becoming an active part of Church on the Rock? *
INFORMATION FOR BACKGROUND CHECK
In connection with my application for volunteer service with Church on the Rock, I authorize Church on the Rock and their agent, to solicit background information relative to my criminal record history. I understand that Church on the Rock may conduct inquiries into my background that may include criminal records, personal references and other public record reports pertaining to me. I authorize those contracted by COTR to furnish information for background reports relative to my criminal history now and as needed for as long as I hold a role within COTR which requires this.
I authorize without reservation, any person, agency, or other entity contact by Church on the Rock, or their agent, for purposes of obtaining background report information, to furnish the above mentioned information. I AUTHORIZE FOR THIS BACKGROUND CHECK TO BE RE-RUN EVERY TWO YEARS. i RELEASE CHURCH ON THE ROCK, THEIR RESPECTIVE EMPLOYEES, OR THEIR AGENT AND EMPLOYEES AND ALL PERSONS, AGENCIES AND ENTITIES PROVIDING INFORMATION OR REPORTS ABOUT ME FROM ANY AND ALL LIABILITY ARISING OUT OF FURNISHING ANY SUCH INFORMATION OR REPORTS.
Previous Address *
Previous Address
By typing your name below, you are signing this document to be true and accurate.
Date *
Date
STATE OF ILLINOIS - COUNTY OF KANE