Author: Debby

Birth- 12th grade

Mailing address:
Crossroads Community Church
1538 Janice Drive
Schererville, IN. 46375
Phone:
219.322.6400

Volunteer,
You are taking your next step toward living beyond yourself. Children’s Ministry and Youth/Student Ministry have far-reaching and lasting impact!
I still remember the couple who named their daughter “Faith”. They started coming to Crossroads while they were pregnant anticipating that their daughter would need a place to learn good values. What they did not anticipate was that God would change their lives in the process. When their daughter was born they named her Faith because it was her birth that had brought them back to faith in God. The work you do in JAM or Brickhouse has the potential to transform the lives of children, but it also has the potential to transform the lives of their parents.
Don’t underestimate the impact you can have. Whether it is changing a diaper, chasing a toddler, telling a Bible story, or laughing through an object lesson you are living out our mission!
Before you dive in, we know it is always worth it to do a little homework together.
We want you serving in a place that is a good fit for you. Filling out this information will help us do that. Finding the right fit doesn’t mean serving will always be easy but it will be a commitment that brings fulfillment to you and those you serve. Some of this is basic information, but there are parts we hope will be a reflective experience for you and will guide us in helping you find the right role.
We also take some steps to provide a safe and secure environment for the students under our care. So, along with everyone else who serves students of all ages and select leadership positions, we are asking you to go through a criminal background check.
Please fill out this application completely. The information you provide will be strictly confidential. I look forward to seeing how your unique gifts and passion will be used by God build His Kingdom through the lives of children and students that you serve!
Thanks for serving!
Kris Vos
Senior Pastor

General Information (Please Print)
Name: Today’s Date:
First Middle Last
Primary Phone: Other Phone:
E-mail:
Address:
Street City State Zip
For other purposes:
Children’s names & birthdates:
Marital Status: □ Single □ Separated □ Divorced □ Widowed □ Married (Spouse name: ________)
□ Teenager (My parent’s email is: ___________________________)
Background Information
Please tell us about how and when you became a Christ-follower and describe your present spiritual life:
In what ways has your life been impacted by Crossroads?
In what areas have you served at Crossroads?
(You may use the last page of this form if you need more space)

Ministry Information
List all previous kids/youth or teen ministry experience:
List all non-church related experience involving kids/students:
List any gifts, training, or other qualifications that have prepared you to serve with kids/students ministry:
Why do you want to contribute in ministry with kids or students?
Preferences & Availability
Please indicate the services you are available to volunteer
□ Saturday 5:30 p.m. □ Sunday 9:00 a.m. □ Sunday 10:30 a.m.
□ Sunday 5:00 p.m. (Brickhouse)
Age Group you prefer:
□ Under 2 yrs □ Two’s-Three’s □ Special Needs Ministry
□ Four’s-Five’s □ Kindergarten & 1st □ 2nd & 3rd grades □ 4th & 5th grades
Brickhouse Student Ministries:
□ Grades 6-8 □ Grades 9-12
Can also help:
□ Preparing Crafts/Material □ Chaperone Kids Event □ Cleaning Toys
□ Weekday Ministry: GEMS, Cadets, Moppets, Other, VBS
Health Information
Do you have any medical conditions or issues of which we should be aware? □No □Yes
If yes, please explain here:

Personal References
List three references (not related to you) who you have known for at least one year and have definite knowledge of your character. Of the three, list one individual who attends Crossroads(may have known you for less than a year)
Crossroads Attendee:
Name E-mail
Address Phone
Street City, State Zip
Ministry at Crossroads
Other:
Name E-mail
Address Phone
Street City, State Zip
Relationship
Previous Church:
Name E-mail
Address Phone
Street City, State Zip
Relationship
Personal History (DO NOT SKIP THIS SECTION)
The questions below are part of the process to help provide a safe and secure environment for our children. All information is held strictly confidential by the Children’s or Student Ministry Staff. It is our desire to work with you to find a ministry that is fulfilling and suited to your strengths and experiences.
Have you ever had any experiences that might make it difficult for you to minister to children at church?____
Have you ever been arrested, convicted or plead guilty to a crime?
Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography or other addiction? _
Is there any circumstances or pattern in your life which would make it inappropriate for you to serve with minors or would compromise the integrity of Crossroads Church? ___________
If you have answered yes to any of these questions, please explain _____________________________________________________________________________________________________________________________________________________________________________________________
(We may call you to clarify.)
(You may use the last page of this form if you need more space.)

Authorization for Criminal Records Check (Mandatory)
A criminal records check is mandatory for every individual who works with or plans to work with minors at Crossroads Community Church.
I hereby request and authorize Crossroads Community Church of NW Indiana, to obtain all information which pertains to any record of arrests and/or convictions. These records may be obtained via reporting agencies and law enforcement files at the local, state and/or national level. By signing below, I release Crossroads and the agency conducting the search, from any and all liability resulting from such disclosure.
Today’s Date: Date of Birth: Place of Birth:
Print Legal Name: Maiden/Other Name:
Address:
Street City State Zip
Other states where you have lived :
Social Security :
Signature: Gender: Male or Female
My signature above authorizes Crossroads to perform a criminal records search at any time within 3 years of today’s date. Note: A report concerning a crime related to assault, battery, abuse or sexual misconduct will automatically disqualify you from working with minors. Any other reported misdemeanor or felony will be discussed with you and may be grounds for denial of application to work with minors.
Applicant’s Statement
The information I have submitted is correct. I authorize any references to give Crossroads Community Church any information (including opinions) that they may have regarding my character and fitness to serve with children and/or students. I will hold Crossroads Community Church harmless of any and all liability related to the processing of this application to serve with minors. I waive any right to inspect any information provided about me by any person or organization in this application.
I agree to refrain from a pattern of unbiblical conduct.
I have read and understand the information contained in this application. I am signing this of my own free will.
Applicant’s Signature: Date:
Parent’s Signature (if applicant is a minor) Date:
Parent’s Email:________________________________________________________

For Office Use: Gray Area

__________________________________BGCheck: Complete/Clear
__________________Orientation:______________________
__________________Manual Training
___________________Observations:______________________
__________________PCO
_________________Nametag

Staff Contacts:
Children’s Ministry:
Debra Vos
dvos@aboutccc.com

Phone: 219.322.6400
Toll Free Number: 800.891.3771 Website: www.aboutccc.com

Last update: 3/14/2013