The Lords House of Prayer - Eleven:59 Volunteer Application

Eleven:59 Volunteer Application

Thank you for your interest in Eleven:59. We are in need of people who want to come to Eleven:59 to just love and accept our awesome teens. Please complete this application.
Name	*
Address	*
Phone Number	*
Your Email Address	*
Availability	*
Which Areas Are You Interested In?	*
Is there an area where you would like to help but are uncertain and would like support in that area?
What churches have you attended in the last 5 years? Please include name of church, name of pastor, and how many years you attended.
Please provide the name and contact information for at least two references *
Have you at any time ever been arrested for any reason?	*
Have you at any time ever been convicted of, or plead guilty or no contest to any crime?	*
Have you at any time ever engaged in, or been accused of, any child molestation, exploitation, or abuse?	*
Are you aware of having any traits or tendencies that could pose any risk to children, youth, or others?	*
Are you aware of any reason why you should not work with children, youth or others?	*
If you responded yes to any of the above questions please explain your response in detail.
Please provide the name and contact information of someone you would like us to notify in case of emergency. *
I recognize that The Lord’s House of Prayer is relying on the accuracy of the information I provide on the Eleven:59 Youth Worker Application form.
Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.
I authorize the organization to contact any person or entity listed on the Eleven:59 Youth Worker Application form,
and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background and qualifications.
I voluntarily release the organization and any such person or entity listed on the Eleven:59 Youth Worker Application form from liability involving
the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation
if such a check is deemed necessary.
Please type in the box to the right »	*