First Assembly of God

56522 Hwy. 54 West   Zephyrhills. FL 33541 (813) 788-3490


     This application is to be completed by all applicants FOR any position (volunteer or compensated) involving the supervision or custody of minors, It is being used to help the church provide a safe and secure environment FOR those children and youth who participate in our programs and use our facilities.



     Christians who are in places of responsibility in the church are required to be examples in faith, conduct and business affairs. To maintain a high standard for workers is one of the best ways to present Christ to the people of our community. Therefore, the following guidelines will be required of any person who works in youth or children’s ministry at First Assembly of God.


1. Must be in agreement with the tenets of faith of First Assembly of God.


2. Must be a member of First Assembly of God, and completed the membership class.


3. Be able to make a minimum six-month commitment.


4. Be loyal to the pastor and vision of First Assembly of God.


5. Be faithful to selected ministry position.


6. Live by acceptable Christian conduct standards, always striving to be more righteous           and holy before God.


7. Attend all workers meetings.


8. Be faithful in regular church attendance, with a minimum attendance of one service per        week other than our ministry service.


9. Be at designated place of ministry a minimum of thirty (30) minutes before start of       service.


10. Be dressed appropriately and neatly.


11. Give a minimum of thirty (30) days notice of resignation.









Name:                                                                       Home Phone (       )                         .

            Last                 First      Middle

Alias (or other names-you have gone by):                                                                         .

Present address:                                                                                                                .

    Number       Street                                        City                  State    Zip

Social Security #          -        -                   Birth Date                                                        

Place of Employment                                               Work Number (       )                         .  

Drivers License #                                                        State                                              .


Marital Status:   r Married      r Single     r Engaged     r Widowed

r Separated       r Divorced         r Remarried


Please check all that apply to you:

ruse tobacco     r drink alcoholic beverages      ruse illegal drugs


Are you a Christian?                                   When were you saved?                                   .

Have you been baptized in water(Acts 2:38)?                      When?                                   .

Are you baptized in the Holy Spirit (Acts 2:4)?                   When?                                    .

Name of church of which you are a member?                                                                    .

How long have you been in attendance at that church?                                                      .

If not First Assembly of God, how long have you been in attendance here?                        .

List (name and address) all other churches you have attended regularly during the past five years.                                                                                                                                .                                                                                                                                          .



List all previous church work involving youth (identify church and type of work).                                                                                                                                                       .                                                                                                                                          .

List any gifts, callings, training, education, or other factors that have prepared you for children / youth work:                                                                                                       .                                                                                                                                          . Have you ever been convicted of a criminal offense (excluding minor traffic violations)?

                          If so, please explain:                                                                                .                                                                                                                                          .

Have you ever been accused of and/ or convicted of child abuse or a crime involving actual or attempted sexual molestation?                           If yes, explain                            .


Have you been involved in homosexual activity within the last ten (10) years?                   .

If yes, explain                                                                                                                    .  Do you presently have any communicable diseases (including HIV or AIDS)?                  . If yes, explain                                                                                                                    .

Have you ever been treated for and/or diagnosed with any mental illness?                         .


Were you, or any member of your immediate family, abused as a child?                             .


Do you have any physical handicaps or conditions preventing you from performing certain types of activities relating to youth or children’s work?                                   If yes, please explain                                                                                                                              .

What type of children/youth work do you prefer?                                                              .


On what date would you be available?                                                                               .

Minimum length of commitment:                                                                                       .

Would you be willing (if able) to provide transportation to church for those involved in your ministry?     r  Yes, regularly.             r  Yes, on an ”as needed” basis.

r  No, except in emergencies. r  No, not at all.

Will you be able to arrange your work schedule to attend all scheduled functions of your chosen ministry?                                                                                                                .  



(Not former employers or relatives)


Name:                                                                                                                               .

Address:                                                                                                                           .

Telephone:                                                                                                                        .


Name:                                                                                                                               .

Address:                                                                                                                           .

Telephone:                                                                                                                        .



 (Former Senior Pastor, Associate Pastor, or Ministerial Supervisor)


Name:                                                                                                                               .

Address:                                                                                                                           .

Telephone:                                                                                                                        .



For Office Use Only:

Reference 1:                                                                           Date                                  .

Reference 2:                                                                           Date                                  .

Reference 8:                                                                           Date                                  .

Pedophile Web Listing Search :                                            Date:                                .

Pastor Approval Signature:                                                      Date                              .

Ministry Leader Approval:                                                       Date                              .









The information contained in this application is correct to the best of my knowledge. I authorize, without reservation, any references or churches listed in this application to give you any information they may have regarding my character and fitness for children/youth work, and I release all such references from liability for any damage that may result from furnishing such evaluations to you. In addition, I authorize the pastoral staff of First Assembly to conduct a felony police search as part of the screening procedure, and I understand that all such information will be held in the strictest of confidence. Should my application be accepted, I agree to be bound by the Constitution, Bylaws and policies of First Assembly and to refrain from unscriptural conduct in the performance of my services on behalf of the church. I understand that I will be required to attend a minimum of one service per week (not including ministry service) in the sanctuary in order to continue my ministry. Because First Assembly values the safety and well being of their children, I understand that acceptance of this application may require a fingerprint registration with the local sheriff’s department. I understand that this is a precautionary measure only, and I will be willing to comply with such procedures.


Applicant’s Signature                                                                    Date                       .

Witness                                                                                         Date                       .

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