Your Name (required)

Gender (Male or Female)

Driver's License Number

State of DL


Your Email (required)

Phone Number

I am interested in working with
InfantsToddlerPre-School (3-5 years old)Elementary (1st-5th grade)Ministry AssistantSecurity/Check-In

Are there any concerns or special interests in your life right now that would have an impact on your commitment and involvement in the children’s ministry? (e.g. relationships, other commitments or ministries, etc.)?

What experience have you had working with children/youth?

Please list any gifts, callings, training, education or other factors that have prepared you for children’s or youth work.

List two people you have known for at least one year, who are not related to you and have definite knowledge of your character and qualifications to represent Harvest Bible Chapel Chattanooga and to work with children. You may include Harvest leaders or staff.

First Reference Name, Email, & Phone Number

Second Reference Name, Email, & Phone Number

Have you ever had to deal with the issue of child abuse (being abused yourself, committing child abuse, or being accused of child abuse)? If yes, please explain.

Have you ever sought pastoral care or other professional guidance (such as counseling or medical treatment) for issues involving addiction to alcohol, legal or illegal drugs, electronic or printed pornography, or any other addiction?; or has anyone suggested that you may have a problem with these sorts of addiction issues? If yes, please explain.

Have you ever been arrested for or convicted of illegal use of drugs, pornography, or abuse of a child? If yes, please explain.

By typing my full name, I authorize Harvest Bible Chapel Chattanooga or other outside service company employed & engaged by Harvest for the purpose of performing a criminal background investigation, to seek information from the references listed on this application. I also authorize any references, churches and others listed in this application to give information (including opinions) that they may have regarding my character and fitness for work with children or youth. I attest and affirm that the information included in this application is both honest and complete in any area information is requested. I voluntarily release Harvest Bible Chapel and any person, organization from any liability regarding the communication of information regarding my background or qualifications. I understand that communication of this information will be kept confidential within Harvest leadership. I waive any right that I may have to inspect any information provided about me by those I have listed in this application.