MISSIONARY ASSOCIATE APPLICATION CHECKLIST

Assemblies of God U.S. Missions

Thank you for your interest in becoming a missionary associate with Assemblies of God U.S. Missions. In order to ensure this process goes as smoothly as possible, please include the following items when you send in your application:

Completed application Current photo (include a photo of spouse, if married) Copy of driver’s license (include a copy of spouse’s license, if married) Copy of Social Security card (include a copy of spouse’s Social Security card, if married) Copy of Green Card (if applicable) Background Authorization (include a background check for spouse, if married)

Signed Christian Conciliation and Arbitration Agreement (if married, spouse must sign) Completed I-9 form Completed Bank Direct Deposit form Signed 5% and Half-Tithe Agreement Responsibilities Signed Missionary Info Release form Signed Assumption of Risk form

Mail the above items to:

Assemblies of God U.S. Missions Attn: U.S. MAPS 1445 N. Boonville Avenue Springfield, MO 65802

Or Fax to: (417) 862–0409 Attn: U.S. MAPS

Or E-mail to: usmaps@ag.org If you have any questions, please contact the U.S. Missions MAPS office at (417) 862–2781, ext. 1389.

MISSIONARY ASSOCIATE APPLICATION

Assemblies of God U.S. Missions CONFIDENTIAL

PERSONAL INFORMATION Applicant name First Middle Last Preferred Name Nickname

Maiden name, if applicable Social security number Gender Current address Street

City State Zip Permanent mailing address Street

City State Zip

Primary phone Work Cell (if different from primary)

E-mail address Marital status Married* Single Widowed

*Anniversary Date Divorced** Annulment** Remarried** Separated**

**Please explain

Sexual orientation Heterosexual Homosexual Bisexual What city, state, and country were you born in? Country of Citizenship Lapsed Revoked Suspended Date Please explain

Languages spoken Do you have ministerial credentials? If yes, where are you currently credentialed?

SPOUSE’S INFORMATION (Complete this section if married.) Spouse’s name First Middle Last Nickname

Maiden name, if applicable Social security number Gender Current address Street

City State Zip Permanent mailing address Street

City State Zip

Primary phone Work Cell (If different from primary phone) E-mail address Marital status Married* Single Widowed

*Anniversary Date Divorced** Annulment** Remarried** Separated**

**Please explain

Sexual orientation Heterosexual Homosexual Bisexual What city, state, and country was your spouse born in? Languages spoken

Date of marriage (projected date, if engaged) Spouse’s name

FIANCÉ(E)’S INFORMATION (Complete this section if engaged to be married) Fiancé(e)’s name First Middle Last Nickname Pending marriage date

CHILDREN Please provide the following information for each child (if applicable). Full name of child Birth date Gender Full name of child Birth date Gender Full name of child Birth date Gender Full name of child Birth date Gender Full name of child Birth date Gender

FINANCIAL INFORMATION Can you provide your U.S. missionary associate support from personal funds? Do you tithe faithfully? If no, explain. Have you ever filed for bankruptcy? If yes, explain. What company is your current medical insurance provider? Nature of Obligation/Debt Total Amount Monthly Payment Plan for Meeting Obligation Rent Mortgage Student loans Vehicles Credit cards Insurance (include life, care, and home.) IRS Other

Date of marriage (projected date, if engaged) Spouse’s name

EDUCATION Highest level of education achieved Name of High School (full name) City and State Postsecondary Schools/Other Training Dates (from/to) Major/Minor Degree/Certification Earned Specialized experience, skills, and training Awards or areas of academic excellence

EMPLOYMENT HISTORY Employer Job/ministry duty City/State of business Start date End date Reason for leaving Employer Job/ministry duty City/State of business Start date End date Reason for leaving Employer Job/ministry duty City/State of business Start date End date Reason for leaving

EMERGENCY CONTACT (other than spouse) Emergency contacts must not live at the same address. Primary contact Name Relationship Primary phone Secondary phone Address City State Zip code Secondary contact Name Relationship Cell phone Alternate phone Address City State Zip code

SPIRITUAL JOURNEY Conversion date (estimated) Brief Testimony Water Baptized? If yes, when baptized? (estimated)

Where? (estimated) Spirit filled? If yes, when filled? (estimated)

Where? (estimated)

Describe how you know you received the baptism in the Holy Spirit.

Evaluate your current spiritual relationship with the Lord. Describe the pattern of your personal devotional time. Home church name Address City State Phone number Areas of service/ministry in this church Pastor’s name E-mail address

MISSIONS INTEREST AND MINISTRY SELECTION Which U.S. Missions department are you applying to? I would like to be assigned to this missionary/ministry leader What type of ministry are you interested in? I’m not sure. I need help determining this. How long are you wanting to participate in a missionary associate assignment? 2 to 3 months (or summer) 4 to 11 months 1 to 2 years Need help deciding

CHARACTER AND PERSONAL Describe any serious illness, special dietary needs, emotional difficulties, learning disabilities, or substance abuse problems you, your spouse, or your children have now or have had in the past. Describe your primary personal character strengths.

Other than minor traffic violations, have you been convicted or pled guilty to violating any law or ordinance? If yes, please explain.

SIGNATURE By signing below, I certify that (1) I answered all questions truthfully, with the information contained in this application to be correct to the best of my knowledge, (2) I voluntarily and knowingly authorize U.S. Missions to contact the personal references named attached, and (3) I will abstain from the use of illegal drugs, alcohol, and tobacco while under U.S. Missions as a missionary associate. Signature Print name Date Spouse’s signature Spouse’s print name Date

BACKGROUND AUTHORIZATION Assemblies of God U.S. Missions

I, , hereby authorize Assemblies of God U.S. Missions and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for U.S. Missions status now and, if applicable, during the tenure of my ministry with Assemblies of God U.S. Missions. I release Assemblies of God U.S. Missions and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name and all information is true and correct to the best of my knowledge: Applicant’s full name Maiden name or other names used Date of birth Social Security Number Please list all residences where you have lived in the past 5 years. If necessary, use an attached sheet to complete this request.

Current residence Previous residence

Street address Street address City, State, Zip City, State, Zip Years at residence Years at residence

Previous residence Previous residence

Street address Street address City, State, Zip City, State, Zip Years at residence Years at residence

Signature Date

MISSIONARY ASSOCIATE CHRISTIAN CONCILIATION AND ARBITRATION AGREEMENT

Assemblies of God U.S. Missions

In consideration of my acceptance as a recognized member of field personnel or as the spouse of a recognized member of field personnel in cooperation with Assemblies of God U.S. Missions of The General Council of the Assemblies of God, I represent and agree to the following:

• I accept the Bible as the inspired Word of God. I believe God desires that Christians resolve their disputes within the Church and that they be reconciled in their relationships in accordance with the principles stated in Matthew 5:23–24, Matthew19:15–20, and 1 Corinthians 6:1–8.

• Accordingly, the undersigned parties hereby agree that, if any dispute or controversy arises between them and is not resolved in private meetings between the parties pursuant to Matthew 5:23–24 and 18:15, then the dispute or controversy will be settled by biblically based mediation and, if necessary, legally binding arbitration, in accordance with the Rules of Procedure for Christian Conciliation (Rules) of the Institute for Christian Conciliation, a division of Peacemaker Ministries (rules available at www.HisPeace.org). The undersigned parties agree that these methods shall be the sole remedy for any dispute or controversy between them and, to the full extent permitted by applicable law, expressly waive their right to file a lawsuit in any civil court against one another for such disputes, except to enforce an arbitration decision, or to final, binding, and fully enforceable according to its terms in any court of competent jurisdiction. This agreement shall not apply to any claims resulting from the termination or discipline of a recognized member of field personnel, since such claims are governed by Assemblies of God U.S. Missions Internal Policies.

By entering your name, you agree to accept the terms of the above document with an electronic signature. Signature Date Spousal signature (if married) Date Witness Address City, State, Zip

Witness Address City, State, Zip

ASSUMPTION OF RISK Assemblies of God U.S. Missions

What an honor it is to have you apply for missionary service. We want to acquaint you with the philosophy and

expectations of Assemblies of God U.S. Missions (AGUSM). We also want to give you the opportunity to fully

evaluate the undeniable fact that times of extreme stress and crisis will come that could cause you to question

whether or not you would have participated on this mission if you had known all the facts. It is impossible to

predict, fully prepare you, or furnish you with all aspects of what you may face. We have, therefore, prepared

some basic assumptions which we both must make. Please prayerfully consider the following assumption

statement before signing and returning it to AGUSM. Your application cannot be processed without the proper

signatures on this form.

I, , IN CONSIDERATION of my acceptance as U.S. Missoins

personnel, in cooperation with the Assemblies of God U.S. Missions, and other considerations the sufficiency of which is acknowledged, represent and agree that:

1. Status. I am a volunteer and/or self-employed worker and acknowledge that I am not traveling as an employee of The General Council of the Assemblies of God.

I attest and certify that I am physically fit and have no medical conditions that would prevent me from from performing my duties.

2. Risks of Travel. I am aware of the hazards and risks to my person and property associated with serving in a missions capacity, such as hazards and risks including but not being limited to injury; increased stress; accident; disease; inadequate medical servies and supplies; death; criminal acts (including terrorism); natural disasters; weather conditions; government action; risks of traveling to or from destinations. I recognize that I may be subjected to potential risks, illnesses, injuries, and even death. I have made my own investigation of these risks, understand these risks, and assume them knowingly and willingly. I further recognize that such risks have always been associated with missionary service (2 Corinthians 11:23–28).

I also acknowledge that in working, living and traveling in cities, I may experience problems associated with urban living, including increased crime, pollution, high population density or standards of living and health standards that are different from those to which I am accustomed. I acknowledge that it is my responsibility to take every precaution to safeguard my health and to protect my personal belongings from damage or theft. I acknowledge that Assemblies of God U.S. Missions recommends that I never travel alone, particularly at night. Being alone, especially at night, may present additional danger to my safety and well-being.

3. GENERAL RELEASE AND ASSUMPTION OF RISK:

KNOWING THE RISKS DESCRIBED ABOVE, I AGREE, ON BEHALF OF MY FAMILY, HEIRS, AND PERSONAL REPRESENTATIVES, TO ASSUME ALL THE RISKS AND RESPONSIBILITIES SURROUNDING MY JOB DUTIES, BOTH KNOWN AND UNKNOWN. TO THE MAXIMUM EXTENT ALLOWED BY LAW, I RELEASE, HOLD HARMLESS, AND AGREE TO INDEMNIFY THE GENERAL COUNCIL OF THE ASSEMBLIES OF GOD, AND ITS AFFILIATED MINISTRIES, AND ANY ASSEMBLIES OF GOD CHURCH AND/OR DISTRICT COUNCIL, AND ANY ASSEMBLIES OF GOD SCHOOL, COLLEGE OR UNIVERSITY, AND THEIR OFFICERS, DIRECTORS, EMPLOYEES, VOLUNTEERS, AND AGENTS, FROM AND AGAINST ANY PRESENT OR FUTURE CLAIMS, LOSSES, LIABILITIES, COSTS AND EXPENSES FOR INJURY TO PERSON OR PROPERTY, OR FOR ANY OTHER DAMAGE, WHICH I MAY SUFFER, OR FOR WHICH I MAY BE LIABLE TO ANY OTHER PERSON, RELATED TO MY PARTICIPATING IN SAID ACTIVITIES (INCLUDING PERIODS IN TRANSIT TO OR FROM MY DESTINATIONS), RESULTING FROM ANY CAUSE, INCLUDING

BUT NOT LIMITED TO NEGLIGENCE ON MY PART OR ON THE PART OF ANY OF THE RELEASED PARTIES; PROVIDED THAT THIS RELEASE OF LIABILITY SHALL NOT APPLY TO GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT.

4. Minor children. In the event that I have minor children who will accompany me on my assignment, I, acting both

on my own behalf and on their behalf as their parent and legal guardian, do hereby assume all risks of death, illness, or injury that they may suffer as a result of said assignment, from those causes described.

5. I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms.

6. Invalidation of any one or more of the provisions of this Agreement shall in no way affect any of the other

provisions hereof, which shall remain in full force and effect.

7. I expressly agree that this assumption of risk, release, and indemnity agreement is intended to be broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS, AND I VOLUNTEARILY SIGN THIS AGREEMENT AS MY OWN FREE ACT.

I certify that I am age 18 or older. I understand and agree that no oral or written representations can or will alter the contents of this document. This Agreement shall be governed and construed in accordance with the laws of the State of Missouri, excluding its choice of law rules, and all claims relating to or arising out of this Agreement, including claims for injuries or wrongful death in any way related to my job duties, shall likewise be governed by the laws of the State of Missouri, excluding its choice of law rules. Signature Name Witness signature* Date witnessed *witness cannot be spouse