PLEASE PRINT OR TYPE

FULL LEGAL NAME ____________________________________________________________________

Last First Middle

Name you go by: __________________________ Home Phone: ____________ Cell: _________________

(If selected for the Team, this name will be put on your name badge) Do you text?___________________

Address: _______________________________________________________________________________

Street City State Zip

E-Mail Address: __________________________________________________________________________

Date of Birth: _____/_____/_____ Age as of June 1, 2010: ____________ Sex: Male Female

Driver’s License #: _______________ State Issued: _________ Expiration Date: __________________

License issued (month and year): ___________________________________________________________

Any State of Oregon Driving Restrictions? _____________________________________________________

PARENTS:

Father’s Name: ________________________________ Mother’s Name: __________________________

Address: _______________________________________________________________________________

Street City State Zip

Parent’s Home #: _____________ Parent’s Work #: _______________ Parent’s Cell #: _______________

Parent’s E-Mail Address: __________________________________________________________________

CHURCH:

Do you regularly attend Oregon City Evangelical Church? Yes No

SCHOOL:

School Name (currently attending): ___________________________________________________________

Current year in School: ___________________________________________________________________

If not currently in college, are you planning to attend? Yes No

If you plan to attend, where do you plan to go? _________________________________________________

EMERGENCY: In case of emergency or accident, whom should we notify?

Name: _________________________________________ Relationship: __________________________

Address: _______________________________________________________________________________

Street City State Zip

Phone: ___________________________________ Work Phone: _____________________________

Insurance Company: __________________________________ Policy #: ___________________________

Medical allergies, medications being taken, medical problems or other pertinent information:

_______________________________________________________________________________________

_______________________________________________________________________________________

EXPERIENCE: List any previous employment experience that you have had (attach additional sheet if needed).

1. Employer ______________________________________________________________________

From _____/_____/_____ to _____/_____/_____

Type of Work ___________________________________________________________________

2. Employer ______________________________________________________________________

From _____/_____/_____ to _____/_____/_____

Type of Work ___________________________________________________________________

3. Employer ______________________________________________________________________

From _____/_____/_____ to _____/_____/_____

Type of Work ___________________________________________________________________

PERSONAL REFERENCES (Examples: Sunday School Teachers, Pastors, Bible Study Leaders.

People (preferably at OCEC) who will tell us about your character. No relatives, please!)

Name: ___________________________ Relationship: _____________________ Phone: _____________

Address: _______________________________________________________________________________

Street City State Zip

Name: ___________________________ Relationship: _____________________ Phone: _____________

Address: _______________________________________________________________________________ Street City State Zip

DOCTRINAL SURVEY: Please answer briefly, giving Scripture references when applicable.

1. Who is Jesus Christ, according to your understanding? Why did He die on the cross? What is the

significance of His resurrection?

2. Who is the Holy Spirit and what is His purpose?

3. How does a person become a Christian?

4. What is the purpose of the Bible in your life? Do you consider it your final authority for how you make

decisions? How would you rate your Bible knowledge? (very strong; moderate; minimal)?

5. Do you agree with the biblical teachings and practices of OCEC? If not, with what teachings or practices

do you disagree?

BIOGRAPHICAL INFORMATION:

Attach another sheet of paper with your answers. Please number them!

1. Tell how and when you came to know Christ. What is your current relationship with Him?

2. What are your reasons for wanting to be on the OCEC Summer Ministries Leadership Team?

3. Write a brief biography of your life. Include: a) significant happenings in your life; b) a description of your

personality, including your strengths and weaknesses; c) family background (i.e., who do you live with?

What kind of relationship do you have with family members? How do your family members feel about you

being a member of the OCEC Summer Ministries Leadership Team?)

4. With what OCEC ministries have you been involved? Include: a) length of your commitment; b) duties/

responsibilities.

5. With what other experiences/ministries have you been involved that have prepared you for involvement with

the OCEC Summer Ministries Leadership Team?

6. Do you play a musical instrument that you would be interested in using in this Summer Ministries Leadership

Team program? If yes, what instrument? ____________________________ How long have you played?

______________________

7. What are your hobbies?

CRIMINAL BACKGROUND CHECK: (Note: A criminal background check will be performed on all selected

adult Summer Ministries Leadership Team Members. If any of the questions below are answered “YES,” please

provide a complete explanation, attaching additional sheets as necessary.)

A. Have you EVER been convicted of a sex-related crime? [ ] Yes [ ] No

If YES, was the conviction in Oregon or another state? (Please specify if another state) State: ____________

If YES, did the crime involve force or minors? [ ] Yes [ ] No

B. Have you EVER been convicted of a crime involving violence or threat of violence? [ ] Yes [ ] No

If YES, was the conviction in Oregon or another state? (Please specify if another state) State: ____________

C. Have you EVER been convicted of a crime involving criminal activity in drugs or alcoholic beverages,

including providing alcohol or drugs to a minor and/or driving while under the influence of alcohol

or drugs? [ ] Yes [ ] No

If YES, was the conviction in Oregon or another state? (Please specify if another state) State: ____________

D. Have you EVER been convicted of any other crime except minor traffic violation?

(includes Traffic Crimes) [ ] Yes [ ] No

E. Have you been arrested within the last three years for a crime for which there has not yet been

an acquittal or dismissal? [ ] Yes [ ] No

F. Have you been convicted of any traffic violations in the past three years? [ ] Yes [ ] No

MY PERSONAL COMMITMENT:

I am committed to standards of faithfulness to God and purity of lifestyle. Therefore:

I will refrain from the use of illegal drugs. Yes No If no, please explain: I will refrain from drinking alcohol. Yes No If no, please explain: I will remain sexually pure. Yes No If no, please explain: I will seek to present a Christian witness in every aspect of my life. Therefore, I give permission to the Team Director (Raelene Gilmore) and Pastor of Children (Sue Burson) to check out my MySpace or Facebook account. I agree to accept them as a “friend” so they have access to my MySpace/Facebook accounts.** Yes No If no, please explain:

My “MySpace” screen name: _________________________________________

My “Facebook” screen name: _________________________________________

(**We do not endorse the practice of using MySpace or Facebook accounts other than to represent a life dedicated to Christ.

However, we wish to view how you are representing yourself in public and therefore will check your page on a regular basis.)

CHURCH SERVICE:

OCEC desires that you continue to be involved in the church following the activities of the Summer Ministries Lead-

ership Team. There are a number of ways you can be involved, such as Children/Youth Worker, Sunday School

leader, S.W.A.T. Leader, KLUB JESUS, etc. In what areas of ministry do you anticipate being involved in the future?

_______________________________________________________________________________________

_______________________________________________________________________________________

TEAM UNIFORM:

Team members will be required to wear a Summer Ministries Leadership Team T-shirt to all Team events. One

T-shirt will be provided. Additional T-shirt(s) may be purchased for $7 each. (Extra T-shirts are suggested to help ensure daily

presentability, and can lighten your laundry load.)

T-shirt Size: ________________ I would like to purchase ______ additional T-shirt(s) for $7 each.

SIGNATURES: (Applicant/Parent)

I hereby certify that all the above information and statements are correct.

Signature of Applicant: _________________________________________ Date: ____________________

If Applicant is under 18:

I hereby give approval for my son/daughter to become an OCEC Summer Ministries Leadership Team Member. I

understand that a calendar of events/times will be provided and I will make sure my son/daughter has transportation

and will arrive on time for his/her responsibilities.

Signature of Parent/Guardian: ___________________________________ Date: ____________________

Applications due in the Church Office by Monday, APRIL 12, 2010.