General Info
First Name Please provide a valid value.
Last Name Please provide a valid value.
Middle Initial Please provide a valid value.
Previous Name/Maiden Name Please provide a valid value.
Email
Name For Name Tag
Date of Birth Please provide a valid value.
Gender Male Female
Marital Status
Spouse Name Please provide a valid value.
Spouse Gender Male Female
When did you start attending Crossroads?
Site/Service Time where you attend
Street Address Please provide a valid value.
City Please provide a valid value.
State Please provide a valid value.
Zip Please provide a valid value.
Cell Phone Please provide a valid value.
Home Phone Please provide a valid value.
Employer
Company Name
Position
Work Phone (If you can receive calls at this number)
Children's Name and Birthdays
Name
Birthday
Name Please provide a valid value.
Birthday
Name Please provide a valid value.
Birthday
Name Please provide a valid value.
Birthday
About You
Have you ever been arrested, convicted of or pleaded no contest to any crime? No Yes
Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography, or other addiction; or has anyone suggested that you do? No Yes
Have you ever been accused, alleged, investigated, charged or convicted of any act of neglecting,abusing, exploiting or molesting any child? No Yes
Have you ever been treated for or diagnosed with a psychiatric disorder? No Yes
Currently, or in the past year, have you been sexually active outside of marriage? No Yes
How would you define your spiritual life? Pick as many as you like.
Searching for answers.
I have received Jesus.
Focusing on obedience—I’ve quit negotiating with God.
I’m actively replicating my faith in others.
Please Explain
What prompted you to fill out an application and check us out? Please provide a valid value.
Any special talents, abilities, skills or experiences that may be helpful? (Juggling, fire eating, acting, or making weird noises with your armpit count.) Please provide a valid value.
Serving Opportunities
What is your availability?
During the Week
Weekend Services
Weekend Site/Service Time
What areas most interest you? (Check all that apply)
Serving in a Classroom
Welcoming New Familites and showing them to their room
One-on-one helper with a kid who has special needs
Tech (Provide tech and systems support)
Prepping the rooms (set up props, activities, etc on thursday and/or friday mornings)
Administrative tasks (Data entry, filing, mailing, etc)
Shopping for supplies
Creating the weekend experience (Write Lessons or songs, brainstorm acitivites, etc)
Want to serve directly with kids? What age do you prefer? (check all that apply)
Birth - 2 years old
3-year olds - Pre-K
Kinder - 5th Grade
Personal References

List three adults (18 or older) you have know for at least one year, who are not related to you and have a definite knowledge of your character and ability to work with kids and students (e.g. pastor, close friend, teacher, and/or employer).

#### First Reference

Name
Length of time known
Home Phone
Mobile Phone
Work Phone
Email
Nature of Association
Occupation

#### Second Reference

Name
Length of time known
Home Phone
Mobile Phone
Work Phone
Email
Nature of Association
Occupation

#### Third Reference

Name
Length of time known
Home Phone
Mobile Phone
Work Phone
Email
Nature of Association
Occupation

Agree Yes No
Date