Guardian Ministry Application

GUARDIAN MINISTRY APPLICATION
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Email*
Phone number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Driver’s License State*
DL Number*
Concealed License/License to Carry State*
License Number*
Concealed License/License to Carry Expiration Date*

MonthDayYear
Parish Name/City *
Email of team leader*
(Kindly provide the accurate email address to ensure that a copy of this form is sent to the team leader. Please read instructions below.)
Note: Please view the email list below for each Team Leader email address. If your parish is not listed, kindly include the email address of a neighboring parish within the same deanery.

View email list
View deanery list
In which team roles would you like to become involved? *
Are you currently or have you ever been a Police Officer?*

YesNo
If yes, please provide the State who held your license and city that held your commission *
Have you completed any certification or formal training related to this role?*

YesNo
If yes, please describe*
What skills would you bring to the team? *

What other safety or security related work experience do you have? (Please list)*

Have you ever:
Been accused, arrested, or convicted of any crime?*

YesNo
If yes, please explain*
Been investigated by a state agency (CPS, Police Agency, etc) for misconduct with a child?*

YesNo
If yes, please explain*
Lost or been denied the privilege to carry a concealed weapon?*

YesNo
If yes, please explain*
Have any life experiences that may hinder you from a productive ministry on the safety and security team?*

YesNo
Please explain*
Are you aware of any reason you should not serve on this team?*

YesNo
If yes, please explain*
EXTRACURRICULAR ACTIVITY
Disclaimer: The contact information provided below may be contacted as a part of the applicant screening process.

What organizations, ministries or groups have you been a part of in the past 3 years?*

EMERGENCY CONTACT
Emergency Contact Information*
VERIFICATION AND RELEASE
I recognize that my church is relying on the accuracy of the information provided on this application form. Accordingly, I attest and affirm that the information I have provided is true and correct.*
I authorize the organization to contact any person or entity on this application form to ascertain information, opinions, and impressions relating to my background or qualifications.*
Printed Name*
I Accept*
Date*

MonthDayYear
Should be Empty:

GUARDIAN MINISTRY APPLICATION