LIABILITY QUESTIONEER FOR CHURCH STAFF & YOUTH/SUNDAY SCHOOL WORKERS
BY ROBERT FORBUSH

First Name:________________ MI________ Last Name:____________________

Address:___________________ City:______________ State:___________

Zip Code:________________ Phone Number:________________

The following information is required by our present insurance company. All answers w 11 be held in confidential files. Please answer these questions as completely as possible.

1. Have you received the baptism of the Holy Ghost?

2. What date?

3. Have you been baptized in the Name of Jesus according to Acts 2:38?

4. What date?

5. Have you ever been convicted of a felony?

6. If so please explain on the back of this form. In section A

7. Have you ever held this Departmental position before?

8. If so where? and for how long?

9. How does your vision for this department meet with your pastors?

10. Have you ever been accused or convicted of child molestation?

11. It so what was the outcome of the investigation? Please explain in Section B

12. Have you ever been charged/accused with any sexual misconduct?

13. If so please explain in full Section C.

14. Are you willing to submit to the authority of your pastor?

15. Do you feel that you can accept a position of authority without it erecting your personality?

16. Have you ever handled finances for a business?

17. If so for whom, when and for how long?

18. Do you feel you have control of your finances?

19. As your Pastor so You feel you can freely communicate with me?

20. What is your vision for ministry? Please explain Section D

Section A Question #6

Section B Question #11

Section C Question #13

Section D Question #20

Commitment

As is with keeping the attitude and spirit of Christ, as we should seek continually to be like Jesus. I affirm that all the questions are true and correct. I also affirm that if at anytime I am in disagreement with the pastor I will talk with him privately. By signing this agreement I affirm that I will support the Pastor as leader of this Assembly and seek his spiritual guidance in regards to this Department. I understand that the pastor may at anytime according to his discretion, modify this Departmental Job Description.
This is to be signed in the presence of a witness. The witness may not be related to the individual for whom the application refers.

THE ABOVE MATERIAL WAS PUBLISHED BY THE UPCI SUNDAY SCHOOL DIVISION, JULY 8, 1997, AND MAY BE USED FOR STUDY & RESEARCH PURPOSES ONLY.