Name *

First Name

Last Name

Address *

Where are you currently residing?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Age *

MM

DD

YYYY

Do you attend Bethesda *

Yes

No

Are you currently volunteering with our Community Connections and/or Conversation Cafe, or have in the recent past? *

Yes

No

Reference #1 *

First Name

Last Name

Phone for Reference #1 *

(###)

###

####

Reference #2 *

First Name

Last Name

Phone

(###)

###

####

Permission *

Please read the following information carefully before signing this application. I give Bethesda Pentecostal Church the right to investigate all references and to secure additional information about me. I hereby release from liability Bethesda Pentecostal Church and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. I certify that the information provided on this form is correct and complete to the best of my knowledge and I have not withheld any information that would unfavorably affect my application. I understand that information on this form may be verified by Bethesda. I agree to protect the privacy and confidentiality of all personal information I become aware of through working under the Community Connections and Conversation Cafe ministry at Bethesda and agree not to copy, transmit, or share this information except with the consent and direction of Bethesda staff. I commit to not do anything to undermine or work against the mission of Bethesda and to respect the authority of Bethesda church leadership. I will do my best to demonstrate teamwork, dependability, safety, integrity, and kindness in my volunteer service.

Yes

No