Name

Email

Telphone

Street Address

City

State

Zip Code

Teacher/Facilitator Teacher/Facilitator Small Group Bible Study Small Group Book Study Sunday School Vacation Bible School Children, Middle, Youth (CMY) Church Wide Bible Study

Classroom Assistant Classroom Assistant Small Group Bible Study Small Group Book Study Sunday School Vacation Bible School Children, Middle, Youth (CMY) Church Wide Bible Study

General/Floater General/Floater Small Group Bible Study Small Group Book Study Sunday School Vacation Bible School Children, Middle, Youth (CMY) Church Wide Bible Study

Nursery Worker Nursery Worker Yes No

Special Events Special Events Yes No

Ministry Meeting/Classes Ministry Meeting/Classes Yes No

Age Groups Age Groups 0 to 12 months 13 to 47 months PK to 1st Grade 2nd to 3rd Grade 4th to 5th Grade Middle School High School Young Adult Adult

Days Available Days Available Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Time of Day Available Time of Day Available Morning Afternoon Evening

Have you accepted Jesus as your personal Lord and Savior? Have you accepted Jesus as your personal Lord and Savior? Yes No

Are You A Member of St. James Are You A Member of St. James Yes No

Have you completed Safe Sanctuaries Training in the last three years? Have you completed Safe Sanctuaries Training in the last three years? Yes No

Do you hold a current CPR certification? Do you hold a current CPR certification? Yes No

Do you consent to a background check? Do you consent to a background check? Yes No

How many times a month do you attend worship services at St. James UMC?

How many times a month do you attend worship services at other faith based organizations?

How many times a month do you attend Bible Study classes at St. James UMC?

How many times a month do you attend Bible Study classes at other faith based organizations?

Of which ministries are you a member or serve? Past ministries?

Which Bible Study classes have you taken?

Which Bible Study classes have you taught?

Which Servant Worker roles do you currently hold? Past roles?

Emergency Contact's Name

Emergency Contact's Name

Relationship To Emergency Contact

Emergency Contact's Phone

Emergency Contact's Street Address

Emergency Contact's City

Emergency Contact's Zip

Share information about yourself and experience that would help evaluate your fit for this servant worker position.

What are your strengths that could be used in this servant worker position?

What are your strengths that could be used in this servant worker position?

What specific skills do you bring to this servant worker position?

Where do you feel you will need the most training and support to be successful in this servant worker position?

I understand that I will be given access to all policies associated with the performance of my duties in this servant worker position. I also understand that acceptance as a servant worker is contingent on the results of a background check and successful completion of Safe Sanctuaries training. Acceptance and agreement to abide by St. James UMC’s policies and guidelines is required prior to placement in this servant worker position. I understand that I will be given access to all policies associated with the performance of my duties in this servant worker position. I also understand that acceptance as a servant worker is contingent on the results of a background check and successful completion of Safe Sanctuaries training. Acceptance and agreement to abide by St. James UMC’s policies and guidelines is required prior to placement in this servant worker position. Yes