Name:___________________________________________________ Phone:___________________

Address:____________________________________ City/State:__________________ Zip:________

Have you been a resident of any other state?____________ If so, which one?___________________

Previous Address: ___________________________________________________________________

Previous Address: ___________________________________________________________________

Previous Address: ___________________________________________________________________

Social Security No.________________________ Driver's License:____________________________ Birth Date:___/___/___

Male/Female:_____ No. of Children: _______ Nationality: ______________ Marital Status:____________

Maiden Name:_____________________________________________

Have you had a prior criminal record? __________________________________________________

How did you hear about us ? _________________________________________________

Are you involved in Community Outreach Services? ___Y ___N

If yes, which? _____________________________________________________________________ _________________________________________________________________________________

Personal References: (References cannot be related to you and must be adults. If you have regularly attended a previous church please provide the name and phone number.)

Name / Address:________________________________________ Home Phone:________________

Name / Address:________________________________________ Home Phone:________________

Name / Address:________________________________________ Home Phone :________________

Indicate Areas of Interest: Available Times: ______________________

Sunday ______________________

Applicant's Statement: The information contained in this application is correct to the best of my knowledge. I authorize references listed in this application to give you any information they may have regarding my character and fitness for ministry. I release all such references from liability for any damage that may result from furnishing such evaluations to you and I waive any right that I have to inspect the references provided on my behalf. Should my application be accepted, I agree to observe the constitution and policies of Victory Fellowship Church and to strive for New Testament conduct in the performance of my services on behalf of the church.

Date: _______________________ Applicant's Signature:_________________________________________________ Date:________________________ Parent Signature if Minor:_____________________________________________

An interview will be performed for all applicants. All volunteers for children's church will need to fill out additional Paperwork at that time in order to comply with church policy of a criminal background check.