We are so excited that you are interested in serving with Central Assembly!
Fill out the form below and we will get back to you shortly!

Name *
This is confidential, and for a background check.
Date of Birth *
Date of Birth
Address *
Other Names Used
Home Telephone *
Home Telephone
Cell *
Work *
May we call you at work? *
Do you have a physical limitations or medical conditions which may limit your ability to complete your duties? *
For example: If working with children, will you be able to run short distances in an emergency.
Are you taking prescription medications which might impair your duties? *
Do you have personal habits which might cause someone to question your Christian testimony, such as smoking, drinking, gambling, violence, or use of pornography? *
Do you now have a valid driver’s license and a good driving record? *
Have you ever had your driver’s license suspended or revoked for any reason? *
Have you ever been convicted of a felony criminal offense? *
Have you ever been convicted of a crime of violence? *
Have you ever been convicted of a sex crime? *
What type of children's/youth work do you prefer? *
You may select more than one
Which days are you available and will to serve? *
You may select more than one
Please put your initials
Have you accepted Christ as Lord? *
Do you understand the sixteen Statements of Fundamental Truths of the Assemblies of God? *
Do you agree not to teach beliefs contrary to our tenants of faith? *
Have you received the Baptism in the Holy Spirit as recorded in Acts 2:4; 10:44-46 and 19:6? *
Have you become a member? *
What is your attendance pattern? *