CCCC SECURED ROLE APPLICATION-Care & Support

At CCCC we believe our staff and volunteers directly impact the spiritual formation of the people they serve; therefore, it is critical that we serve with integrity.  This information along with a criminal record and identity check will enable us to have a conversation with you to address any character or lifestyle issues that could impact your ability to serve.

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Marital Status:
Maiden Name:
Spouse's Name:
*Date of Birth:
Primary Phone Number:
Primary Email Address:
*Occupation:
Work Phone Number:
*CPR Trained: 
*Which Campus do you attend?:
*Are you in a Small Group?
Small Group Navigator's Name:
*Date First Attended Clear Creek Community Church:
*Preferred Method of Contact:
*Based on the following statements, check the one that best describes your spiritual life.
Describe any training, education, skills, etc., that has helped you prepare you for this role.
You may choose to discuss the questions below in confidence with a church staff member rather than answering on this form. Answering "Yes" or leaving these questions blank will not automatically disqualify an applicant from serving. 
Have you ever been charged or convicted of a crime (felony or misdemeanor, not including minor traffic violations)?
If yes, please describe offense, state disposition of charge, date disposed, city, county and state in which you were charged with offense. 
Have you ever been convicted of a sexual offense, offense relating to children, or crime of violence (not covered in question 1 above)?
If you have been convicted of such an offense please attach a statement or explanation, including the nature of the offense charged, date, law enforcement agency making the charge, and any other relevant information. 
Have you ever been reported to the social services agency, law enforcement, child abuse registry, or similar organization, in this state or any other state of the United States, regarding abuse or misconduct involving children? 
If yes, please explain.
Have you ever had a protective order placed against you? 
If yes, please list date of order, duration of order, who the order was to protect, and explain circumstances surrounding placement of protective order. 
Have you had any painful experience (personal abuse in any form), physical disabilities or mental health issues that have better equipped you, or may hinder you from a productive ministry? 
If yes, please explain.
Are there any experiences, marital struggles, addictions (drugs, alcohol, pornography, etc.), character issues (anger, integrity, etc.) or other situations that we need to be aware of as you consider leading others on their spiritual journey? 
If yes, please explain.
I give my permission to Clear Creek Community Church (CCCC) to obtain information relating to my criminal record and identity. The criminal history record, as received from reporting agencies, may include arrest and conviction data, plea bargains and deferred adjudications. I understand this information may be used, in part, to determine my eligibility as a volunteer here. The criminal history records check may be repeated at any time. I understand I will have an opportunity to review the criminal history and a procedure is available for clarification if I dispute the records as received. 

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) they may have regarding my character and fitness for serving at CCCC. In consideration or receipt and evaluation of this application by CCCC, I hereby release any individual , church, organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages or whatever kind or nature which may at any time result to me, my heirs or family on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me on this application. 

Should my application be accepted, I agree to be bound by the bylaws and policies of CCCC to refrain from unscriptural conduct i the performance of my services on behalf of the church. 

I further state that I have carefully read the foregoing release and know the contents thereof, and I sign this release as my own free act. This is a legally binding contract which I have read and understand.
Applicant Signature:
Date:
Submit Form

Central Office:

999 FM 270, League City, TX 77573 | 281.338.5433