Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Birthday *

MM

DD

YYYY

What ministry are you applying for? *

(Click all that apply)

Worship Arts (Tech, Singing, Instruments)

Hospitality (Coffee, Greeters, Connections)

Facilities (Set Up, Building Maintenance)

262 Student Ministries (Middle and High School)

Mosaic Kids (Nursery - 5th Grade)

Adult Discipleship (Growth Groups)

Care Ministry (Benevolence. Counseling, Assistance)

Administration (Office, Finances, Ministry Assistance)

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Do you understand and agree to the Mission, Vision, and Core Values of Mosaic Church? *

Please review at www.mosaicwi.com before responding.

Yes

No

Unsure

Do you understand and agree to the Doctrinal Statement of the Alliance and Mosaic Church? *

Please review the simplified doctrinal statement at mosaicwi.com and the full statement at http://www.cmalliance.org/about/beliefs

Yes

No

Unsure

Have you ever been charged, arrested, or convicted of any crime other than minor traffic violations that may be a concern?

Yes

No

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Do you authorize Mosaic Church to perform a background check?

Yes

No

Please talk to me about this