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Form Entry
First Name
First Name is required.
Last Name
Last Name is required.
Email
Email address is not valid
Email is required.
Mobile Phone
Mobile Phone is required.
Birthdate
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1911
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1908
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1906
1905
1904
1903
1902
1901
1900
Birthdate cannot be a future date.
Gender
Male
Female
Gender is required.
Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
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MA
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VA
WA
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Involvement at Mosaic
How long have you attended Mosaic?
How long have you attended Mosaic? is required.
Have you participated in a Mosaic Group within the last 12 months?
No
Yes
Have you participated in a Mosaic Group within the last 12 months? is required.
Are you currently on a Mosaic Serving team?
No
Yes
Are you currently on a Mosaic Serving team? is required.
Have you served in any leadership roles at Mosaic?
No
Yes
Have you served in any leadership roles at Mosaic? is required.
Have you been consciously baptized, by water emersion?
No
Yes
Have you been consciously baptized, by water emersion? is required.
Background
Are you active military?
No
Yes
Are you active military? is required.
What security and/or medical background do you have to help you be qualified to serve on this team?
What security and/or medical background do you have to help you be qualified to serve on this team? is required.
Have you ever served on a security team at another church before?
No
Yes
Have you ever served on a security team at another church before? is required.
Have you ever been arrested or convicted of a crime?
No
Yes
Have you ever been arrested or convicted of a crime? is required.
Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, molesting, or battering a child or adult?
No
Yes
Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, molesting, or battering a child or adult? is required.
Is there any circumstance in your life that would make it inappropriate for you to serve with minors or that would compromise the integrity of Mosaic that we should be aware of?
No
Yes
Is there any circumstance in your life that would make it inappropriate for you to serve with minors or that would compromise the integrity of Mosaic that we should be aware of? is required.
Concealed Carry Permit
Do you currently hold a concealed carry permit?
No
Yes
Do you currently hold a concealed carry permit? is required.
Reference #1
Reference #1: First and Last Name
Reference #1: First and Last Name is required.
Reference #1: Email Address
Email address is not valid
Reference #1: Email Address is required.
Reference #1: Phone Number
Reference #1: Phone Number is required.
Reference #1: Relationship to You
Reference #1: Relationship to You is required.
Reference #1: Length of Time Known
Reference #1: Length of Time Known is required.
Reference #2
Reference #2: First and Last Name
Reference #2: First and Last Name is required.
Reference #2: Email Address
Email address is not valid
Reference #2: Email Address is required.
Reference #2: Phone Number
Reference #2: Phone Number is required.
Reference #2: Relationship to You
Reference #2: Relationship to You is required.
Reference #2: Length of Time Known
Reference #2: Length of Time Known is required.
Officers with Marked Vehicles
Do you drive a marked vehicle?
No
Yes
Do you drive a marked vehicle? is required.
Team Expectations
INTEGRITY: Your actions do not compromise your ability to meet the requirements of and serve on this team, including a background check run every three years.
I understand and agree to the above statement.
INTEGRITY: Your actions do not compromise your ability to meet the requirements of and serve on this team, including a background check run every three years. is required.
ACCOUNTABILITY: Follow-through is paramount to ensuring our team is staffed, communication is clear and everyone has what they need to ensure a safe and secure environment. As a member of the team, you commit to honoring your fellow team members and leaders by your accountability to your serving schedule, communicating with others, and doing what's necessary to protect everyone.
I understand and agree to the above statement.
ACCOUNTABILITY: Follow-through is paramount to ensuring our team is staffed, communication is clear and everyone has what they need to ensure a safe and secure environment. As a member of the team, you commit to honoring your fellow team members and leaders by your accountability to your serving schedule, communicating with others, and doing what's necessary to protect everyone. is required.
EMBRACING CHANGE: Things change quickly and our team will need to embrace, champion and drive change with lots of different volunteers and guests. Things may move quickly and adjustments may need to happen in case of emergency, necessary weekend serving team coverage and staffing special events.
I understand and agree to the above statement.
EMBRACING CHANGE: Things change quickly and our team will need to embrace, champion and drive change with lots of different volunteers and guests. Things may move quickly and adjustments may need to happen in case of emergency, necessary weekend serving team coverage and staffing special events. is required.
HUMILITY AND HONOR: While we are a SRT member, above all we are serving the CHURCH and its people. When things are going well and you’re doing your job right, they have no idea who you are or what you’re doing. This is not an easily recognizable position that gets frequent recognition. There is a unique blend of ensuring that any safety-related situation is handled with the appropriate level of action, but also doing so in the least confrontational/abrasive way possible. The goal is to simultaneously protect our church from potentially harmful situations, while still upholding our values and setting a Christ-like example, as we are ALL broken, messy people.
I understand and agree to the above statement.
HUMILITY AND HONOR: While we are a SRT member, above all we are serving the CHURCH and its people. When things are going well and you’re doing your job right, they have no idea who you are or what you’re doing. This is not an easily recognizable position that gets frequent recognition. There is a unique blend of ensuring that any safety-related situation is handled with the appropriate level of action, but also doing so in the least confrontational/abrasive way possible. The goal is to simultaneously protect our church from potentially harmful situations, while still upholding our values and setting a Christ-like example, as we are ALL broken, messy people. is required.
Applicant Information
SSN
SSN is required.
Driver's License Number
Driver's License Number is required.
Driver's License Issuing State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver's License Issuing State is required.
Applicant Authorization
In the interest of safety and security I, the undersigned applicant (also known as “consumer”), authorize Mosaic Christian Church through its independent contractor, Protect my Ministry, to procure background information (also known as a “consumer report and/or investigative consumer report”) about me, prior to, and at any time during my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records.
I understand and agree to the above statement.
In the interest of safety and security I, the undersigned applicant (also known as “consumer”), authorize Mosaic Christian Church through its independent contractor, Protect my Ministry, to procure background information (also known as a “consumer report and/or investigative consumer report”) about me, prior to, and at any time during my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. is required.
I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Mosaic Christian Church if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.
I understand and agree to the above statement.
I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Mosaic Christian Church if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act. is required.
Applicant Signature
By typing your name below, you are allowing Mosaic to complete this background check report on you.
By typing your name below, you are allowing Mosaic to complete this background check report on you. is required.
Date Signed
Date Signed is required.
Submit