Country

City

State

Birth Date

Gender
Male
Female

Marital Status
Single
Engaged
Married
Divorced
Widowed

Do you currently serve on CJCLife Team?
Yes
No

What type of life group would you like to lead?
Financial
Marriage / Family / Parenting
Men's Group
Women's Group
Prayer
Student's Group
Outreach
Recovery & Restoration
Other

Please provide a brief description of why you would like to be a life group leader:

Please provide the name and phone numbers of any references we may contact:

Has anyone ever brought or threatened to bring civil or criminal claims against you alleging physical/sexual abuse or harassment?
Yes
No

Have you ever terminated your employment or had your employment terminated due to allegations against you of physical/sexual abuse or harassment?
Yes
No

Have you ever been reprimanded as a student for harassment or inappropriate behavior with another individual?
Yes
No

Have you ever been arrested, charged, or convicted of a felony or misdemeanor?
Yes
No

If there is anything from your past that might come up as a questionable issue, please provide a brief explanation.

Statement of Beliefs (I believe in the virgin birth and deity of Jesus Christ. I believe that Jesus is God's Son and only sacrifice for sin. I believe that Jesus rose bodily from the dead. I believe that a person must be born again to receive eternal life. I believe in the infallibility of the Holy Bible. I believe in the eternal damnation of the lost.) . I am a born-again Christian and the statements listed above are true.
Yes, I Agree
Unsure, I have questions that I would like to discuss with a Pastor

Life Group Leader Qualifications.(To fulfill the responsibilities outlined in the CJCLife Group Manual. To abide by the CJCLife Group Leader Honor Code. To help fulfill the Mission, Vision, and Purpose of CJCLife. To embrace and teach Christian principles as stated in CJCLife Group Manual.) . I believe that I meet the qualifications for serving as a Life Group Leader.
Yes, I Agree
Unsure, I have questions that I would like to discuss with a Pastor

Life Group Leader Requirements(To fulfill the responsibilities outlined in the CJCLife Group Manual. To abide by the CJCLife Group Leader Honor Code. To help fulfill the Mission, Vision, and Purpose of CJCLife. To embrace and teach Christian principles as stated in CJCLife Group Manual.) . I agree to observe the requirements of a Life Group Leader.
Yes, I Agree
Unsure, I have questions that I would like to discuss with a Pastor

I have attended a Life Group Leader training session.
Yes
No, but I will attend a session prior to serving as a leader.

Life Group Leader Agreement: Should my application be accepted, I agree to submit to the policies and procedures of CJCLife Groups, and will refrain from unscriptural conduct in the performances of my services on behalf of CJCLife.
Yes, I Agree
Unsure, I have questions that I would like to discuss with a Pastor

I certify that the information contained in this application is complete, accurate, and not misleading in any way.
Yes, I Agree

Leader Name(s) and Contact Information (Please include email address and/or phone number)

What day of the week will the group meet?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What time will the group meetings start?

What time will the group meetings end?

Meeting Location:

Will childcare be provided?
Yes, free of charge
Yes, for a fee
No

Are you planning to follow curriculum from a book or DVD? If so, please provide the title and author.

Anything else you'd like to share?