Leader Info:
First Name*
 Last Name*
 DOB*
Spouse First Name
 Spouse Last Name
 Spouse DOB
Address*
 City*
 State*          Zip Code*
  
Home Phone
 Business Phone
  
Primary Cell
 Spouse Cell
Primary Email*
 Spouse Email
  
Marital Status*

 Single Married Divorced
Children - please list Name,Age, DOB for each child on a separate line
 

James River Assembly Church History:
How long have you regularly attended JRA?  Years*   Months*
Are you an official member of JRA?* Yes No
Do you tithe regularly to JRA?* Yes No
Are you currently involved in a ministry at JRA?       Yes No Which?
 

Information on previous church attended:
Name of church
 Name of Pastor
 City/State                Years Attended
  
 

Spiritual History:
Have you been born-again according to John 3:5?* Yes No      When?  
Have you been baptized by immersion in water according to Matthew 28:19?*   Yes No    When?  
Do you have an active, daily prayer and devotional time set aside each day to spend with the Lord?*
      Yes No
 

Background Information:
Has anyone ever brought or threatened a civil or criminal claim against you alleging physical or sexual abuse or sexual harassment?* Yes No
Have you been charged, arrested, or convicted of a felony?* Yes No
Is there anything in your past that might come up as questionable issues? (i.e. pornography, sexual addiction)* Yes No    If yes, explain   
Please complete the background screening form and turn in to complete the background process.
 

Doctrine and Theology:
Do you adhere to and believe in the 16 Fundamental Truths held by the Assemblies of God and this church as listed below?*   Yes No
  1. The Scriptures Inspired
  2. The One True God
  3. The Deity of the Lord Jesus Christ
  4. The Fall of Man
  5. The Salvation of Man
  6. The Ordinances of the Church
  7. The Baptism in the Holy Spirit
  8. The Initial Physical Evidence of the Baptism in the Holy Spirit
  1. Sanctification
  2. The Church and its Mission
  3. The Ministry
  4. Divine Healing
  5. The Blessed Hope
  6. The Millennial Reign of Christ
  7. The Final Judgment
  8. The New Heavens and the New Earth
If no, please explain  
 

Ministry-Related Experience:
Position/Ministry Ministry Leader
 

Life Group Information:
What type of group would you like to lead?
Single:    College (18-25) Never Married (+25) Single Parent Single Again
Married:    18-29 30-40s 50+          
Married and Single (mixed):  
In which region would you like to meet?
Springfield
Republic
Fairgrove 		Ozark/Sparta
Bolivar
Branson/Forsythe 		Nixa
Willard
Rogersville 		Strafford/Marshfield
Reeds Spring/Kimberling City
Aurora/Marionville
other region?   
When do you plan to meet?* 2nd & 4th Sunday Night
Or other night  Mon Tue Thur Fri Sat
                       Biweekly Weekly
Meeting Time            Meeting Place  
 

Commitment:
Are you willing to make an 18-24 month commitment?* Yes No
Are you committed to raising up an apprentice with the intent of multiplying your life group after 18-24 months?* Yes No
Please provide the name of three personal references (excluding family members).
Name Relationship Phone
 
By signing below, I certify that the information contained in this application is complete, accurate, and not misleading in anyway. I authorize James River Assembly and its agents to contact references provided as well as any sources not provided in order to obtain information regarding my character and fitness for leadership. Should my application be accepted, I agree to submit to the policies and procedures of James River Assembly and to refrain from unscriptural conduct in the performance of my services on behalf of James River Assembly.

I agree to work with the Life Group Director toward implementing church objectives in discipleship, fellowship, evangelism, outreach, prayer, and helping believers grow upward in worship, inward in commitment, and outward in evangelism.
 
Applicant Name         Date  
Electronic Signature: Enter city of birth