• Please fill out this form fully and completely.
  • Date Format: MM slash DD slash YYYY
    Click the calendar icon to pick a date.
  • Date Format: MM slash DD slash YYYY
    Date needs to be 8 digits: mm/dd/yyyy
  • If under a year, please answer "0"
  • Heartland Leadership puts a very high value on the safety of the children we care for and minister to. We know that parents are counting on us to screen every volunteer who works with minors in our care. In caring for minors, we believe it is our responsibility to seek an adult staff that is able to provide a safe, healthy and nurturing learning environment. After we receive your application, we will contact you to set up a short one-on-one meeting with you and one of our Child Protection Program team members.
  • Personal Information

  • Applicant's Statement

  • The information I have given in this application is correct and complete. I understand that any false information or significant omissions I have made on this application may disqualify me from further consideration for service in the ministries of Heartland Community Church. I also authorize Heartland Community to contact any references I have submitted and to conduct background checks that could include review of personal records such as driving, police, department of corrections, court records, etc. I understand that any such information contained in said reports or this application will be held in strictest confidentiality by the professional church staff and designated volunteers.
  • Date Format: MM slash DD slash YYYY
  • If applicant is between the ages of 16 and 17, parent/guardian signature is required.As this student’s parent/guardian, I affirm and support his/her desire to serve at Heartland. I have read his/her application, and to the best of my knowledge, it is complete and accurate.
  • Date Format: MM slash DD slash YYYY
  • Thank you for your interest in serving at Heartland!