Ekklesia Community Leader


Please carefully fill in all required boxes with the correct information or the form will not process. Thank you.

general information


The following questions are asked to insure a safe and protected environment for those who are ministered to at our church. Please understand that these are asked of every potential mentor or leader.


All references must have known you for six months. No family members. One reference must attend Ekklesia.



reference waiver/ interview agreement

By entering my initials and today's date below I certify that all of the above information is true to the best of my knowledge and I waive the right to inspect references and the right to hold the church liable for damages that may result from such evaluations. I also understand that I cannot lead a Community Group without approval of the Ekklesia Pastors and Elders and that this approval will require a background check with the State of Oregon.

criminal history authorization

In order to protect those who are ministered to at Ekklesia, the Pastors and Elders require every potential leader to undergo a criminal history background check. Information provided by this check will not necessarily disqualify a candidate from serving as a Community Group Leader. However, the prospective volunteer will not be allowed to lead a group until the background check is completed. All information received will be kept confidential and only available to the pastors.

The information on this page will be used to complete the criminal history background check. This form will be retained in your application file.

By entering my initials and today's date below, I hereby authorize Oregon State Police to release any information, which pertains to any record of conviction, in it's files or in any criminal file maintained on my whether local, state or national. I hereby release OSP and Ekklesia from any liability resulting from such disclosure.

I understand that I may obtain a copy of the Criminal History Report and will be given the opportunity to challenge the accuracy and completeness of this report and obtain a prompt determination as to the validity of the challenge before a final decision is made by Ekklesia.

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