mentor application


Please carefully fill in all boxes with the correct information. If a question does not apply to you, please write "N/A" or "not applicable" in the box, or else the form will not process. Thank you.

general information

Please thoroughly respond to the questions.


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 Mentor. However, the prospective volunteer will not be allowed to mentor 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.

Thank you for your interest! Please make sure you have filled out all boxes for the form to process.

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