Islamic Outreach Application
  • Part One: General Information

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  • If none, write N/A
  • Part Two: Passport Information

  • Part Three: Team Member Information

  • Part Four: Spiritual Information

  • Part Five: Health & Personal Information

    This will be kept confidential and viewed only by Outreach Staff and your Team Leader(s)
  • How would you rate your present state of health?
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    good
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    poor
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    good
  • If none, write N/A
  • Please list ALL medications you are taking and for what condition:
  • Part Six: Emergency Contact Information

  • First Contact
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  • Second Contact
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  • Third Contact
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  • Part Seven: Background Check Consent

    Please note, you are only required to fill out this section if it's been longer than 2 years since you've had a background check performed by Water of Life.

  • A SUMMARY OF YOUR RIGHTS under CALIFORNIA LAW:

    Under California Law, you are entitled, upon presentation of proper identification (*), to find out from an investigative “consumer reporting agency” (“CRA”) what is in your file, as follows:

    1. In person, by visual inspection of your file during normal business hours and on reasonable notice;

    2. By obtaining a summary of it via telephone call, if you have made a written request, with proper identification, for telephone disclosure and the toll charge, if any, for the telephone call is prepaid by you or charged directly to you; or

    3. By requesting in writing, with proper identification, that a copy of it be sent to a specified addressee by certified mail. Investigative CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative CRAs. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file. The investigative CRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An investigative CRA may require you to furnish a written statement granting permission to the CRA to discuss your file in such person’s presence.

    (*) the term “proper identification” as used above shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if the consumer in unable to reasonably identify himself with the information described herein, may an investigative CRA require additional information concerning your employment and personal or family history in order to verify your identify.

  • FOR QUESTIONS OR CONCERNS REGARDING

    CRAs and creditors, please call:

    California Attorney General’s Office Public Inquiry Unit P.O. Box 944255
    Sacramento, CA 94244-2550
    *800-952-5225

    OR

    California Department of Consumer Affairs
    400 R Street, Suite 1080
    Sacramento, CA 95814
    *800-952-5210

  • DISCLOSURE and AUTHORIZATION TO OBTAIN INFORMATION:

    In connection with my suitability for employment or service with Water of Life Community Church, (herein “Client’) or if employed, I understand that prior to or at any time after my employment commences a consumer report may be requested for employment/volunteer purposes from Protect My Ministry, Inc.,(herein: “Protect My Ministry”) from public records including; but not limited to, Social Security number, motor vehicle operation history/driving records, workers’ compensation information and criminal history to the extent permitted by law from various local, state, and federal agencies. Further, I understand that an Employment Credit Report may be requested. Finally, I understand that an Investigative Consumer Report may be requested and, as required under §606(a)(1) of the federal Fair Credit Reporting Act (FCRA), IS U.S.C. §1681 et seq., I understand that this Report will include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance, experience, along with reasons for termination of past employment, whichever are applicable, obtained through personal interviews with associates who have knowledge concerning such items of information.
    I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER OR SUPERVISOR, COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING, ADMINISTRATOR, LAW ENFORCEMENT AGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY, CREDIT BUREAU, PRIVATE BUSINESS, MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDS CENTER, PERSONAL REFERENCE, AND/OR OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL HISTORY, MOTOR VEHICLE HISTORY/DRIVING HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, GENERAL REPUTATION, MODE OF LIVING,AND EMPLOYMENT (INCLUDING REASONS FOR TERMINATION), CREDIT HISTORY, CREDIT CAPACITY, OR CREDIT STANDING OR ANY OTHER INFORMATION REQUESTED BY PROTECT MY MINISTRY DEEMED PERTINENT TO MY EMPLOYMENT.
    In accordance with the FCRA and applicable state laws, I understand that I have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested. Further, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Reporting Agency. If so, I will be so advised in writing and be given the name, address and toll free number of the agency, a statement that the action was based in whole or in part on information contained in the Report, and written notice that I have the right (i) if I request, to obtain within sixty days a free copy of the Report from the Reporting Agency (under no circumstances shall such cost exceed the actual costs of duplication), and from any other Consumer Reporting Agency which compiles and maintains files on consumers on a nationwide basis; and, (ii) to dispute the accuracy or completeness of any information in a consumer report furnished by the Reporting Agency. I understand that upon my request with reasonable notice and after furnishing proper identification, Protect My Ministry’s trained personnel will provide me with investigative information in my file during normal business hours in person or upon written request, by certified mail to a specified addressee, or telephone as permitted by law. Further, I understand that should I wish to review my file in person; I am permitted to be accompanied by one other person of my choosing who shall furnish reasonable identification and if requested, Protect My Ministry will provide a written explanation of any coded information contained in my file. I understand that Protect My Ministry is a Consumer Reporting Agency and it is Protect My Ministry’s policy to not be involved in or make hiring decisions or recommendation.
    Protect My Ministry’s privacy policy limits the information it provides to the client named herein, however I hereby authorize the client to share such information with parties in interest who have a “need to know” such information to protect them and their employees. Protect My Ministry does not sell or otherwise provide any of the information found in its background investigations to any other party other than the client.

    Consumer Reporting Agency contact information Protect My Ministry 14499 Dale Mabry Hwy, Suite 201 South, Tampa FL 33618 Phone: 800-319-5581 Fax: 800-319-5582 www.protectmyministry.com

  • BACKGROUND RELEASE INFORMATION:

    The following must be filled out completely, signed, AND SUBMITTED WITH A COPY OF PHOTO ID for your application to be considered.

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  • AUTHORIZATION:

    I hereby authorize Water of Life Community Church and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.
    I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Water of Life Community Church or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.
    Water of Life Community Church and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to, addresses, social security numbers, and dates of birth.
    *Email address is being collected only as an additional source of personally identifiable information, and not for any marketing purpose or third party use.

  • The information contained in this application is correct to the best of my knowledge.

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