Please complete this application in full to be considered as a Groundwire Spiritual Response Coach. Please understand you will not act as a counselor, but the role you will play is that of a mentor, safe person, or trusted individual to coach and share the Lord's love with the individuals who may be assigned to you. This is a very serious and rewarding responsibility and we expect and trust that you will represent this ministry with the respect pleasing to God.

Full Name (*)

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Maiden Name

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SSN# (*)

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Age (*)

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Date of Birth (MM/DD/YYYY) (*)

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Present Address (*)

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How long at this address?

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If less then 3 years, please list last address

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Email Address (*)

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Phone Number (best # to reach you) with no spaces or dashes (*)

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Church affiliation/membership

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Briefly describe your salvation experience (1,050 Character limit)

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What skills can you offer as a Spiritual Response Coach?

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List specific situations you do not feel comfortable with.

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What areas do you feel most comfortable in mentoring students and young adults?

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Do you have any special training or credentials?
YesNo
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If yes, please list.

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Do you have a reliable computer and access to the Internet/email?
YesNo
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Please provide 1 reference of no relation to you and 1 Pastoral reference.

Reference: Name, Address, Telephone/Email (*)

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Pastoral Reference: Name, Church, Telephone/Email (*)

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The intent of the following 3 questions is to reduce the risk of abuse in any form on the Groundwire Response mechanism. It is designed to protect those to whom we minister, as well as to uphold the personal dignity of all who would be involved in serving them.

Have you ever been accused of child abuse or a crime involving actual or attempted sexual molestation of a minor? (*)
YesNo
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If yes, please explain

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Have you ever been convicted by any court of a felony? (*)
YesNo
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Have you been arrested for an offense for which a trial is pending? (*)
YesNo
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If you answered yes to any of the previous 3 questions, please indicate the date and place of arrest and a brief explanation of the offense and sentence imposed. If you were convicted under another name, list the other name as well.



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In the space below, please list a basic Gospel presentation and how you would lead someone to accepting Christ. (1,050 character maximum)

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Typically, Spiritual Response Coaches average 2-4 hours per week on the chat line. While you are certainly encouraged to be on as much as your schedule allows, we do ask for you to consider this minimum time request as you submit this application. Knowing that schedules can change and that you are not committing to a set time every week and to assist us in looking at upcoming coaches and our scheduling needs, would you list 3 times below that you foresee being available most of the time.

3 times (2 hour blocks preferred) that I see myself being available are:

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The information contained in this application is correct to the best of my knowledge. I acknowledge that a printed copy of this electronic submission shall be valid as the original. I authorize Champion Ministries/Groundwire to conduct a background check to determine my ability to minister to teens and/or adults as a Spiritual Response Coach or Groundwire staff member. THE FAIR CREDIT REPORTING ACT, also know as Public Law 95-508, requires us to advise you that a routine inquiry may be made into your background which will provide applicable information concerning character, general reputation, personal characteristics and mode of living. Further information on the nature and scope of such report, if one is made, will be provided upon written request. Any offer of employment or volunteer work is contingent upon successfully passing a background check. I authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, Church, non-profit organization, reference, insurance company contacted by Champion Ministries dba Groundwire or its consumer reporting agency or its agent, to furnish the information described above. I release all such references from any liability for furnishing such evaluations to you, provided they do so in good faith and without malice. I understand that if any of the above records contain information which is used to deny my involvement as a Spiritual Response Coach and/or Groundwire staff member, that I will be notified of my rights and where I can obtain a copy of the information. Should my application be accepted, I agree to be bound by the rules and standards of Champion Ministries dba Groundwire, and to refrain from unscriptural conduct in the performances of my services on behalf of Champion Ministries dba Groundwire. If acting as a Spiritual Response Coach, I agree to abide by all policies and procedures as set forth in the Groundwire Spiritual Response Coach Manual and any other policies that shall be set forth by the Coaching Coordinator or any representative of Groundwire. I understand that violating any of these precepts is grounds for dismissal from the Spiritual Response Coach program. I understand I will be issued a login and password and I agree I will not allow any other person to utilize my login and password. I understand the Coach Coordinator may disable my login at any time. I do hereby consent to my e-mail and live chats being monitored and/or saved and I acknowledge I may not be made aware of such monitoring and/or saving. I understand that employment at Groundwire is "at will", and is no guarantee, contract, or promise of employment for any specific length of time.

I further state that I have carefully read the foregoing release and know the contents thereof. By typing my name in the signature box below I am agreeing to that being used as my signature of acceptance. (*)

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Applications are received and volunteers are approved without regard to race, creed, color, sex age, national origin, marital status, disability, veteran's status, and citizenship. The receipt of this application does not mean that volunteer positions exist or does not obligate us in any way. We appreciate your interest in Groundwire.





Once you've clicked submit, please verify that the application successfully processed. If the application reappears, please scroll down to find the field(s) marked with "invalid input" and correct the information. Once your application is processed, you should see a "Thanks for submitting your application" as well as receive a copy to your email.