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Are you a born again believer in Jesus Christ as your Lord and Savior?
Please list which Sundays you are available to serve monthly. (Minimum of two)


I hereby give my permission for the Salem Baptist Church of Chicago to obtain information pertaining to any charges and/or convictions I may have had for federal and state criminal law violations. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication.

I understand that this information will be used, in part, to determine my eligibility for an employment/volunteer position with this organization.

I also understand that as long as I remain an employee or volunteer here, the criminal history records check may be repeated at any time I understand that I will have an opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received.

I, the undersigned, do, for myself, my heirs, executors and administrators, hereby remiss, release and forever discharge and agree to indemnify the Salem Baptist Church of Chicago and each of their officers, directors, employees and agents agents to be found harmless from and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever, and any and all related attorneys’ fee, court costs, and other expenses resulting from the investigation of my background in connection with my application to become an employee or volunteer with the SALEM BAPTIST CHURCH.

Select an option

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