City Impact Staff Application

Step 1 of 6

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Name*
First Last
Gender
- Female
- Male
- Prefer not to say
Phone
Email*
Address
Street Address Address Line 2 City State ZIP Code
What position(s) are you interested in applying for?*
- CI Success Coordinator (FT)
- CI Success Director (FT)
- CI Mentoring Director (PT)
- Nursery Coordinator (PT)
Birthday
Date Format: MM slash DD slash YYYY
Employment Status
- Unemployed
- Employed
- Retired
- Student
Permanent Address
If you’re a student please give us a permanent address

Street Address Address Line 2 City State ZIP Code
Employer Name
Employer Address
Street Address Address Line 2 City State ZIP Code
Marital Status
- Married
- Other
Emergency Contact Name
First Last
Emergency Contact Relationship
Emergency Contact Phone
Emergency Contact Address
Street Address Address Line 2 City State ZIP Code

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How did you hear about City Impact?
Why do you wish to work/volunteer at City Impact?
Have you worked or volunteered with City Impact previously?
- Yes
- No
If yes, in what capacity did you work/volunteer for City Impact?
Highest Level of Education Completed?
Area/field of degrees received/courses taken:
Is it necessary for you to limit your physical activity?
- Yes
- No
If yes, please explain.
Are you licensed to practice a profession?
- Yes
- No
If yes, please explain.
Do you have any mental or emotional challenges that will keep you from performing daily tasks?
- Yes
- No
If yes, please explain.
Do you have a police record?
- Yes
- No
If yes, please explain.
Have you ever struggled with substance abuse? If so, what did you do to overcome this?
- Yes
- No
If yes, please explain.
Have you ever been accused, charged, or convicted of abuse (sexual abuse, child abuse, or other)?
- Yes
- No
If yes, please explain.
Describe any skills/experience/talents you bring to this position.
Do you speak any other languages? Please specify and provide level of fluency.
With what other types of ministry/volunteer opportunities/community groups have you been involved?
Area Age Group

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Do you have specific skills or experience in any of the following?
- Teaching
- Public Speaking
- Fundraising
- Phone Skills
- Developing Teams
- Administration
- Grant Writing
- Letter Writing
- Public Relations
- Leading & Managing Volunteers
- Data Entry
- Leading Retreats & Training Staff/Volunteers
- Multi-tasking
Describe your personality including your strongest and weakest traits.
Please give further details about the above or other skills.

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City Impact is a Christian, humanitarian organization seeking to meet physical and spiritual needs of under-resourced youth in Lincoln. Because of the unique nature of our ministry, it’s important that our staff feel comfortable within our Christian ministry. With this in mind, please answer the following.
Are you presently attending a church?
- Yes
- No
Church Name
Church Address
Street Address Address Line 2 City State ZIP Code
Church Phone
Pastor's Name
First Last
In what way are you involved in the church?
Please share with us about who Jesus Christ is to you:

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References
List those familiar with your capabilities (do not list relatives). If possible, we prefer to have a combination of friend, employer, teacher, and/or fellow worker. IMPORTANT: Three (3) references are required. Please provide an address or email address for each reference.
Reference One
Name*
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Email*
Years known
Organization
Position
Reference Two
Name*
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Email*
Years known
Organization
Position
Reference Three
Name
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Email
Years known
Organization

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City Impact Staff Agreement
I acknowledge that if accepted as a City Impact staff member, I agree to abide by the rules and regulations of City Impact..*
- Confirm
I have not been convicted within the past 10 years of any felony or misdemeanor classified as an offense against a person or family, of public indecency or a violation involving a state or federally controlled substance.*
- Confirm
I am not currently under indictment.*
- Confirm
I give permission for City Impact to perform a check of my background including Social Security Number verification, Nationwide Criminal Record search, Statewide Criminal Record search, Nebraska Adult Abuse Registry search and Nebraska Child Abuse Registry search. I understand that I do not have to agree to this background check, but the refusal to do so may exclude me from consideration for some types of work. I understand that information collected during this background check will be limited to that appropriate to determining my suitability for particular types of work and that all such information collected during the check will be kept confidential.*
- Confirm
I give permission for City Impact to contact my identified references. I understand that by contacting these individuals they will be asked to give their full and honest evaluation of my suitability of the described work and such other information as they deem appropriate.*
- Confirm
I understand that City Impact reserves the right to take my picture and use it for promotional purposes, unless check marked in the statement below.*
- Confirm
- I do NOT wish to have photographs I might be in, published for the promotion of City Impact
Statement Of Faith & Ministry Standards
City Impact is a Christian, humanitarian organization seeking to mentor, teach, and empower under-resourced youth in Lincoln. Because of the unique nature of our ministry, we ask staff to sign a statement of agreement with our Statement of Faith and Ministry Standards.
City Impact Statement of Faith
• There is one living and true God, infinitely perfect in glory, wisdom, holiness, justice, power and love, one in His essence but eternally existing in three persons: God the Father, God the Son and God the Holy Spirit.

• God autonomously created the world out of nothing, so that His creation, while wholly dependent upon Him, neither comprises part of God, nor conditions His essential perfection. (Genesis 1:2; Matthew 28: 19,20)

• The Bible is the inspired, inerrant and infallible Word of God as originally given. (2 Timothy 3:16).

• God created humans in His own image, in a state of original righteousness, from which they subsequently fell by a voluntary revolt, and consequently are guilty, inherently corrupt and subject to divine wrath.

• Jesus Christ, the eternal Son of God, became man without ceasing to be God by uniting to His divine nature a true human nature in His incarnation, and so continues to be both God and man, in two distinct nature and one person, forever. He was conceived by the Holy Spirit, born of the virgin Mary, exhibited His deity by manifold miracles, fulfilled the requirements of the Law by His sinless life, shed His blood as a vicarious and propitiatory atonement for man’s sin, was resurrected from the dead in the same body, now glorified. He ascended into heaven and now intercedes in glory for His redeemed as our great high priest and advocate, and as the Head of the Church. (Matthew 1:20,21; John 1:1-14; Romans 3:21-26; 5:6-11; 1 Peter 3:18; 1 John 2:1-2; Luke 24; Acts 1:9; Hebrews 8).

• The Holy Spirit convicts the world of sin, righteousness and judgment, through the ministry of regeneration and sanctification places believers into the Church, guides and comforts God’s children, indwells, directs, gifts and empowers the church in godly living and service in order to fulfill the great commission, and seals and keeps the believer until Christ returns. (John 16:1-33; 1 Corinthians 12:12; Ephesians 1:13-14).

• Humans are saved by grace through faith; and that not of themselves, but as a gift from God; not as a result of works. (Ephesians 2:7-8)
1. I have read City Impact’s Statement of Faith (please check appropriate box):
- I agree with and support City Impact’s Statement of Faith.
- I am not in full agreement with City Impact’s Statement of Faith, but (see bullet points below**):
Ministry Standards
• Seek to follow Christ in all areas of your life, i.e., words, choices, actions, and thoughts.

• Pursue the fruit of the Spirit – love, joy, peace, patience, goodness, kindness, gentleness, faithfulness, and self- control. (Galatians 5:22)

• Seek to reflect Jesus and share the hope that I have because of His grace and forgiveness. (I Peter 3:15)

• Live a lifestyle that is free of drug and alcohol abuse, and any other pervasive/habitual sin.

• Grow in your relationship with God through prayer, scripture, fellowship and involvement in a body of believers.

• Refrain from any activity that may cause any physical, sexual, or emotional harm to City Impact youth / families.

• Live as a law-abiding citizen.
2. I have read City Impact’s Ministry Standards (please check appropriate box):
- I agree to live in accordance with City Impact’s Ministry Standards.
- I cannot agree to live in accordance with City Impact’s Ministry Standards.
• Agree that the position held by City Impact is a valid doctrinal position and can be defended in Scripture.

• Agree not to promote my differing position in a formal teaching setting or by leading staff or City Impact children or families into any doctrine contrary to that adopted by City Impact.

• Agree to make an honest effort not to call attention to such differences wherever possible.
Note: An inability to agree with City Impact’s Statement of Faith and/or Ministry Standards will not necessarily eliminate a candidate from consideration as City Impact staff. A discussion between you and a City Impact Ministry Director might be arranged to identify specific areas of disagreement. Consideration might also be given to the position being applied for. A determination will then be made by City Impact to continue or discontinue the application process.
I understand that City Impact reserves the right to deny application to any person and to terminate a part-time staff from the program. This program does not accept responsibility for relationships when meeting outside of program.

I have read the above statements and agree to the contents. To the best of my knowledge and belief, all statements in this application are true and accurate.
Signature
Date
Date Format: MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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1035 North 33rd Street
Lincoln, NE 68503

402.477.8080

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References

Reference One

Reference Two

Reference Three

City Impact Staff Agreement

Statement Of Faith & Ministry Standards

City Impact Statement of Faith

Ministry Standards