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619.226.ROCK
What’s Required:
• Have a living space that can accommodate 10-15 students and 2-3 adults
• 10 month commitment, one night a week (September through June) (Holidays off)
• Commit your space from 6:30-8:30 PM on that night
• Completed and accepted Host Home application
• Cleared CIA background check for every adult living in the home
4. What times will you need our house, rec room, patio area, etc?
Our leaders will show up around 6:30 PM for a leader meeting. All students will be gone by 8:30
PM unless they belong to you. Leaders will be sure that all litter and is picked up and your home is
back in order.
The information contained in this application is correct to the best of my knowledge. I, the undersigned, give my authorization to the
Rock Church or its representatives to release any and all records or information relating to working with minors. The Rock Church
may contact my references and appropriate government agencies as deemed necessary in order to verify my suitability as a youth
worker.
I understand that the personal information in this application will be held confidential by the professional church staff.
Signature: Date:
2277 Rosecrans St, San Diego, CA 92106
619.226.ROCK
q I acknowledge the Lordship of Jesus Christ in my life and I have a personal relationship with Him.
q I am committed toward growing and maturing in my relationship with God through quiet times, active attendance at
church, and involvement in accountability with another believer of the same sex.
q I am committed to making choices and living a lifestyle that are both Godly and "above reproach", knowing that my
lifestyle is a model for the students.
q I agree sex is reserved for one man and one woman in a marriage covenant. I will abide by the Rock Church’s PMS Policy.
q If I have any alcohol in the house it will be moved to a discreet location during my commitment period
Signature: Date:
..
.. 4801 Arapaho Rd, Suite 300
.. Addison, TX 75001
.. Office: 214-382-2727
.. Fax: 214-382-2732
.. www.ciabackgroundchecks.com
..
..
. CLEAR INVESTIGATIVE ADVANTAGE LLC-- RELEASE FORM
The purpose of this form is to notify you that an investigation report will be conducted on
you in the course of consideration for this request:
Company Address: 2448 Historic Decatur Rd. #105, San Diego, CA 92071
Present Address:
Please list your last seven years of residence (Include city and state).
In connection with this request, I hereby authorize all corporations, employers, education
institutions, law enforcement agencies, city, state, county, and federal courts, military
services and persons to release information they may have about me to the person or
company with which this form has been filed or their agent, Clear Investigative Advantage,
LLC. This releases the aforesaid parties from any liability and responsibility for collecting
any information.
www.ciabackgroundchecks.com