Please list the names, addresses and daytime telephone numbers of two (2) persons (non-family members) who have known you for at least five (5) years either personally or professionally.

Please provide us with one of the following: (Required)

I understand that I will be working with or in the vicinity of minor children. I understand and hereby authorize any background checks to be performed from one or more private/public sources and/or agencies to determine my suitability for this role. I understand that all information disclosed by background checks will not be shared with me by Kingdom Builders' Family Life Center and shall be used solely for the purpose of volunteer screening and shall not be disclosed to other persons or institutions unless authorized by law.