Campus Personnel Application This form is used to assess the qualifications and academic standing of Host Pastors, their spouses, Campus Directors, and Faculty Members. If your not already a student please visit here and apply first THEN return to this pay and apply for appropriate role. I am applying for status as an LCU: * Host Pastor Host Pastor Spouse Campus Director Faculty Member Host Pastor Application Host Pastor's Spouse Application Campus Director Application Faculty Member Application IMPORTANT! ANSWER ALL QUESTIONS. Applications will not be processed nor academic standing be assessed unless all questions are answered and the application signed and dated by the applicant. Do not leave any question blank. Put “N/A” if an item does not apply. 1. Personal Information Title * MrMrsMsMissRevDr First Name * Initial Last Name * Generation SrJrIIIIIIV Birthdate * Gender * Male Female Marital Status * Single Married Race * Asian Black Caucasian Hispanic Native American Other I Prefer * English Spanish Citizenship * USAAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Maiden Name (if applicable) 2. Contact Information Mailing Address * City * Country * USAAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe State * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code * Province Postal Code Primary Email Address * Secondary Email Address Home Area Code + Phone Number * Work Area Code + Phone * Mobile Area Code + Phone Number Home Country Code + Phone Number * Work Country Code + Phone Number * Mobile Country Code + Phone Number Emergency Contact First & Last Name * Contact's Area Code + Phone Number * Contact's Country Code + Phone Number * Relationship with Contact * SpouseAdult ChildParentPastorAssociateAssistant/SecretaryOther 3. Church Background, Membership, and Ministry Experience Church/Denominational Background * Church Currently Attending * Pastor's Name (if yourself, please enter "Self" * Current Ministry Involvements, if any (check all that apply) * Senior Pastor Assistant Pastor Missionary Evangelist Itinerant Teacher Children's Minister Youth Minister Music Minister Lay Minister Church/Ministry Administrator Chaplain Other (please specify) Christian Broadcasting N/A Other * Past Ministry Involvements, if any (check all that apply) * Senior Pastor Assistant Pastor Missionary Evangelist Itinerant Teacher Children's Minister Youth Minister Music Minister Lay Minister Church/Ministry Administrator Chaplain Other (please specify) Christian Broadcasting N/A Other * Ministry Started * Ministerial Credentials? * None Ordained Licensed Credentialing Organization * 4. Educational Information (only needed for those who will teach at their campus) Have you ever previously attended Life Christian University or Life Christian Bible Institute? * No Yes LCU Student ID# For those who plan to teach for credit towards earned degrees, all prior education listed below must be supported by official transcripts. All instructors — including Host Pastors — must receive an Approved Faculty Letter before they may start teaching any LCU course. High School Name, City * Graduated? * Yes No With a: * Diploma G.E.D. On: * I have attended one or more colleges and/or Bible schools No Yes Colleges and/or Bible Schools Attended School Name * Started * Ended * Major * Graduated? * Yes No Diploma/Degree Earned * plus2 Add minus2 Remove 5. Please State Your Salvation Testimony * Your Testimony * 6. Please State Your Ministry Goals * Your Goals * FACULTY CODE OF CONDUCT & FACULTY PROGRAM AGREEMENT: NON-COMPETE AND NON-DISCLOSURE I, the undersigned, acknowledge and agree that the following applies to me as a member of the faculty in any approved Life Christian University extension campus under contract with Life Christian University,Inc., (hereinafter “LCU”). LCU Faculty Code of Conduct: A faculty member who represents LCU is expected to uphold standards of care, truthfulness, honesty, and biblical Christ-like standards of behavior towards the LCU students, faculty, staff, administration, and the general public. I agree to act in accordance with the above standards. I have read and am in agreement with LCU’s Statement of Faith. Failure to meet these standards will result in termination of any participation in LCU’s academic programs within any extension campus. Intellectual Property: • I am not entitled to any rights to any copyrights, trademarks, trade names, trade secrets, or otherintellectual property (hereinafter “Works”) of LCU entrusted to my use. Neither are any of myassistants, family members, friends, or other associates entitled to such rights.• The Works are copyrighted and subject to both United States and international copyright law.• I am legally obligated to protect the Works from any and all forms of infringement.• I am not allowed to duplicate, alter, disseminate, or otherwise use the Works outside of my local campus without the express written permission of LCU corporate headquarters in Tampa, Florida.• I understand I will be held liable for any financial or other damages caused to LCU by myunauthorized use and/or distribution of the Works, and LCU will use all available legal remedies to protect its interest in these intellectual properties.• My use of the Works is forbidden once the business relationship between my local campus and myself has been terminated. Once such termination occurs, all of the Works in my possession must be immediately returned to my campus director. If my campus’ officials are unavailable for any reason, I will either return the Works in my possession directly to LCU corporate headquarters or I will destroy these materials.• Faculty members may not disclose to third parties not related to this agreement LCU confidential business or ministry practices, materials, or records. Faculty Policies & Procedures: • I will adhere to all policies and procedures as stated in the LCU Student Handbook and the LCU Faculty Handbook.• I will ensure my students abide by all polices and procedures as stated within the LCU Student Handbook regarding class attendance, attire, course completion deadlines, and plagiarism. I agree to report any violations immediately to my campus director for corrective action.• Specifically regarding class preparation and teaching requirements:o I will read the required textbook(s).o I will listen to the course lectures from the Main Campus before teaching any course for thefirst time. I will contact my Campus Director for access to these lectures. Governing Law: the governing law for all legal proceedings shall be that of the State of Florida. Non-Discrimination Policy Life Christian University does not discriminate on the basis of nationality, ethnic origin, age, or gender. We guarantee the rights and privileges, and the availability of programs and activities to all students of the University. Privacy Rights of Individuals Associated with Life Christian University STATUTE 20, UNITED STATES CODE, §1232g and regulations adopted pursuant thereto, hereinafter referred to as the Code, requires that each student be notified of the rights accorded him or her by the Code. The following is provided as basic general information relative to the Code: The Code provides for an institution to establish a category of student information termed “directory information.” When available in college records, any information falling in the category of “directory information” will be available to all persons on request (i.e., the IRS, FBI, or other government agencies, and for use in LCU publications). LCU has identified the data listed at right as "directory information:" All other information, such as health and medical records, disciplinary records, records of personal counseling, required student and family financial income records, transcripts or student permanent academic records, student placement records and other personally identifiable information shall be open for inspection only to the student and such members of the professional staff of the college as have responsibility for working with the student. Such information will not be released to second parties without consent of the student. Except as required for use by the president in the discharge of his official responsibilities as prescribed by laws, regulations of the state board, and board policies, the designated custodian of such records may release information from these records to others only upon authorization in writing from the student or upon a subpoena by a court of competent jurisdiction. Directory Information Name Address Telephone listing Race Date of birth Major field of study Church membership Denominational affiliation Dates of attendance/participation Degrees & awards received Most recent previous educational institution attended PLEASE READ CAREFULLY THE FOLLOWING AFFIDAVIT OF AGREEMENT BEFORE SIGNING. Declaration #1 * I certify I have truthfully and accurately answered all questions contained in this application. Declaration #2 * I understand falsification of any kind is grounds for refusal of my application or cancellation of my business relationship with Life Christian University should falsehood be discovered after approval by the University. Declaration #3 * I understand I must provide LCU with proof of high school graduation and/or sealed official college transcripts for all education documented in this form. Declaration #4 * I understand I am not permitted to teach any LCU classes at my campus until I receive an official Faculty Approval Letter from the University. Declaration #5 * I acknowledge I have been notified of my rights as recorded by Statute 20, §1232g. Declaration #6 * I agree to abide by all the procedural guidelines of the university. Declaration #7 * I agree to abide by FACULTY CODE OF CONDUCT & FACULTY PROGRAM AGREEMENT: NON-COMPETE AND NON-DISCLOSURE Signature * signature keyboard Clear Date Captcha Submit If you are human, leave this field blank.
