Please provide the following contact information:

Name
Profession/Occupation
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
Social Security #
Drivers License #

Please list the supervisor and phone number of youth agencies/churches

where you have worked with young people:

Have you ever been charge or convicted of a criminal offense?

YES
NO

If yes, please explain (note:  As a part of the this application and in

order to insure a safe environment for our youth, we reserve the right

to conduct a police criminal check for each and every application)

 

Please list 3 personal references in the section below:

Name
Work Phone

Name
Work Phone

Name
Work Phone

Select any of the following options that apply:

hospitality (information booths/airport,hotels,convention centers,etc)
Nurse/Medical staff (professional only)
Construction Projects (home repair,painting,landscape,etc)
Care Projects (nursing homes, food services,personal care packages, etc)
Community Programs (day camps in area parks,gyms,community centers)
Compassion/Evangelism Projects (homeless shelters, soup kitchens, missions,etc)
Cultural Ministries (community centers,outreach events,multiple ethnic groups)
Office/secretarial assistance (assisting staff in various offices)
Prayer support
On-site ministries (sign language,handicapped,workshops,etc)
Logistics (assisting with traffic at convention centers, general transportation, buses)

List experience (if any) that you have had in these areas: