Missions Department- Staff Outreach

Applicant Information

Staff Outreach*

Email*

Phone*

Birth Date*

Marital Status*

Passport Number*

Passport Expiration Date*

Country of Citizenship*

Supervisor's Information

Phone*

Supervisor's Email*

Department*

Emergency Contact

Relationship to you*

Emergency Contact's Email*

Phone*

Personal History

Salvation Date*

Describe why you made a decision to follow Christ*

Describe your current relationship with God*

Describe your church involvement*

If you answered Yes to any of the above, please provide a detailed explanation including dates.*

Medical History

NOTE: If anything in your present or past medical history is of concern for the Outreach Leader you may be asked to obtain a Medical Release Form from your physician.

Describe your current medical condition. Include a description of all conditions which may limit your physical and/or mental abilities. For example: asthma, recurring injuries to knees or back, hypoglycemia, allergies to meds/foods/bites, depression, etc.*

Please list all current medication you are taking (include all prescription and non-prescription medications/vitamins).*

References 1

Please choose pastors, friends, co-workers, roommates, etc. who are not family members and who know you well enough to answer personal questions about your life (ie: your gifts in ministry, ability to work in a team, areas of struggle).

Email*

Phone*

References 2

Please choose pastors, friends, co-workers, roommates, etc. who are not family members and who know you well enough to answer personal questions about your life (ie: your gifts in ministry, ability to work in a team, areas of struggle).

Email*

Phone*

Signature