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Working Visitor Online Application

Thank you for your interest in serving with HCJB World Radio. Please complete and submit the following form. If you have a question you may email that to .

Personal Data

Name (first, middle, last)

Present Address (Street, City, State/Province, Zip/Postal Code/Country)

Email Address

Telephone (home, work, cell)

Church presently attending

Gender
Male Female

Date of Birth

Reference Information

Reference #1

Name

Address

Telephone

Email

Reference #2

Name

Address (Street, City, State/Province, Zip/Postal Code/Country)

Telephone

Email

Reference #3

Name

Address (Street, City, State/Province, Zip/Postal Code/Country)

Telephone

Email

Health Status

Rate your present health
Vigorous Good Average Poor

List physical limitations/specific health problems which might impair your ability to serve at a High Altitude if considering Quito

Are you presently under the care of a physician?Yes No
(if so give reason)

Church Background

Denomination Affiliation

Email

Telephone

Pastor's Name

Please share a personal statement of your relationship with Jesus Christ

Education

Give the last formal educational experience you have had (Name of Institution, Location, Major, Year Graduated or Left, Degree/Certificate)

Ministry Goals and Experience

Please give brief explanation of why you are applying with HCJB

What training/experience/skills do you offer and in what context would you desire to serve?

Specific dates you wish to serve:

*Specify proficiency as to reading, writing, and/or speaking each one:

* If applying for the medical field in Ecuador it is imperative that you are adequately fluent to function independently in Spanish!
What expectations do you have for your field experience?:

Financial Obligations
A working visitor is self-supporting and responsible for the cost of room, board, travel and other related expenses.

Making application in no way implies acceptance to the program. Please wait until you have received an official invitation from the Working Visitor Coordinator before making travel arrangements. An orientation folder will be sent with the acceptance notification covering most of the needed information regarding living in the country of service.

Sumit Form

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