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Download this Form in MS Word format
Please complete the following form in its entirety (if not applicable, please type N/A)
If there is interest in your application, you will receive communication regarding next steps.
Please do NOT make any travel arrangements before receiving written formal acceptance.
Completing this application in no way implies acceptance to the program.
By completing this application, you acknowlege responsibility for the cost of housing, food, travel and other related expenses either by raising support from donors, or from funding yourself, if accepted to serve. If your application is accepted, you must have medical insurance coverage, for the location you will be at, and valid for the entire length of time you will be serving.
Thank you for your interest in serving as the voice and hands of Jesus with HCJB Global.
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PERSONAL DATA
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| Name: |
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| Address: |
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| Zip/Postal Code: |
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| Country: |
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| Phone: |
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| Secondary Phone: |
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| Email: |
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| Are you at least 18 years of age or older? |
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| How did you hear about HCJB Global? |
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REFERENCE INFORMATION |
REFERENCE #1 - PASTOR or CHURCH LEADER (who knows you well)
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REFERENCE #2 - SUPERVISOR
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REFERENCE #3 - FRIEND and/or MENTOR
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| Name: |
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| Email: |
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HEALTH STATUS
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Rate your present health:
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List physical limitations/specific health problems which might impair your ability to serve at a high altitude or in extreme weather conditions:
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| Have you ever received a physical, emotional or behavioral health diagnosis? |
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| If yes, please explain: |
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| Have you ever been hospitalized for a physical, emotional or behavioral health diagnosis? |
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| If yes, please explain: |
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| Are you presently under the care of a physician? |
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| If yes, please explain: |
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| Are you presently taking prescription medication? |
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| if yes, please list medication and reason for prescription: |
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CHRISTIAN BACKGROUND
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| Church presently attending: |
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| Denomination/Affiliation: |
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| Church Website: |
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| Pastor: |
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| Email: |
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| Phone: |
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| Please share a personal statement of your relationship with Jesus Christ: |
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| Please list any formal Bible classes in which you have participated: |
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EDUCATION
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Give the last formal educational experience you have had (Name of Institution, Location, Major, Year Graduated or Left, Degree/Certificate):
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| If you are currently studying, please indicate which institution, area of study and anticipated graduation date: |
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MINISTRY GOALS AND EXPERIENCE
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| Please give a brief explanation of why you are applying with HCJB Global: |
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| What training/experience/skills do you offer and in what context would you desire to serve? |
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| Have you been outside of the country previously? |
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| (If yes, where and for how long?) |
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| With what languages are you familiar? (Please specify proficiency as to reading, writing, and/or speaking each one. Specific roles have specific language requirements.) |
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If planning to serve for 3+ months, are you willing to undertake a period of language study if not already proficient in the language of your desired destination country? |
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| What expectations do you have for your field experience? |
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| Specific dates you are available to serve: |
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Where is your desired field of service? (check one)
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PERSONALITY AND CULTURAL ADJUSTMENTS
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| How do you handle unfamiliar or ambiguous situations? |
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| Are you a picky eater? |
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| How do you react to people with different values/backgrounds than yourself? |
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Do you work best independently or in a group? (Please explain)
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| In what type of atmosphere do you work best? (Examples of different atmosphere types include, but are not limited to: busy, serene, varied, constant, etc.): |
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| What do you feel are your greatest strengths? |
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| What could you improve on? |
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| What other cultures have you experienced within your own country? |
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| What did you enjoy about those cultures? |
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| What did you find hard or difficult about those cultures? |
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| What other cultures have you experienced outside your own country? |
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| What did you enjoy about those cultures? |
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| What did you find hard or difficult about those cultures? |
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Which of the following is most important to you?
Please rank the top five (with one being the most important and five the least important) with a brief explanation of why:
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| Being organized |
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| Being a self-starter |
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| Being highly motivated |
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| The ability to work well under pressure |
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| Having a spirit of service |
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| Having a pleasant demeanor |
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| Excellent communication skills |
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| Being a team player |
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| Please explain why you ranked the above items the way you did. |
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EMERGENCY CONTACT INFORMATION |
Emergency Contact 1 |
| Name: |
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| City: |
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| Zip/Postal Code: |
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| Relationship |
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Emergency Contact 2 |
| Name: |
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| Relationship: |
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