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Basic Information!
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Name___________________________________________________________!
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First ! !
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Last!
Street Address ____________________________________________________!
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City!
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State! !
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Zip!
Phones __________________________________________________________!
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Home!
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Cell!
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Work!
(It’s okay to call me at work □. Best way to reach me is _____________________)!
Current Employer _________________________________________________!
Employer Address _________________________________________________!
Position at work __________________________Years at current job _________!
E-mail ___________________Driver’s license (state and number) ___________!
Church membership:
□ Member
□ Regular attendee Where?
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How long have you regularly attended this church? _______________________!
Emergency Contact _______________________ Emergency Phone _________!
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Education!
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Name and relationship!
High School ________________________City ______ State ___ Grad Yr.____!
College/Trade School ________________ City _______State ___ Grad Yr.____!
Degree and Major ___________________________ Minor _________________!
Other education, training or licenses ___________________________________!
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Ministry Experience (list most recent first)!
Church (name, city, state, zip) Dates!
Area of Service _
Contact ___
Phone!
l. _______________________________________________________________!
2. ______________________________________________________________!
3. ______________________________________________________________!
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Tell us about yourself- please attach another piece of paper if you need more room for your answers!
1. When and how did you become a Christian?!
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2. What have you been doing to grow spiritually in the past year?!
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3. What would you do to maintain your spiritual growth as an intern?!
4. What are your expectations of an intern?!
5. Explain your background in student ministry.!
6. What special qualities or qualifications would you contribute as an intern?!
7. What is your belief concerning the following issues:!
a. The authority of the Bible.!
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b. Use of tobacco, drugs, alcoholic beverages!
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c. Premarital/extramarital sex!
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d. Homosexuality!
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References!
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Please provide three character references (other than family members) that can identify your strengths and weaknesses and describe your background.!
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l. _______________________________________________________________!
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Name! !
Address!
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Home/Work Phone!
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Relationship!
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2. ______________________________________________________________!
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Name! !
Address!
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Home/Work Phone!
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Relationship!
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3. ______________________________________________________________!
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Name! !
Address!
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Home/Work Phone!
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Relationship!
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Self-description!
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Please circle the words that best describe you. Cross out words that least describes you.!
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Trustworthy dependable active compassionate reliable self-starter punctual flexible laid-back quick thinker spontaneous decisive teachable team player humorous thoughtful solitary leader cautious risk taker patient reflective honest organized creative disciplined faithful! !!
Please list any personal weaknesses, areas where you need to grow, or special concerns that could affect your ministry with students.!
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2. ______________________________________________________________!
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3. ______________________________________________________________!
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Background Information!
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Have you, at any time, been involved in or accused, rightly or wrongly, of sexual abuse, maltreatment, or neglect?! !
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□yes
□no!
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Have you ever been accused or convicted of possession/sales of controlled substances or of driving under the influence of alcohol or drugs? □yes
□no!
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Are you using