Staff Application

Contact Information
Name*
Mr/Mrs/Miss First Middle Inital Last Prefer to be Called
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Position Details
Position applying for*
Start Date*
Related & Other Skills
General Information
Date of Birth*
Date Format: MM slash DD slash YYYY
Age*
Place of Birth*
Country of Citizenship*
Do you have a passport?*
- Yes
- No
If yes, expiration
Driver's License #
State
Marital Status*
- Single
- Married
- Seperated
- Divorced
- Engaged
Spouse's Name
Country of Citizenship
Date of Birth
Date Format: MM slash DD slash YYYY
Age
Place of Birth
Number of children accompanying you (please list names and ages below)
Emergency Contact
Full Name*
Relationship*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Home Church
Name
Pastor's Name
Address
City State / Province / Region
Email
Phone
Length of Attendance

How did you hear about the Honolulu base?*
What reasons most influenced your decision to apply for a staff position in Honolulu?*
What would you like to gain out of your time on staff?*
What would you like to give into the base while you are here?*
What do you see are your character weaknesses and strengths?*
What are your spiritual gifts?*
What are your long-term goals?*
How can we help you in fulfilling these goals?*
Do you have a calling to the Pacific and Asia region?*
Have you been in a leadership position in the past? Please explain:*
Have you been “sent out” by your local church?*
What was your life like before Christ?*
How and when did you decide to come to Jesus?*
Have you overcome issues of the past (sexual immorality, poor body image, drug addiction, abuse, rape, etc...)? Are you now walking in freedom, forgiveness and holiness or at least walking toward it?

Release of Liability
I/we do hereby release Youth With A Mission, Inc., it’s staff, agents and volunteer assistants from any liability whatsoever arising out of any injury, damage or loss, which may be sustained by said person(s) during the course of renting with Youth With A Mission Honolulu.
Applicant’s Name*
Applicant’s Initials*
Date*
Date Format: MM slash DD slash YYYY
Consent for Treatment
In case of emergency, I/we hereby agree to the performance of such treatment, including anesthesia and surgery, that the attending doctor or physician may deem necessary.
Applicant’s Name*
Applicant’s Initials*
Date*
Date Format: MM slash DD slash YYYY

Contact Information