Staff Application Contact InformationName* Dr.MissMr.Mrs.Ms.Prof.Rev. Mr/Mrs/Miss First Middle Inital Last Prefer to be Called Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Position DetailsPosition applying for* Start Date* Related & Other SkillsGeneral InformationDate of Birth* 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 MM slash DD slash YYYY Age Place of Birth Number of children accompanying you (please list names and ages below) Emergency ContactFull Name* Relationship* Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Home ChurchName Pastor's Name Address City State / Province / Region Email PhoneLength of Attendance Educational HistoryHigh/Secondary School (or equivalent) from which you graduated* Location Date of Graduation MM slash DD slash YYYY College/University/Vocational School/Seminary Attended Location From MM slash DD slash YYYY To MM slash DD slash YYYY YWAM BackgroundSchool/Staff Position Location From MM slash DD slash YYYY To MM slash DD slash YYYY Field Assignment Leader School/Staff Position Location From MM slash DD slash YYYY To MM slash DD slash YYYY Field Assignment Leader Financial SupportDo you have financial support?* Yes No If not, how do you plan to come up with the necessary finances? Do you have any outstanding debt? Please explain: 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 LiabilityI/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* MM slash DD slash YYYY Consent for TreatmentIn 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* MM slash DD slash YYYY Health HistoryPlease answer all questions. The omission of health history problems or incomplete explanation of the same can lead to the removal of acceptance status.Have you ever had, or do you now have, any of the following:*If you are allergic to bee sting, you must bring your own up-to-date reaction kit. Skin Trouble Eye Trouble Ear Trouble Head Injury Recurrent Headaches Epilepsy Fainting Spells Mental/Nervous Disorders Weakness Paralysis Insomnia Shortness of Breath Hay Fever Asthma Hepatitis Recurrent Diarrhea Kidney Disease Venereal Disease High Blood Pressure Low Blood Pressure Allergy: Bee Stings* Allergy: Penicillin Allergy: Sulfonamides Allergy: Serum Allergy: Food (specify) Tumor/Cancer Heart Trouble Rheumatism/Arthritis Back Problems Dislocation of Joints Broken Bones Stomach/Duodenal Ulcer Gall Bladder Problems Jaundice Intestinal Troubles Diabetes Anemia Have you ever had any of the following Communicable Diseases? Chicken Pox Measles (Rubella) Measles (Rubeola) Mumps Pertussis Scarlet Fever Tuberculosis Females Only Irregular periods Severe cramps Excessive flow Currently pregnant Previous pregnancies Comment on all positive answers in the space below:I have specific need for counselling in the following area(s): Do you wear contact lenses or glasses? Yes No If yes, specify: Surgeries Performed:Date (month/year)Type of SurgeryOutcome & Long-Term EffectsX-Rays Performed:Date (month/year)Type of SurgeryOutcome & Long-Term EffectsAre you at present under a doctor’s care for any condition?* Yes No If yes, please specify:Are you taking any medications at this time?* Yes No If yes, please specify:Have any of your relatives ever had any of the following? Tuberculosis Diabetes Kidney Disease Heart Disease Arthritis Asthma, Hay Fever Stomach Disease Epilepsy, Convulsions If yes, please specify relationship: