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ywamburtigny.com
Isaiah 58:10
"Pour yourself out for the hungry
and start giving of yourself
to the down and out"
Esaïe 58.10
"Engage-toi en faveur des
affamés et dévoue-toi
pour les opprimés"
Staff Application B
Staff Application Form B
Type the answers with a text editor first and then copy and paste, because you might lose everything you typed if you have an internet connection failure while submiting the online application form.
Your Name
Email
Home Church
Denomination
Pastor's Name
Length of Attendance
Church's Permanent Mailing Address
Church's Phone Number
Church's Fax Number
Is your church/Pastor in favour of you applying to be staff in YWAM BUrtigny?
Yes
No
In Case your church of Pastor are not in favour of you joining YWAM, would you like to comment on that?
Education Background
Have you aquired any degree or major?
List any significant job/occupational experience you have had?
Other skills, talents or special interests
Type of driving license:
List of languages that you speak
Are you a U of N degree student?
Yes
No
List any previous YWAM/U of N experience or schools:
Health information
Medical Insurance Company
Policy Number
Would you consider yourself to be in good health?
Have you ever had, or do you have, any of the following? (Please tick to indicate a YES and, if so, supply more details below. If your answer is NO leave the area blank)
Back problems
Eye trouble
Ear trouble
Migraines
Insomnia
Hay Fever
Mental/Nervous Disorders
Rheumatism Arthritis
Cancer
Shortness of breath
Allergies
High Blood Pressure
Heart Trouble
Asthma
Low Blood Pressure
Stomach Ulcer
Diabetes
Hepatitis
Epilepsy
HIV/Aids
Depression
Chronic Fatigue
Auto immune condition
Any other illnesses or conditions we should know of?
Are you at present under a doctor’s care? Yes / No (specify)#Yes
Are you taking any medication at present? Yes / No (specify)
Are you allergic to any drugs? Yes / No (specify)
Do you have any impairment, handicaps, or health conditions which require special attention, housing or dietary needs? Yes / No (specify)
Are you underweight or overweight? Yes/No. If so, by how much?
Consent for Treatment: In case of emergency, I/we hereby agree to the performance of such treatment, including anesthesia and surgery, as the attending doctor or physician may deem necessary.
No, I do not agree
Yes, I agree
In case of an emergency please contact:
Financial Questions
Financial Information - I have pledged support amounting to...
I have this much towards relocation expenses...
How do you plan to raise additional funds?
Do you currently have any outstanding debts or financial obligations? Yes / No. If yes, please explain.
Acknowledgement of Responsibility
No, I do not agree
Yes, I agree
Release of Liability
No, I do not agree
Yes, I agree
Do you commit to paying off all expenses incurred during involvement with Jem Burtigny?
I certify that all information on this application form is accurate to the best of my knowledge and judgment
Yes
No
Yes, please send me an email copy of this form
Please Provide Security Code
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