Legal Name:
*
First Name
Last Name
Email:
*
Phone:
*
(###)
###
####
Date of Birth:
*
MM
DD
YYYY
Marital Status:
*
Spouse's Name:
First Name
Last Name
If married, will you and your spouse be looking to intern together?:
Yes
No
Legal Name:
*
First Name
Last Name
Relationship:
*
Spouse's Phone:
*
(###)
###
####
Start Date:
*
MM
DD
YYYY
End Date:
*
MM
DD
YYYY
Home Church:
*
Senior Pastor:
*
First Name
Last Name
1. How long have you attended your home church?:
*
2. In what areas have you served in at your home church?:
*
1. Why do you want to volunteer with Red Roots?:
*
2. What do you feel are your gifts /talents /areas of expertise?:
3. What are your expectations during your time with us?:
*
4. We want you to leave a sustainable difference in Bolivia. What and how do you feel you can contribute to this?:
*
1. Do you have any physical handicaps, disabilities, or diseases that might affect your ability to fully function in remote areas or harsh conditions?:
*
Yes
No
If yes, please explain:
2. Do you have any chronic illnesses or allergies?:
*
Yes
No
If yes, please explain:
3. Have you ever been diagnosed or treated for any mental or psychological illnesses or disorders?:
*
Yes
No
If yes, please explain:
4. Do you have any other medical conditions that we should be aware of?:
*
Yes
No
If yes, please explain:
1. Have you ever been involved with:
*
If yes, please explain:
2. Have you ever struggled with:
*
If yes, please explain:
3. Have you ever intentionally inflicted harm upon yourself?:
*
Yes
No
Only thoughts of doing so
If yes, please explain:
4. Have you ever been arrested, been charged with or convicted of a crime?:
*
Yes
No
If yes, please explain:
5. Have you participated in any activity that may affect or bring into question your fitness for working with or supervising children?:
*
Yes
No
If yes, please explain:
6. Have you ever had professional counseling?
*
If yes, please explain:
1. Reference Name:
*
First Name
Last Name
Email:
*
What role has this person played in your life?:
*
2. Reference Name:
*
First Name
Last Name
Email:
*
What role has this person played in your life?:
*
Select the box that applies:
*
Thank you
Please inform your pastoral and personal references that we will be in touch via email.
After receiving those references, we will contact you.
Talk soon!
God Bless,
Melinda Gore
P.S.
If you have any further questions, feel free to contact me or Romon at info@redroots.org.
