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Citipointe Internship Academy Application Form
Please read each question carefully, answer truthfully and be yourself.
Please choose which intake are you applying to do the Citipointe Internship Academy?
Beginning 2019 Intake - Start Date: 22nd January 2019
Mid 2019 Intake - Start Date 12th May 2019
What are your Given Name(s)?
What is your Surname?
What is your address?
What is your mobile number?
Include Country Code - ie. Australia is +61
What is your date of birth?
What is your email address?
What is your Gender?
Do you have any medical condition(s) that you would need to make Citipointe Church aware of?
Eg. Diabetes, heart condition, mental health etc.
Please indicate the country you are a citizen of:
United States of America
Do you have a current "Working with Children Check" (Blue Card)?
For more information please visit
If you answered Yes to having a "Working with Children Check" (Blue Card), Please provide your card details.
Card number and expiry date
If you answered No to having a "Working with Children Check" (Blue Card), Please tick the option that best describes your situation?
I have never applied for a blue card
I used to have one but it expired
I have recently applied but have not received confirmation yet if I have been approved
I have previously applied but been declined
Do you have a Drivers License?
This question is pertaining to having your provisional License ("P's") or above. If you have your Learners please select "No"
If you answered Yes to having a drivers license, Please provide the details of what type of license you have?
Opens, P's, Heavy or Medium Ridged etc. Please do not disclose your license number.
Do you have a criminal conviction?
If yes, please provide some details by emailing
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