2019 AMOS Volunteer/Intern Application Form
Thank you for your interest in serving with AMOS Health & Hope! This application form is the initial step of the application process to becoming a volunteer or intern with us. Please fill out the whole form to the best of your knowledge. The information will be submitted to the AMOS Communications Team and you will be contacted upon review. Thank you for taking the time to apply with AMOS!
General Information
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Date of Birth - DD/MM/YYYY *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Preferred Email Address *
Your answer
Sex *
Marital Status
Your answer
Dependent Children
Your answer
Citizen of the United States *
If NO, which country?
Your answer
Valid Passport *
Passport Number
Your answer
Have you ever been convicted of a criminal offense? *
If yes, please explain.
Your answer
Position applying for? *
How did you hear about this position? *
Your answer
When are you available to start? *
Your answer
How long are you available to volunteer? *
Typically a minimum of 6 weeks is required. For the Global Health Practicum this is a set 3 weeks. For the Internship program this is 8 weeks (total).
Your answer
Are there any dates within the term when you will not be available? *
If so, please state and explain.
Your answer
Educational and Relevant Experience
High School
Name, Location, # of years, Degree
Your answer
College
Name, Location, # of years, Major, Degree
Your answer
Post-College
Name, Location, # of years, Major, Degree
Your answer
Other Training
Name, Location, # of years, Major, Degree
Your answer
Level of Spanish Fluency *
Typcial volunteers or interns are all required to be fluent.
*
Please explain your Spanish fluency (i.e. 3 semesters of Spanish courses in university)
Your answer
Have you had other experiences abroad? *
When, where, and with which organizations?
Your answer
Other Applicable Skills, Qualifications, or Experiences:
Your answer
Emergency Contact Form
Emergency Contact Name *
Your answer
Relationship *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Work Phone Number *
Your answer
Email Address *
Your answer
Medical Information
General Health for the past 2 years *
If necessary, please explain.
Your answer
Allergies *
Required
If necessary, please explain.
Your answer
Special Dietary Needs *
If necessary, please explain.
Your answer
Current Prescriptions/ Medications/ Special Health Information: *
Your answer
Participant's Physician *
Your answer
Last Physical Examination *
Your answer
Blood Type *
Your answer
Do You Have International Health Insurance? *
If yes, policy number
Your answer
If yes, person of contact
Your answer
If yes, phone number
Your answer
Do you agree to the statement below? *
If a medical emergency should arise regarding me, I hereby give permission to a qualified medical physician and/or hospital to provide the appropriate care and to administer any emergency medical treatment, which may be required for me. I also hereby give such medical personnel and/or hospital my permission to any necessary examination, anesthesia, medical diagnosis, or treatment and/or hospital care to me. I understand AMOS Health and Hope and any representatives or missionaries cannot assume responsibility for medical expenses for me and I agree to bear such responsibility and pay any such expenses incurred with respect to such medical emergency.
Personal Information
Share your reasons for coming to work with AMOS
Your answer
How do you feel you would be able to use your education, skills, or expertise to benefit the mission of AMOS?
Your answer
Share any previous experience that you have In the area of community service, health care, or community development.
Your answer
Give a brief definition/description of what you think it means to serve.
Your answer
Please state what expectations you have during your volunteer service/ internship at AMOS.
Your answer
I authorize that I am, indeed, the person applying for this position and that the submitted information is true: *
Initials *
Your answer
Date *
Your answer
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