RINCE | Long Term Applicants
This form is confidential for all long-term team member applicants. Your honest and complete answers are appreciated.
Please attach a copy of your CV/Resume *
Required
Full Name (include maiden name if applicable):
For if you are going alone without a family.
Spouse's Full Name (If Applicable)
Children's Full Names
Birthday:
DD/MM/YYYY (Distinguish each person's date of birth)
Personal Mailing Address:
Personal Email Address:
Only if applicant is 18 and over.
Telephone Number:
A phone number that is the easiest and quickest to reach you. Inform us if it's best to call or text you. 18 and over.
Work Name:
School Name:
Degree Seeking/Obtained:
Do you live with your parent/parents?
Only for applicants who are traveling alone.
How does your parent/parents feel about you going off to the mission field for a lengthy period of time?
Single travelers only.
Skype name:
18 and over only.
Formal Biblical or Missionary Training? Explain.
Home Church Name and Address:
Church's Phone Number:
Church's Email Address:
Name of Senior Pastor:
Email and phone number of Pastor or Contact Person:
Will your church be in agreement with you leaving?
Is your pastor in agreement with you leaving?
Will your church sponsor you?
List of specific gifts or special abilities for service:
Do you speak in tongues? Please share your thoughts about speaking in tongues.
Describe your strengths and weaknesses.
Share what you are passionate about.
What is your vision? Explain.
How long will you stay?
MEDICIAL HISTORY
Self
Husband
Wife
Son 1
Son 2
Daughter 1
Daughter 2
Sickle Cell Disease/Traits
Stroke
Diabetes
Cancer
Kidney Problems
Coronary Artery Disease
Tuberculosis
Allergies
Epileptic Seizures
Suicide Attempts
Depression
Mental Illness
High Blood Pressure
Diphtheria
Rheumatic Fever
Swollen or painful joints
Mumps
Whooping Cough
Frequent or severe headaches
Dizziness
Chronic or sever colds
Toothache or gum trouble
Sinusitis
Allergies(food, seasons)
Thyroid Disease
Tuberculosis/Exposed to TB
Night Sweats
Pain/Pressure in chest
Pounding heart/Heart disease
Stomach trouble
Liver Trouble
Gall bladder trouble/Stones
Jaundice
Tumor/Cyst
Hernia
Hemorrhoids or rectal disease
Kidney Stones
Sugar or Albumin in Urine
Arthritis or Rheumatism
Bone/joint/deformity pain
Trouble sleeping
Foot trouble/corn/bunions/flat foot
Chronic back pain
Paralysis
Frequent or severe diarrhea
Frequent or severe vomiting
Abnormal bleeding
Loss of memory/Amnesia
Nervous trouble of any sort
History of chemical dependency/drugs
Recent rapid gain or loss of weight
Venereal Disease
Debilitating shortness of breathe
Worn/wear glasses
Worn/wear hearing aid
Stuttered/stutters or stammered
Worn/wear brace or back support
Worn/wear contacts
Blood Type
Distinguish everyone's individual blood type.
Any other medicial conditions we should be aware of? Explain
Confidential Information:
This section is for each person in the family and individuals who might be going to Congo. This section is to help us help each other when and if the past comes up and tries to affect us on the field.
MM
/
DD
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YYYY
Confidential Information
Self
Husband
Wife
Son 1
Son 2
Daughter 1
Daughter 2
Have you ever used tobacco products?
Have you ever used alcoholic beverages?
Have you ever used narcotics or illegal drugs?
Have you ever used other drugs(apart from temporary medications)?
Have you ever had sexual activities outside of marriage?
Have you ever been involved in homosexual activities?
Have you ever had any eating disorder?
Have you ever been actively involved in viewing pornography?
Have you ever been molested or abused?
Have you ever been convicted of a crime or had a restraining order placed on you?
Are you dealing with any pending legal issues at this time?
Have you ever been involved in child molestation activity?
Are there any circumstances involving your lifestyle or history that could call into question your ability to work safely with children or youth?
Have you ever been expelled from or had your employment terminated by any organization or employer for assault or violence against any child or other persons?
Have you ever been investigated by any organization for suspected child abuse?