Application to serve overseas for a short-term or a long-term period of time
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Name *
Date of Birth *
Complete Address: (City, State, Zip Code, Country) *
Phone (including international code if outside the USA) *
email *
Country(s)/region(s) where you are interested in serving: *
Length of time you are able to commit *
Occupation or Title *
Specialty if applicable
Current Employer *
Professional License (if applicable)
List below all the schools attended and degrees earned (Please include years) *
Special professional training, skills and/or hobbies
Volunteer work / community affiliation
Languages spoken
Name of church you attend *
Are you a member? If yes, since when? *
Past mission trips and length of trips
Type in below a brief testimony of your spiritual walk *
Describe your desire to serve overseas *
Have you ever been convicted or plead guilty or no contest to any criminal offense? If yes, please explain *
Any known physical or mental health issues that would prevent you from being able to fulfill your commitment in a sometimes physically demanding, high stress environment? If yes, please explain *
Please provide the name, titles, email and phone number of two references: one professional and one church leader *
By typing my name below, I acknowledge that the information contained in this application is correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would unfavorably affect my application. I authorize Health Outreach to the Middle East (HOME) to verify information listed herein such as employment, church affiliation and references. I hereby release HOME and its agents from any and all liability arising there from. *
Thank you for your interest! Someone will contact you within a few days.
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