Staff Application

Church Information
Name of Home Church and Denomination:
Church E-mail
example@example.com
Church Phone Number

Country CodeArea CodePhone Number
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pastor/Spiritual Leader's Name:
Does your pastor/spiritual leader know you are applying for YWAM Lebanon, PA staff? (It is our policy to contact your pastor personally and introduce our ministry to him/her. We will invite his/her counsel and input regarding your application.)
How long have you been a part of this fellowship?
Describe your current relationship with your present church?
Ministry experience:

Health/Personal History
Please list any physical impairments, disabilities or health conditions, including allergies, which require special attention? (Please note YWAM may not be able to accommodate special dietary requirements):
Are you under a doctor's care and/or taking any type of medication?
Please give details and names of medications:
Are your immunizations, including tetanus, up to date?
Do you or have you had problems with addictions (smoking, alcohol, drugs, self-harm, food, pornography, etc.)?
Do you have medical insurance or coverage?
If no, how do you plan to deal with any health needs?
Are there any unusual circumstances we should know in relationship to your involvement on staff? Please explain:
Describe your present relationship with your parents, family and their feelings about your decision for missions.
Is there a domestic situation that might make it necessary for you to return home? (Explain)

Emergency Information and Consent for Treatment
In case of emergency, please contact:

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency contact relationship to you
e.g. parent, spouse, etc.
In case of emergency, I/we hereby agree to the performance of such treatment, including anesthesia and surgery, as the attending doctor or physician may deem necessary.
(print full name or signature)
Date (dd/mm/yyyy)
Name of Medical Insurance Carrier, Policy Number and Expiry Date

Reference Letters and Certification
For your application to be completed and processed, you must have THREE REFERENCES: (1) your pastor/spiritual leader, (2) your current or former employer, and (3) your DTS Leader.

For international applicants, please note the reference requests will be in English.
Reference #1
Pastor/Spiritual Leader

First NameLast Name
Pastor E-mail
example@example.com
Phone Number

Area CodePhone Number
Reference #2
Past or Current Employer

First NameLast Name
Employer E-mail
example@example.com
Phone Number

Area CodePhone Number
Reference #3
DTS Leader

First NameLast Name
DTS Leader E-mail
example@example.com
Phone Number

Area CodePhone Number
YWAM Lebanon is an operating location of University of the Nations, a degree granting instituation (Associate, Bachelor and Master). University of the Nations is Not accredited by an accrediting agency recognized by the United States Secretary of Education. University of the Nations (UofN) admits students of any race, color, national and ethnic origin to all the rights, privileges, program and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies and school administered programs.

YWAM Lebanon, PO Box 480, Lebanon, PA 17042 ywampa@comcast.net
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Experience and Skills