Staff Application

Staff Application

Youth With A Mission - Lebanon, Pennsylvania
Position applying for: *
Date available for service *

Month Day Year
Personal Information
Please upload apersonal passport-style photo *
Full Name (as shown on passport): *

First Name Middle Name Last Name
Preferred Name
Gender *

Male Female
Age
Birth Date *

Month Day Year

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
E-mail *
example@example.com
Facebook URL
Marital Status *
Check if your spouse will be accompanying you? (application required)
Spouse's Full Name (as shown on passport):

First Name Middle Name Last Name
Please give names and ages of any children accompanying you:
Country of Citizenship *
City and Country where passport was issued *
Passport # *
Passport Expiry Date *

Month Day Year
Do you have a US visa? *

No Yes
Visa Type and Number
e.g. B1/2 #US12345
Visa Expiry Date

Month Day Year

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

- Country Code - Area Code Phone Number

Church Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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.) *

Yes No
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? *

Yes No
Please give details and names of medications: *
Are your immunizations, including tetanus, up to date? *

Yes No
Do you or have you had problems with addictions (smoking, alcohol, drugs, self-harm, food, pornography, etc.)? *

No Yes
Do you have medical insurance or coverage? *

Yes No
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 Name Last Name
Phone Number *

- Area Code Phone 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

Christian Life and Ministry
Describe your conversion experience. How? When? Where? *
Describe your present relationship and devotional life with the Lord. *
How did God call you and how long have you considered missionary service? *
What steps have you taken to prepare yourself for missionary service? *
In what ways are you involved in sharing your faith with others? *
What do you think your calling and gifts are? *
Please give a statement describing your desire to be a missionary with YWAM. *
How did you hear about YWAM Lebanon PA? What influenced you to apply here? *
What expectations do you have about serving at YWAM Lebanon, PA *

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 Name Last Name
Pastor E-mail *
example@example.com
Phone Number *

- Area Code Phone Number
Reference #2
Past or Current Employer *

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

- Area Code Phone Number
Reference #3
DTS Leader *

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

- Area Code Phone Number
*

I have reviewed this application. By checking this box, I certify all the information I have provided is true and accurate to the best of my knowledge. Certification: I certify that all the information in this application and its supplements is complete and accurate. If I am accepted as staff, I agree that I will serve in accordance with YWAM Foundational Values. I understand that I will serve full-time hours (40 hours/week) in cooperation with YWAM Lebanon policies.
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, 1275 Birch Rd., Lebanon, PA 17042 ywampa@comcast.net
Should be Empty:

Staff Application

Personal Information

Experience and Skills

Church Information

Health/Personal History

Emergency Information and Consent for Treatment

Staff and Financial Information

Christian Life and Ministry

Reference Letters and Certification

Reference #1

Reference #2

Reference #3