Name
*
First Name
Last Name
Age
*
Date of Birth
MM
DD
YYYY
Current Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Permanent Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Are you a United States Citizen?
If 'No', Are you authorized to work in the U.S.?
Marital Status
*
Do you have children?
*
If 'Yes', what are their name(s) and age(s)?
*
How did you hear about His Mansion Ministries?
*
If 'Other', Please explain
*
When is your desired start date?
*
MM
DD
YYYY
Emergency Contact Name
*
First Name
Last Name
Relationship to You
*
Emergency Contact Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Primary Phone
*
(###)
###
####
Secondary Phone
*
(###)
###
####
Emergency Contact Email
*
High School
High School Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Dates Attended
Did you Graduate?
Diploma
College
College Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Dates Attended
Did you graduate?
Degree Earned?
Other forms of Education
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Dates Attended
Did you complete your commitment?
Degree or Certificate Earned
Reference #1 Name
First Name
Last Name
Relationship to You
Company
Address
Phone
(###)
###
####
Email
Reference #2 Name
First Name
Last Name
Relationship to You
Company
Address
Phone
(###)
###
####
Email
Reference #3 Name
First Name
Last Name
Relationship to You
Company
Address
Phone
(###)
###
####
Email
Are you currently employed?
Employer
Phone
(###)
###
####
Address
Supervisor
Position
Please check one
Responsibilities
May we contact your employer?
If not, why?
Approximately how many other jobs have you had?
Please list previous employment/service experience that would be relevant to your service at His Mansion:
Branch:
Dates Served:
Rank at Discharge:
Type of Discharge:
Are you currently a member of a church?
Church Name
Denomination
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
How long have you attended?
Have you discussed your intent to serve at His Mansion with your pastor and/or church leadership?
If not, why?
May we contact your pastor to discuss your application?
If not, why?
Please list and explain any medical conditions or health issues:
Have you received any diagnosis from a mental health professional?
If yes, what is the diagnosis?
Do you take prescribed medications in accordance with a physician's direction?
If yes, please list the medication(s) and the dosage(s)
Is your diet restricted?
If yes, please explain
Do you have any allergies? (e.g. drug, food, seasonal, animal, etc.)?
If yes, please explain
Does anything hinder you from doing physical work (e.g. back, neck, knee problems etc.)?
If yes, please explain
Have you ever been charged or convicted of any criminal act that has not been expunged?
If yes, please provide the details of the charge(s) and the outcome, including sentencing, if applicable.
Who are you? How would you describe yourself?
How did you come to know God? Describe your relationship with God.
In your understanding, what is the Gospel?
What do you believe about the Bible? What role does it play in your life?
Why do you want to serve at His Mansion? How do you hope to grow by serving at His Mansion?
Signature
Date
MM
DD
YYYY
