Love’s Door for All Nations Application

LOVES DOOR 4 ALL NATIONS

Intern and Volunteer Application Form

Guide to Completing Application

Instructions:

1. All information given in this application is confidential and will only be read by staff and those directly involved in the interview process.
2.Your answers to sensitive areas of your past do not necessarily disqualify you from an internship or from volunteering. Our interest is to see that progress is being made in all areas of your life and that you are ready to enter this next step in your development. If there are any questions on the personal history, medical history and/or moral areas of this application that you would prefer to discuss in person during the interview process, please inform us upon submitting your application.
3.Please answer all questions completely and legibly. Use the application form and attach additional sheets as necessary to the end of the application.
4.All applications should be emailed to allnationszam@gmail.com.
5.This application form is not complete without one reference form from your pastor and two reference forms from a mentor/leader directly over you, and someone who has worked with you in ministry with whom you have been open and vulnerable. Please ask them to email these forms to allnationszam@gmail.org
6.Please attach a passport-size photo to your application (it doesnt have to be an actual passport photo. You may also cut a larger picture to that size, as long as it clearly shows your face).
7. Please include proof of payment in the amount of $35 made out to Loves Door, a non-refundable application fee.  Mail the payment to: Loves Door, PO Box 1185, Philomath, OR  97370

Internship and Volunteer – application

Date of application:  ____/_____/____Application fee enclosed: $ _________________

Dates desiring to come:

Personal Information

Full legal name:  ________________________________________________________    Attach

Preferred name: ________________________________________________________    Picture

Current address: ________________________________________________________

City/State/Zip: ________________________________________Email: ____________________________

Phone: (home) _________________________________ (work) __________________________________

Place of Employment: ____________________________

Birth date:

Gender: _________

Social Security/ID Number: _______________________________________________________________

Family Information

Marital Status: (complete all that apply)

❑ SingleAre you currently dating anyone?________ If so, whom? _______________________

❑ EngagedFiancés name: _____________________________________ Birth Date: ___________

Date of wedding ____/____/____

❑ MarriedSpouses name: ____________________________________ Birth Date: ___________

❑ DivorcedNumber of divorce(s) and date(s) of divorce: __________________________________

❑ Widow(er)Date of spouses death: __________________________________________________

Child(ren)s names: ____________________________________________  Birth date ____/_____/_____

     ____________________________________________  Birth date ____/_____/_____

     ____________________________________________  Birth date ____/_____/_____

If you are expecting a child, please give the due date:  __________________________________________

Passport Information

Country of Citizenship: _________________________________Passport #: _______________________

Name as listed on Passport: ___________________________ City/Country of Issue: _________________

Expiration date: ____/____/_____. Have you ever been refused a visa?  __________ If so, give the nation and describe the circumstances under which you were refused. __________________________________

Education Information

Highest level of formal education (please check only one)

❑ Have not finished high school

High school diploma or Grade 12

❑ Some collegeClassification? _______________________________________
❑ Technical school degreeWhat major?  ________________________________________
❑ Bachelors degreeWhat major? _________________________________________
❑ Masters degreeWhat major? _________________________________________
❑ Ph.D. or professional degreeWhat major or degree? _________________________________

Languages

Languages spoken, in decreasing order of fluency:

1) ____________________________ 2) _______________________ 3) ___________________________  

English proficiency:    Elementary speaking;   Limited word proficiency;    Minimum professional;      

                                                    Native speaking proficiency;  

Financial Information

Are you able to meet all your financial needs?      Yes    No

If no, from what source will they come? ____________________________________________________

Do you have any outstanding debts?       Yes   . No

If yes, how will you cover them during your absence? __________________________________________

Skills

Present Occupation: _ ________________________________ Time Period ________________________

Work Experience: ____________________________________ Time Period ________________________

Work Experience: ____________________________________ Time Period ________________________

Work Experience: ____________________________________ Time Period ________________________

How would you describe your relationship with your family? How do they feel about your involvement with Loves Door? ___________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

Emergency Information

In case of emergency, contact _______________________________ Relationship __________________

Address:  _____________________________________________________________________________

Home phone: ______________________________ Work phone: ________________________________

Email address: _________________________________________________________________________

Consent for Treatment

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.

Applicants Signature ______________________________________________  Date ____/_____/_____

Signature of Parent or Guardian (if applicant is under 18):

_____________________________________ Relationship _________________ Date ____/_____/_____

Release of Liability

I/We do hereby release Loves Door, its staff, agents and volunteer assistants from any and all liability whatsoever arising out of any injury, damage, or loss which may be sustained by said person(s) during the course of their involvement with Loves Door.

Applicants Signature ______________________________________________  Date ____/_____/_____

Signature of Parent or Guardian (if applicant is under 18):

_____________________________________ Relationship _________________ Date ____/_____/_____

Work SkillsMinistry AbilitiesOther Skills

 Carpentry/Construction Childrens Programs _______

 Computers Dance/ Drama ______________________________

 Child Care Micro Business ______________________________

 Homesteading knowledge Evangelism ______________________________

 Gardening Health Care ______________________________

 Handyman Music (vocal) ______________________________

 Hospitality/Kitchen Music (list instrument) ______________________________

 Housekeeping Farming/ Gardening ______________________________

 Engineering Skills Simple Church ______________________________

 Vehicle/Building Maintenance Teaching- Bible or English______________________________

 Desktop Publishing/Graphic Design Bible Studies ______________________________

   

Detailed Skills Experience

Do you have experience in any form of counseling/personal ministry/exorcism/healing? ____________

Describe your abilities and knowledge, including ways you have used them. __________________ _______________________________________________________________________________________________________________________________________________________

Do you have experience in administrative/office/computer/web work? __________

Describe your abilities and knowledge, including ways you have used them. _________________________ _________________________________________________________________________________________________________________________________________________

Do you have any experience in evangelism/church planting/disciplship?  ________ If so, please explain: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Describe your experience with childrens ministry/child care/adoption/orphan work. _______________ __________________________________________________________________________

________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________

Do you have any experience in building construction and maintenance?  If so, please explain:

________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________

Do you have experience in cross-cultural ministry?  __ ___________________________________

List the countries you have been to, including the dates, the organization(s) you traveled with, the types of ministry you were involved in, and any leadership positions you held. _____________________________________________________________________________________

_____________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Church Details

What is your home church name? ______________________________ Phone: _____________________

Address:_____________________________________________________________________________

Senior Pastor: ___ __________________________________ How long have you attended? __________

Church email address (is it ok that we contact him?) _________________________________________

Describe your present relationship with your local church.  How have you served in your church?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Christian Experience

At what age did you become a Christian? ____________________________________________________

What is your religious background? ________________________________________________________

Please give us your testimony of how you accepted Christ and the major stages of your history with God (aim for about a page!)

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Please describe your present walk with God, including your personal discipleship, gifts, and passions.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Do you feel specifically called to Zambia? Explain: _________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Where do you want to be in five years? What is your personal vision for your life and ministry? __________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Explain how and why you feel God is calling you to be a part of Loves Door. What area/s of ministry would you specifically like to get involved in, and how do you see yourself fitting in? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you been baptized? ____________________________ Date: _______________________________

What are your views and understanding of the power and the gifts of the Holy Spirit?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Leadership Experience

Check the boxes that describe your current leadership responsibility:

  I have experience leading a small group.

  Mission trips I have been on; mission trips I have led: ______________________________________ ____________________________________________________________________________________

_____________________________________________________________________________________

  Leadership role in the church __________________________________________________________

  Leadership roles outside of the church: __________________________________________________

_____________________________________________________________________________________

Please describe the ministry experience you have had, including the responsibilities it involved: and who mentored you in these areas. How did the mentoring affect you and your personal ministry? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Confidential Personal History

Your answers to sensitive areas of your past do not necessarily disqualify you from bring involved with All Nations. Our interest is to see that progress is being made in all areas of your life, and that you are ready to enter this next step in your spiritual walk. If there are any questions on the personal or health history areas of this application that you would prefer to discuss in person during the interview process, please inform us upon submitting your application.

Height: _____________________                                                     Weight: _________________________

How many days were you absent from work (or school) due to illness last year? _____________________

Are you at the moment covered by medical insurance?_________________________________________

Have you used any narcotics, hallucinogens or drugs not prescribed by a physician in the past five years?

If so, what kind and when? Please also include the last date of usage._____________________________ _____________________________________________________________________________________

Do you presently drink alcoholic beverages? If so, how frequently? ________________________________

Have you been treated for a drug or alcohol problem in the last five years? If yes, please explain.________

__________________________________________________________________________________________________________________________________________________________________________

How often do you tend to experience strong anxiety? Please explain: ______________________________

_____________________________________________________________________________________

Have you had any prolonged problems with depression or mood swings in the past five years? _________ If yes, please explain: ___________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________

Have you ever been involved in the occult, new age practices, ancestral worship or a cult (Mormons, Jehovahs Witness, etc.):_________________________________________________________________

Have you struggled with an eating disorder (anorexia, bulimia, or overeating) in the past five years? If so, please explain the nature of your problem, extent, when you began having difficulty, and any other specifics that may help us to understand your particular situation.________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you seen a professional counselor, psychiatrist or psychologist in the past five years for any reason other than career or premarital counseling? If yes, when and for what purpose? Was it helpful? ____________________________________________________________________________________
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Have you ever been physically or sexually abused or raped? If so, when? __________________ Have you seen a professional counselor about these events? _____________ If so, how was it helpful? __________

__________________________________________________________________________________________________________________________________________________________________________

Have you ever been convicted of a crime or felony? If yes, please explain. __________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Personal Health History

Please answer all questions. Comment on all positive answers on a separate piece of paper.

Yes       No                                  Yes       No                                             Yes       No

          ❑ Skin conditions                  ❑ Heart trouble                       ❑  ❑ Kidney disease

          ❑ Eye trouble                           ❑ High blood pressure​          ❑  ❑ Anemia

          ❑ Ear trouble     ​                       ❑ Low blood pressure           ❑  ❑ Cancer ________________

          ❑ Head injury     ​                     ❑ Rheumatism/Arthritis         ❑  ❑ Eating disorder _________

          ❑ Recurrent headaches               ❑ Back problems​                ❑  ❑ Allergies _______________

          ❑ Epilepsy     ​                             ❑ Dislocation of joints​           ❑  ❑ Diabetes

          ❑ Fainting spells     ​                   ❑ Broken bones​                    ❑  ❑ Special diet ____________

          ❑ Mental/Nervous disorders               ❑ Ulcer (specify) ___________❑  ❑ STD(s) ________________

          ❑ Weakness     ​                           ❑ Gall bladder problems     Females only

          ❑ Paralysis                                   ❑ Surgery (specify) _________❑  ❑ Irregular periods

          ❑ Insomnia                                  ❑ Jaundice                          ❑  ❑ Severe cramps

          ❑ Shortness of breath                 ❑ Hepatitis​                        ❑  ❑ Excessive flow

          ❑ Hay fever, asthma                       ❑ Recurrent diarrhea     ❑  ❑ Are you pregnant?

Other illness or conditions: _______________________________________________________________

Are you presently under a doctors care for any reason? If yes, specify: ____________________________

Are you taking any medication at this time? If yes, specify: ______________________________________

Are you allergic to any drugs? If yes, specify: _________________________________________________

Do you have any other allergies? If yes, specify:  ______________________________________________

Do you have any chronic illness (es)? If yes, specify: ___________________________________________

Do you have a history of emotional instability or psychiatric treatment? If yes, specify: _________________

_____________________________________________________________________________________

Do you now or have you ever received any compensation for disability from any source? If yes, specify: _____________________________________________________________________________________

Do you have any physical impairments, handicaps or health conditions which require special attention? If yes, specify (your answer will not affect admission consideration): ________________________________

_____________________________________________________________________________________

Communicable Diseases: Have you ever had any of the following?

  Chicken Pox  Measles (specify)  Other (specify below):

  Scarlet fever  Tuberculosis________________________________

  Mumps  Other (specify at right)________________________________

Confidential Morals Information

The Bible makes it clear that we should avoid sexual immorality (1 Thes. 4:3-6). Though Gods forgiveness is full and complete, there is a distinction between forgiveness for past sins and necessary, biblical suitability for spiritual leadership. 1 Timothy 3 outlines qualifications necessary for those who desire to be spiritual leaders. Those qualifications include being above reproach and having a good reputation. In light of this, All Nations is highly concerned about the area of moral purity for volunteers and interns. It is critical that those working with All Nations exhibit strong convictions and a lifestyle consistent with biblical standards. A past problem in this area doesnt necessarily disqualify you, provided: 1) it can be determined that convictions are strong and consistent with Scripture, and 2) a sufficient time tested track record of victory has been established. The information that you share with us will be treated confidentially and will be seen only by those directly involved with your application decision. If there are any questions on the personal history, health history and/or moral areas of this application that you would prefer to discuss in person during the interview process, please inform us upon submitting your application.

1. What are your convictions regarding premarital and extra-marital physical involvement? (E.g., petting and sexual involvement) unholy and not health for a Christian. ______________________________________________________________
__________________________________________________________________________________
2. Have you set guidelines for yourself in the physical area to ensure minimal temptation? If so, what are they? _____________________________________________________________________________
__________________________________________________________________________________
3. Have you had a relationship in the past five years with a member of the opposite sex which would not be considered above reproach? (i.e., petting, sexual intercourse, extra-marital involvement, etc.) _____
If so, when was the last occurrence of involvement in this kind of relationship? (Month/year) _________
What was the extent of physical involvement? (please be specific) _____________________________
____________________________________________________________________________________________________________________________________________________________________
a. Singles: Have you dated other men/women since the last occurrence? ___________ If so, what has your physical relationship been with them? _______________________________________________
b. Married: How has this affected your relationship with your spouse? __________________________
____________________________________________________________________________________________________________________________________________________________________
4. Are you currently having any struggles in this area? (i.e., temptation, fantasy, pornography, difficulty applying your guidelines/convictions, etc.) ________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5.     a. Female: Have you ever had an unmarried pregnancy or abortion: ________________
b. Male: Have you ever been responsible for a girlfriends unmarried pregnancy or abortion?  ________
If so, when? Explain the circumstances: __________________________________________________
____________________________________________________________________________________________________________________________________________________________________
6. Have you had any type of homosexual relationship in the last five years? ______________ If so, when was the last occurrence of involvement in this kind of relationship? (Month/year) __________________
What was the extent of physical involvement? (Please be specific) _____________________________
____________________________________________________________________________________________________________________________________________________________________
How does this affect your current relationships with the same sex? ____________________________
____________________________________________________________________________________________________________________________________________________________________

Other

Do you have any additional comments or clarification about anything on this questionnaire? _________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Intern / Volunteer Commitment

I, ________________________________________________________ have completed all portions of this application accurately for admission to Loves Door. I understand that completion of this application form does not guarantee I will be accepted as an intern/volunteer, but that this application will be prayerfully considered by the Loves Door team. I understand that as an intern/volunteer I will not be receiving any financial reimbursement for the work that I do while at Loves Door.

Applicants Signature: ___________________________________________________________  Date ____/_____/_____                        Loves Door

PO BOX 1185, Philomath, OR 97370  

Tel:  503.843.6736 (USA), +26 0979 788 025 (Zambia)    email:  allnationszam@gmail.com

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