SURGE Online Application Form

SURGE Online Application Form

The Phase Manager should fill out this application with the help of the applicant. You may click the 'Save' button found on the bottom of this form to save your work at any time. You will receive an email with instructions and a link to this form. For more information about the question found on this form, please reach out to the SURGE director. !IMPORTANT! This form includes an Approval Workflow. Please wait for your response email after your complete and submit your entry before taking further action.
SECTION A | Staff Information
A10. Staff Email*
Do NOT enter the SURGE applicant's email. This form does not accept private email addresses.
A11. Region*
Select the region that this application refers to.
A12. Date*

MonthDayYear
Date the application form is being filled out for the first time.
SECTION B | Personal Information
B10. Name*

First NameLast Name
B11. Address (center address if currently residing in the program)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
B12. Home Phone Number
Please enter a valid phone number.
B13. Work Phone Number
Please enter a valid phone number.
B14. Email Address
Applicant's email address.
B15. Birth Date*

MonthDayYear
Date
B16. Age
B17. SIN #*
Please enter a valid social insurance number
B18. Driver's Licence Number
B19. Driver's Licence Province*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
B19.1 Upload valid driver's licence*

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B20. Do you have valid photo ID?*
B20.1 Please upload valid photo ID*

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B21. Do you have valid passport?*
B22. Adult & Teen Challenge of Central Canada Graduation Date*

MonthDayYear
Enter the date when you graduated the 4 Tier Program
B23. How long have you been drug & alcohol free?*
B24. Marital Status*
B25. Spouse Name*

First NameLast Name
B26. Spouse Occupation*
B27. Number of Children*
B28. List any hobbies, interests, skills and abilities*
B29. Select the courses you have completed*

Experiencing GodDiscover Your God-Given GiftsKnowing How To Manage Money God's Way
B30. Please explain why you haven't completed the prerequisite courses*
B31. List your top 3 God-Given Gifts in order*
B32. What are your 3 top Character Qualities you need to strengthen?*
SECTION C | Behavioural History
C10. Is there a current criminal record or criminal record check (it must state "negative" on file in the applicant's digital folder?*
This question is for the Phase Manager specifically
C11. Please explain why not*
All applicants must have updated legal records uploaded on their Client Folders.
C12. Are you currently on probation?*
C13. Please explain the conditions of your probation and when your probation will be over*
C14. Name of Probation Officer*

First NameLast Name
C15. Phone Number*
Please enter a valid phone number.
C16. Email*
example@example.com
C17. Please Indicate Previous Addictions*
C18. Please upload existing Criminal Record*

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This can be found in the client's digital file on Google.
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SECTION D | Educational Information
D10. List all high schools and colleges attended beginning with the most recent*
SECTION E | Employment History
E10. Last Employer
E11. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E12. Immediate Supervisor*
E13. Phone Number*
Please enter a valid phone number.
E14. Date Started*

MonthDayYear
Date
E15. Date Left*

MonthDayYear
Date
E16. Please Upload a Copy of Your Resume & a Letter of Recommendation from the Program Director*

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SECTION F | Religious Information
F10. Have You Accepted Christ As Your Personal Saviour and Lord?

YesNo
F11. Date of Salvation*

MonthDayYear
Date
F12. Where?*
F13. Name of Home Church*
F14. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
F15. Phone Number*
Please enter a valid phone number for the church
F16. Pastor*
F17. Phone Number*
Please enter a valid phone number for the pastor.
F18. Denomination*
F19. When and How Did Jesus Become Your Personal Saviour?*
F20. How Are You Currently Cultivating Your Spiritual Life and Seeking To Mature in Christ?*
F21. Why Do You Desire To Become a Student in the SURGE Program?*
F22. Do You Feel God Is Calling or Has Called You to Ministry in Adult & Teen Challenge or Another Similar Ministry? Please Explain.*
F23. State Any Other Aspects of Your Personal Testimony That Would Be Significant to You Becoming a Part of the SURGE Program.*
SECTION G | References

Please List the Names and Addresses of Your References for a Recommendation.
G10. Name*

First NameLast Name
G11. Phone Number*
Please enter a valid phone number.
G12. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
G13. Relationship*
G14. Name*

First NameLast Name
G15. Phone Number*
Please enter a valid phone number.
G16. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
G17. Relationship*
G18.1. Applicant Signature*

Clear
G19. Date*

MonthDayYear
Date
G20. Please Upload a Picture of Yourself*

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Please ensure the photo is JPG or PNG format!
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G21. Please Upload Exit Plan

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H1.1 Supervisor Questions & Comments
H1.2 How is your applicant with Critical Thinking Skills?*
H1.3 What are the areas of strengths of your applicant?*
H1.4 What are the areas of weakness of your applicant?*
H1.5 Can you see them being employed with ATCCC in the next 3-5 years?*
H1.6 Additional Comments*
Where will they be serving is the Program Director in support of this applicant?
Should be Empty:

SURGE Online Application Form

SECTION A | Staff Information

SECTION B | Personal Information

SECTION C | Behavioural History

SECTION D | Educational Information

SECTION E | Employment History

SECTION F | Religious Information

SECTION G | References

H1.1 Supervisor Questions & Comments