Training Program Application

1
Name* This field is required.
First Name
Middle Name
Last Name
Suffix
2
Birth date* This field is required.
Date
Month
Day
Year
3
Email* This field is required.
example@example.com
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Phone Number* This field is required.
Please enter a valid phone number.
6
Gender* This field is required.
Male
Female
7
T-shirt size* This field is required.
X-Small
Small
Medium
Large
X-Large
XX-Large
XXX-Large
8
Weight* This field is required.Information required for bush planes
9
Height* This field is required. Information required for bush planes
10
Instagram Username* This field is required.
11
Facebook Username* This field is required.
12
Ethnicity
13
Are you a citizen of the United States?
YESNO
14
Explain your citizenship status
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Ok
15
What high school did you graduate from? * This field is required.Please include city and state
16
What year did you graduate from high school?* This field is required.
17
What degrees or certificates have earned (or are currently working on)?* This field is required.
18
From what college?* This field is required.
19
What year did you graduate (or expect to graduate)?* This field is required.
20
What was/is your overall GPA?* This field is required.
21
Employment History* This field is required. Please list your work experience, paid or unpaid, beginning with your present or most recent employment. Go back at least five years. Describe each job separately. Note specific tasks and supervisory, technical, or other responsibilities. This section scrolls left to right. Please make sure to fill out each blank and click the blue + to add an additional place of employment.
22
Marital Status* This field is required.
Single
Married
Engaged
Separated
Divorced
Remarried
Widowed
23
Names and Ages of ChildrenMinors only
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Ok
24
Do you use tobacco?* This field is required.
YESNO
25
Do you drink alcohol?* This field is required.
YESNO
26
Do you use prescription drugs?* This field is required.
YESNO
27
Do you use non-prescription drugs?
YESNO
28
Please explain non-prescription drug use?
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Ok
29
Have you ever been convicted of a crime (excluding minor traffic offenses)?* This field is required.
YESNO
30
Have you ever been accused of, engaged in, or investigated for any sexual misconduct involving a minor or adult, including but not limited to child abuse, child molestation, indecent liberties with a child, incest, adultery, sexual harassment, rape, assault, battery, murder, kidnapping, child pornography, sodomy, or sexual contact with a counselee?* This field is required.
YESNO
31
Have you ever been convicted of, or plead guilty or “no contest” to any criminal offense?* This field is required.
YESNO
32
Have you ever been found liable, or participated in an out-of-court settlement in a civil lawsuit?* This field is required.
YESNO
33
Has any of your employers ever been sued as a result of your conduct?* This field is required.
YESNO
34
Have you ever resigned under duress from, or been dismissed from any position?* This field is required.
YESNO
35
Have you ever been subject to discipline by a religious body?* This field is required.
YESNO
36
If you answered yes to any of the prior questions in this "Criminal or Civil Liability" section of the application, please explain:
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37
Have you ever experienced or presently have a physical ailment, injury, handicap or condition that would prevent you from full participation in tasks or activities while part of What i Have?* This field is required.
YESNO
38
Please explainphysical ailment, injury, handicap or condition that would prevent you from full participation in tasks or activities while part of What i Have?
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Ok
39
Are you presently receiving disability?
YESNO
40
Please explainPresently receiving disability
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Ok
41
Have you had complete freedom from addiction of drugs, alcohol, pornography, and sex outside of marriage for a minimum of the last 6 months?* This field is required.
YESNO
42
Please explain your current addictions.
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Ok
43
Do you adhere to Biblical Sexual Ethics as defined by the General Council of the Assemblies of God and National Chi Alpha?* This field is required.
YESNO
44
Please explain your lack of adherence to a Biblical Sexual Ethic.
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Ok
45
Is there any reason that you would not pass a background check?* This field is required.
YESNO
46
Why would you not pass a background check?
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Ok
47
Have you had any inappropriate sexual contact with a child?* This field is required.
YESNO
48
Explain any inappropriate sexual contact with a child.
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Ok
49
Do you attend church regularly?* This field is required. Regularly defined as at least three Sundays per month.
YESNO
50
Please explain your church attendance.
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Ok
51
Have you fully considered and do you fully subscribe to our Statement of Faith?* This field is required.Found at https://ag.org/Beliefs/Statement-of-Fundamental-Truths
YESNO
52
When did you accept Jesus as your Lord and Savior? Describe the experience
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53
Are you baptized in the Holy Spirit?* This field is required.
YESNO
54
Describe your experience being baptized in the Holy Spirit?
55
Have you ever been used in spiritual gifts?* This field is required.
YESNO
56
How have you been used in spiritual gifts?
57
Church* This field is required. Fill out the following details about your church
Name of church you attend
Name of pastor
Address of church
Phone number of church
How long have you attended church there?
58
Pastor/ XA Director Name* This field is required.
First Name
Last Name
59
Pastor/ XA Director Phone Number* This field is required.
Please enter a valid phone number.
60
Pastor/ XA Director Email* This field is required.
example@example.com
61
Ministerial Leader Name* This field is required.
First Name
Last Name
62
Ministerial Leader Phone Number* This field is required.
Please enter a valid phone number.
63
Ministerial Leader Email* This field is required.
example@example.com
64
Friend Name* This field is required.
First Name
Last Name
65
Friend Phone Number* This field is required.
Please enter a valid phone number.
66
Friend Email* This field is required.
example@example.com
67
How did you hear about the What i Have program?* This field is required.
68
Why are you interested in participating in the What i Have program?* This field is required.
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69
Please verify that you are human* This field is required.
Should be Empty: