Mission Builder Application Form

Personal Information

We will only use your personal information in so far as it pertains to the processing of the application and the facilitation of your term as a Mission Builder should you be accepted. We do not share or transfer your personal information given on this form.
Your Name*

First NameLast Name
Birth Date*

DayMonthYear
Gender*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number*
Estimated start date*

DayMonthYear
Length of service anticipated *
Character Reference Name*

First NameLast Name
Character Reference Email*

Personal Questions

Please take some time to answer the following questions. Application is NOT COMPLETE until all questions have been answered.
1. Describe how you became a Christian and your present relationship with the Lord.*
2. What areas of your character are you presently seeking God to further develop / improve?*
3. What are your expectations for joining Pacific Reach as a Mission Builder? (i.e. you want to be challenged, grow closer to God, grow in leadership) Please explain.*
4. How would you describe yourself? Your personality, nature, habits etc.*
5. Do you feel you have a particular ministry (worship leading, teaching, medical, administration etc.)?*
6. Have you ever suffered from depression, anxiety attacks, mental disorders (bipolar, schizophrenia, manic depression, etc.)? If yes, are you clinically or self-diagnosed? Please explain.*
7. Are you currently taking any doctor prescribed medications for depression, mental illness or other health issues? If yes, please give details of your condition. *
8. Have you ever been involved in a crime? Do you have a police record or history?*

YesNo
If yes, please explain*
9. Are you involved in any current or pending lawsuits/legal proceedings?*

YesNo
If yes, please explain*

Pacific Reach has a NO SMOKING policy and all Mission Builders are expected to quit before coming.*

I understand
Do you have any physical handicaps, limitations, or health conditions which may require special attention?*

YesNo
If yes, please detail*
At Pacific Reach anyone requiring "Gluten or Dairy Free Meals" will be asked to make a $300 contribution per school to help cover the extra costs of these meals.
Please list any food allergies or special dietary needs you may have.
If none, enter N/A in the box
Please list any other allergies you may have.
Includes: Penicillin, Serum, Sulfonamides or other medicines, and any other types of allergies.

Consent for Medical Treatment

In case of an emergency, I, hereby agree to the performance of such treatment, anaesthetics, and operations as is deemed necessary by the attending physician.
Applicants signature (Typing your name confirms you agree)*

First NameLast Name
Date*

MonthDayYear
Date

Liability Release Form

I / we hereby release Pacific Reach, its agents, employees, and volunteers from any liability whatsoever arising out of an injury, damage, or loss which may be sustained by said person during the course of involvement with Pacific Reach.
Applicant's Signature (Typing your name confirms you agree)*

First NameLast Name
Date*

MonthDayYear
Date

Signature of Financial Understanding
The boarding cost for mission builders at Pacific Reach is currently $189/week.

Both costs include food, accommodation, and utilities. However, it does not include personal expenses, insurance, and domestic travel.

Invoices are generated monthly and expected to be paid in full by the end of the month.

Volunteer staff members and mission builders are responsible for their own travel costs to and from our location. This includes any outreach airfares and outreach fees if applicable.
I confirm I understand my financial obligations to Pacific Reach, and that payment of required fees must be made monthly and I agree to do so. I, therefore, commit myself to pay all personal expenses incurred during my time with Pacific Reach.
Applicants signature (Typing your name confirms you agree)*

First NameLast Name
Date*

MonthDayYear
Date

Signature of Agreement
I consent to submitting my personal information to Pacific Reach for the purposes of processing this application and the facilitation of my volunteer service should I be accepted
YesNo
I certify that all information in the application is complete and accurate. If accepted by Pacific Reach I will abide by the spirit, rules, and schedule of the ministry.

In accordance with biblical principles, I agree to seek to first resolve any and all disputes with Pacific Reach, its leadership, and/or volunteer staff members by means of reconciliation or mediation.
Applicants signature (Typing your name confirms you agree)*

First NameLast Name
Date*

MonthDayYear
Date

Submit Application

You made it!
Please upload a recent photo of yourself, ensuring it is a clear headshot. Minimum of 72dpi and 600x600 pixels. It does not need to be an official passport photo.

Browse Files

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It's now time to submit your final and completed application. Simply click on the "submit application" button below and your application will be sent directly to Pacific Reach for processing.

We look forward to communicating with you more in the very near future.

God Bless!

Pacific Reach Team

personnel@pacificreach.org
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Personal Information