Mission Builder Application

Mission Builder Application

Personal Details

Emergency Contact Information

Passport Information

Criminal Record

Home Church Information

Education, Occupational Experience and Other Skills

Health Form

Health History

Disease History

Family History

Immunizations

Consent for Treatment

Declaration

Expectations & Personal Outlook/Overview

Personal History Information

Please list your immediate family members (parents, siblings, spouse, children, if applicable):

Mission Builder Application
Guidelines for filling out the application:

Please fill out this application honestly and to the best of your ability.
- Forms - Application form, Leader/DTS Leader's Reference Form - All forms must be completed for acceptance.
Recent Passport Photo*

Cancelof
Starting Date (Month, Year)*
Length of stay (until which date)*
Personal Details
Legal Name*

First NameMiddle NameLast Name
Preferred Name
Permanent Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Phone Number (Including Country Code)*
Other Phone Number (Including Country Code)*
Email*
example@example.com
MaleFemale
Age (on date of application)*
Date of Birth*

DayMonthYear
Date
Place of Birth*
City, Country
SingleEngagedMarriedSeparatedDivorcedRemarriedWidowed
If you selected Married/Separated/Divorced/Remarried/Widowed, please fill in the date for it.

DayMonthYear
Date
Spouse's Name

First NameMiddle NameLast Name
MaleFemale
Spouse's Age (on date of application)
Spouse's Date of Birth

DayMonthYear
Date
Spouse's Place of Birth
City, Country
Please list your immediate family members (parents, siblings, spouse, children, if applicable):

Emergency Contact Information
In case of emergency, contact:*

First NameLast Name
Relationship*
Permanent Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Phone Number (Including Country Code)*
Other Phone Number (Including Country Code)
Email*
example@example.com
Passport Information
Country of Citizenship*
Passport Number*
Name as on Passport*

First NameMiddle NameLast Name
Place of Issue*
Passport Expiry Date*

MonthDayYear
YesNo
If you clicked yes, please list the nations and brief details.
Criminal Record
NoYes
When? (if 'Yes')

DayMonthYear
Date
NoYes
When? (if 'Yes')

DayMonthYear
Date
Please explain further:

Home Church Information
Home Church Name*
Denomination*
Pastor's Name*
Length of Attendance*
Permanent Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number (Including Country Code)*
YesNo

Education, Occupational Experience and Other Skills
High School/Secondary SchoolEquivalent of High School/Secondary SchoolCollege/University

Rows	Name of Institution	Dates of Attendance (FROM)	Dates of Attendance (TO)
#1
#2
#3
#4

NoYes
If yes, degree/major:

List any significant job/occupational experience you've had:

Rows	Company, Position & Skills used	Dates position was held (FROM)	Dates position was held (TO)
#1
#2
#3
#4
#5

Other skills, talents or special interests
First/Native Language*
Other Languages
Level of Ability

Health Form
Legal Name*

First NameMiddle NameLast Name
Email*
example@example.com
Home Phone Number (Including Country Code)*
Note: Medical Insurance & Travel Cover is compulsory at YWAM Tuen Mun, so please ensure you have correct cover for the duration of your stay.
Yes (please include a photocopy of your policy with this application form and complete the details below)No (we recommend that you make an enquiry with Talent Trust Consultants (www.talent-trust.com), a reputable insurer for people around the world involved in Christian Ministry)
Name of Insurance Carrier
Policy/Cover Type
Policy Number
Expiry Date

DayMonthYear
Date
Brief Description of Coverage

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.
Applicant's Signature*

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Date*

DayMonthYear
Date
Parent or Guardian's Signature

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Required if applicant is under 18 years old
Declaration
I commit myself to paying all expenses incurred during my involvement with YWAM Tuen Mun.

I have completed all portions of this application form and if accepted, agree to abide by the spirit, policy and schedule of YWAM Tuen Mun.
Applicant's Signature*

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Date*

DayMonthYear
Date
I/We do hereby release Youth With A Mission HK LTD., Master’s Beauty (HK) LTD., and YWAM Tuen Mun, its staff, agents, andvolunteer assistants from any liability whatsoever arising out of an injury, theft, damage, disability or loss of health, property, emotional stability or life, which may be sustained by said person during the course of involvement with the organization.
Applicant's Signature*

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Date*

DayMonthYear
Date
I agree with the privacy policy as set out by Master's Beauty (HK) LTD / YWAM Tuen Mun at www.ywamtuenmun.org/wp/privacy-policy and agree to allow my information to be saved and distributed by Youth With A Mission HK LTD / Master’sBeauty (HK) LTD. / YWAM Tuen Mun to the necessary parties for the purposes of processing my application.
Applicant's Signature*

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Date*

DayMonthYear
Date

Expectations & Personal Outlook/Overview
How did you first hear of Youth With A Mission Tuen Mun, Hong Kong?*
What are your reasons for applying as a Mission Builder?*
Please list your ministry and spiritual gifts and provide examples of how they have been used.*
How might your gifts and talents be used in Hong Kong?*
Please list areas of weakness, temptation, and personal struggle both in the past and present. (In Hong Kong, these areas are often targeted for spiritual attack and we would like to better provide appropriate support and accountability.)*
What are your goals and expectations for serving with YWAM Tuen Mun?*
Briefly describe any experience you have had in other cultures.*
Do you prefer to work with a team or as an individual? Please describe your past work setting?*
How do you think you would cope with shared living quarters and different foods?*
Are there any pending circumstances that might necessitate your immediate return from the this school? Such as: financial or legal commitments, care for the elderly/Ill family members, ongoing issues with your children, etc. If so, please explain.*
Are there any other factors in your current situation that you would like to share with us or that we should be aware of?*

Personal History Information

Briefly describe the following:
Your conversion experience and present spiritual relationship with the Lord Jesus*
The areas of your character you are seeking to further develop and improve.*
Your long-term goals*
Your relationship with your local church including areas of ministry, service and leadership experience.*
Your business, professional, mission-related (including YWAM involvement) or other experience*
Your relationship with your family.*
How does your family feel about your plans to enroll in a school with YWAM Hong Kong?*

Thank you for submitting your application! We are very happy that you are applying and look forward to getting to know you more! We will process your application and get back to you!
Should be Empty:

Rows	Yes	No
1. Skin Conditions
2. Eye Trouble
3. Ear Trouble
4. Head Injury
5. Recurrent Headache
6. Epilepsy
7. Fainting Spells
8. Mental/Nervous Disorder
9. Depression
10. Paralysis
11. Excessive Flow
12. Currently Pregnant
13. Severe Cramps
14. Gall Bladder
15. Heart Trouble
16. High Blood Pressure
17. Low Blood Pressure
18. Rheumatism
19. Back Problems
20. Dislocation of Joints
21. Broken Bones
22. Stomach Ulcer
23. Sexually Transmitted Diseases
24. Surgery
25. Jaundice
26. Hepatitis
27. Intestinal Trouble
28. Recurrent Diarrhea
29. Diabetes
30. Anemia
31. Kidney Disease

Rows	Yes	No
1. Chickenpox
2. Measles (Rubella)
3. Measles (Rubeola)
4. Mumps
5. Pertussis
6. Scarlet Fever
7. Tuberculosis

Rows	Yes	No
1. Tuberculosis
2. Diabetes
3. Kidney Disease
4. Heart Disease
5. Arthritis
6. Stomach Diseases
7. Asthma/Hay Fever
8. Epilepsy/Convulsions

Rows	Yes	No
1. Hepatitis A
2. Hepatitis B
3. Typhoid
4. Tetanus/Pertussis/Diphtheria
5. Polio
6. Measles/Mumps/Rubella

First Name

Birth Date (DD/MM/YYYY)

Relationship

Family Member 1

Family Member 2

Family Member 3

Family Member 4

Family Member 5