Team Member Application

Team Member Application
Today's Date:

MonthDayYearHourMinutesAM/PM Option
Pre-Application Questions
Please review our Statement of Faith (PDF).
Have you read and do you agree with the HHH Statement of Faith? (See link above)*
Please review our Project Behavior Code (PDF).
Have you read and will support the Project Behavior Code? (See link above)*
How did you hear about His Healing Hands?

Referral by a friendFacebookInternet SearchHis Healing Hands EmployeeHis Healing Hands Board MemberOther
Type a question
Please tell us the name of the person that referred you so that we may thank them for the referral.
Type of Application*
Full Name (as on passport)*

PrefixFirst NameMiddle NameLast NameSuffix
E-mail*
Phone (Cell)*

Area CodePhone Number
Best Way to Reach You

EmailPhoneText
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone (Home)*

Area CodePhone Number
Date of Birth*

MonthDayYear
Citizenship*
Passport Number*
Known Traveler ID Number
Passport Expiration Date (dd/mm/yyyy)*
Preferred Departure Airport
Shirt/Scrub Size*
Gender*
Education
College(s), Location, Dates
Degree(s), Date(s), Major(s)
Employment
Current Employer & Position
Emergency Contact
First Last Name*
We suggest that your Emergency Contact be someone other than the family member traveling with you on this mission trip.
Relationship*
Email*
Phone (Home)*
Phone (Cell)*
Is this person also the designated beneficiary for the travel insurance?*

YesNo
If no, please provide the name of the beneficiary. First Last Name
Relationship
Email
Phone (Cell)
Health Information
Please describe any physical limitations that require accommodation.
List all current medications being used
Describe any physical limitations that require accommodation
List all allergies
Related Experience & Skills
Have you had any mission or cross-cultural experience?*
If YES, please describe:
Do you speak a second language?*
If YES, which language(s) and what is your fluency?
Project Interests
What geographic areas of the world are your most interested in serving?
Which HHH project interests you most & what would you like to accomplish in that project?
Which HHH project interests you most?

Lima, PeruCosta RicaRomaniaMoyobamba, PeruMexico
Check all months that you are MOST available*

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Check all months that you are LEAST available*

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
What is your strongest personality trait?
Religious Affiliation
Please review the HHH Statement of Faith.
Have you read and agree with the HHH Statement of Faith? (See link above)*
Do you know Jesus as your Savior?*
If YES above, briefly describe your testimony:
What best describes your Christian maturity?*
What church/denomination do you attend?
How long?
How often?
Pastor's Name & Telephone Number
Church location:
MEDICAL PROFESSIONALS (Please skip if this does not apply to you)
What is your medical specialty(ies)?
Number of total years in practice:
Should be Empty:

Team Member Application

Pre-Application Questions

Education

Employment

Emergency Contact

Health Information

Related Experience & Skills

Project Interests

Religious Affiliation

MEDICAL PROFESSIONALS (Please skip if this does not apply to you)