M2S Intern Application Form

M2S Intern Application Form
M2S Intern Application Form
Are you applying for a Chaplaincy Intern position or a non-Chaplaincy Intern position? If you are unsure, please select non-Chaplaincy.*

ChaplaincyNon-Chaplaincy
Date of Application*

YearMonthDay
Date

Name*

First NameMiddle NameLast Name
What is your birth date?*

YearMonthDay

Permanent Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred Address*

YesNo

Temporary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred Address*

YesNo

Email*

Confirmation Emailexample@example.com
Home Phone Number

Country CodeArea CodePhone Number
Work Phone Number

Country CodeArea CodePhone Number
Cell Number

Country CodeArea CodePhone Number

Citizenship*
Languages spoken other than English:

Physical Fitness*

Heart problemsBreathing problemsJoint problemsFear of heightsNone of the above
Explain, if applicable
Please list any dietary restrictions or food allergies.*
Are you comfortable to walk 1 km?*

YesNo
Your training will normally include ship visits with our chaplains. Do you have any physical limitations that would prevent you from climbing a flight of stairs?*

YesNo

Status*

EmployedUnemployedSemi-retiredRetiredStudentOther
What is/was your Occupation?
Is this a present or previous occupation?

PresentPrevious

Availability: Please specify your preferred dates:
From*

YearMonthDay
I am available from this date...
To*

YearMonthDay
...to this date.

Church Membership (Optional)
Church Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you regularly attend this church (i.e. most Sundays)?

YesNo
Are you active in this church?

YesNo
In what ways do you participate in the life of the church?

Please tell us a bit about yourself. In particular, we'd love to know about your present situation, work background, passions, hobbies or special skills.*
Why are you interested in volunteering with The Ministry to Seafarers?*
Describe your faith journey, if applicable.*
Describe any cross-cultural experiences you have had.*

Photo Consent: Do you grant permission for use of photos taken of you for promotional purposes?*

YesNo
Background Checks: We require a current background check. Do you already have one that you could supply?*

YesNo
Do you have any criminal convictions/cautions, with the exception of fixed penalty traffic offences?*

YesNo
If yes, please explain

Do you have a valid driver's license?*

YesNo
How many years of driving experience do you have?*
How many at-fault accidents have you had in the past 5 years?*
How many minor traffic violations have you had in the past 3 years?*
How many major traffic violations have you had in the past 3 years?*
Examples: excessive speeding, failure to remain at the scene
Have you had any criminal convictions related to driving?*

YesNo
If yes, please specify.

Important Notes

As your role may involve driving, you will be asked to read and sign a Safe Driving Statement before this application is considered complete.
Applicants with a valid driver's license who are accepted as interns will be required to bring their license with them. We will retain a copy for our files.

References

List two persons other than relatives. One reference should be from an employer, professor or other leader who has mentored you. The other should be completed by someone who can vouch for your character.
Reference #1: Name*

First NameLast Name
What is this person's relationship to you?*
Reference #1's: Email
example@example.com
Reference #1's: Phone Number

Country CodeArea CodePhone Number

Reference #2: Name*

First NameLast Name
What is this person's relationship to you?*
Reference #2's: Email
example@example.com
Reference #2's: Phone Number

Country CodeArea CodePhone Number

Person(s) to contact in case of emergency:

Please list two individuals who have the authority to make decisions on your behalf. Please ensure their contact information is current.
Emergency Contact #1: Name*

First NameLast Name
What is this person's relationship to you?*
Emergency Contact #1: Email
example@example.com
Emergency Contact #1: Phone Number*

Country CodeArea CodePhone Number

Emergency Contact #2: Name*

First NameLast Name
What is this person's relationship to you?*
Emergency Contact #2: Email
example@example.com
Emergency Contact #2: Phone Number*

Country CodeArea CodePhone Number

Thank you for your application. We will respond to you within 5 business days.
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