For Office Use Only Approved by Date Youth With A Mission

Transcription

For Office Use Only
Approved by
Date
Youth With A Mission England and Wales is a registered charity – number 264078
Discipleship Training School Application
Application for
Arts Revolution
Discipleship Training School
1
APPLICANT’
APPLICANT’S NAME
ANTICIPATED START DATE
TO THE APPLICANT
•
•
•
•
Please answer all the questions on this application form.
It will help us if you type your answers or print carefully in black/blue ink
Husbands and wives must complete separate application forms
If you need more space to answer a question, please use a separate piece of paper
PLEASE RETURN THIS FORM TO:
Email: [email protected] OR
Post: YWAM London Urban Key – Taboo Arts Team
252 All Souls Ave, NW10 3AD, UK
Page 1 of 25
2
PERSONAL DETAILS
Surname
Title
First Names
Preferred Name
Present Address
Post/Zip code
Country
Telephone (Home)
(Work)
Mobile
Fax
Email
Permanent address (if different from your present address)
Post/Zip code
Country
Telephone (Home)
(Work)
Mobile
Fax
Email
3
FURTHER DETAILS
Date of birth
Day
/Month /Year
Place of birth
Gender (for accommodation purposes)
Country of birth
Male Female
Marital Status (for accommodation purposes)
Nationality (for visa purposes)
Have you ever been refused a visa to any country? Yes No
(If yes, please give details)
Do you need a visa to work in the UK? Yes No (If yes, please give details below)
Passport number
Page 2 of 25
Passport issue date Day /Month /Year
Passport expiry date Day /Month /Year
Place of Issue
Full name (as in passport)
4
FAMILY
Will your children be accompanying you? Yes No Not Applicable
Names of children accompanying you
Gender
Do they need a visa to live in the UK? Yes No (If yes, please fill in details)
Passport number
Passport expiry date
Nationality
Day
/Month /Year
Passport number
Nationality
Day
/Month /Year
Passport number
5
Nationality
Day
/Month /Year
CHURCH
Which church do you currently attend?
Denomination
Church leader’s name and address
Page 3 of 25
Date of Birth (dd/mm/yy)
Post/Zip code
Country
Telephone (Home)
(Work)
Mobile
Fax
Email
How long have you been attending this church or other churches?
Church name
Dates of attendance
Have you mentioned to your Church Leader you intention of serving with us? Yes No
If NO, please give reason (Please use separate sheet of paper if necessary)
6
YWAM HISTORY (IF APPLICABLE)
Please list your history with YWAM for the last 10 years, starting with the most current
From
To
Course or Position Name of Course/Worker Leader
Please use a separate sheet of paper if necessary.
7
EDUCATION AND QUALIFICATIONS
University/College/Higher or Further Education (post 16 years old) – including dates and
qualifications received:
Page 4 of 25
Location
8
PRESENT OCCUPATION/CAREER DETAILS
Please list all career details other than YWAM for the last 10 years beginning with the most current or send us a copy of CV or
Resume.
From
To
List Employers Job Description or Main Responsibilities
Please use a separate sheet of paper if necessary
9
COMPETENCIES
Which languages do you speak, in order of fluency?
1.
2.
How well do you speak English?
3.
Very Well Well Average Poorly
Practical skills and abilities:
Other talents, special interests, hobbies;
Please note down which genre/s of the arts you will be applying for. Please attach with this form a portfolio (if
applicable) of 10 selections of the last pieces/examples of art under the genre/s you will be applying for.
Visual arts
Photography
Page 5 of 25
Street art
Music
Theatre
Creative Writing
Fashion
Video
Dance
Costume Design
10
CRIMINAL OFFENCES
Have you ever been charged with, cautioned or convicted in relation to any criminal offence not subject to DBS (Disclosure
and Baring Service) filtering rules; or are you at present the subject of a criminal investigations/pending prosecution?
Yes No
If yes, please give details including the nature of the offences and the dates. Please give details of the court(s) where your
conviction(s) were heard, the type of offence and sentence(s) received. Could you also give details of the reasons and
circumstances that led to the offence(s). Continue on a separate sheet if necessary.
Have you ever been the subject of a police investigation in any country, which did not lead to a criminal conviction (not subject
to DBS filtering rules)?
Yes No
If yes, please give details below, including the date of the investigation, the Police Force involved, details of the investigation and
the reason for this, and disposal(s) if known.
To your knowledge have you ever had any allegation made against you, which has been reported to, and investigated by, Social
Services/Social Work Department (Children’s or Adult Social Care)?
Yes No If yes, please provide details, we will need to discuss this with you.
Has there ever been any cause for concern, any disciplinary action ever been taken against you or written warning given to
you in any country, by any employer or any charitable or other organization or body working with children or young people in
relation to your behaviour with children or young people? Yes No (If YES, please give details)
YWAM England and Wales, as an agency working with children and young people, is exempt from the UK Rehabilitation of
Offenders Act (1974) and therefore applicants must declare all previous convictions. Police record checks can be made by
YWAM to verify information.
Page 6 of 25
11
FINANCES
Trainees in YWAM are responsible for providing their own fees and personal living expenses.
ADMINISTRATION FEE
A non-refundable fee of £100 (which covers the cost of processing your application) should be included when you return this
form. Students can send this by paypal to the email address: [email protected]
COSTS
Lecture Phase £2,300 (Includes accommodation and food)
Outreach Phase £1600 (does not include travel to and from your outreach destination)
In addition to the above you should allow some money for leisure etc.
Administration fee £100 due with application (Covers the cost of processing your application, non-refundable.)
Registration fee £200 due when acceptance letter is received (Confirms your acceptance of our offer of a place, nonrefundable. Deducted from total fees)
Lecture fee due on arrival
Outreach fee normally from week 5 (Visa, vaccinations and flight costs payment are responsibility of each trainee.)
If you have any questions or if anything is unclear please contact the School Leader on [email protected]
How will you raise the required finances?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Please state below the support you already have.
£
committed from your church per month
£
committed from friends/relatives per month
£
per month
£
per month
DEBTS and other FINANCIAL OBLIGIATIONS
None
See Below
Liabilities may include doctors’ bills, course fees, loans from banks, credit card debt etc. List any financial obligations you
currently have, and when and how you expect to fulfill them.
Please use a separate sheet of paper if necessary
Page 7 of 25
12
BACKGROUND QUESTIONS
Please answer the following questions on a separate piece of paper (please type or write clearly)
1.
Describe you Christian conversion experience and your present relationship with God
2.
What are your expectations of your time with us?
3.
Do you have any health problems, dietary restrictions or any disabilities that may affect your day-to-day functioning?
If yes, please outline how your functioning may be limited.
4.
Is there anything else you think we should know about yourself or your family? (e.g. current personal issues, health of
yourself and children, children’s educational needs, dependent close relatives)
5.
What is your purpose to training with us?
6.
How do you think you would cope with living closely with others in limited personal space?
7.
What gifts and strengths do you think you bring to the ministry?
8.
How did God lead you to apply to this location? (Please detail any connections you have with this location)
9.
In which areas of your life have you recently seen growth, e.g. spiritual gifts, character etc, and how is this
developing?
10.
13
What do you and others recognize your main weaknesses to be?
DECLARATIONS
I UNDERSTAND THAT:
If I am accepted I will comply with the values and ethos of Youth With A Mission LTD. (These documents can be found in the
YWAM London Urban Key Staff Handbook)
In accordance with the UK Data Protection Act (1998), the information provided on my staff application form will be held
securely, confidentially and will not be kept for longer than is necessary to achieve the stated purposed of recruitment,
selection, supplementary personal details and statistics, or that required by law or our insurance company.
CONSENT FOR TREATMENT – AN EMERGENCY PROVISION
In the event that I am unable to sign a consent form due to incapacity, I hereby give my consent for any treatment/medical
intervention deemed necessary by the attending health care professionals. Whilst YWAM will make every effort to contact my
next of kin/emergency contacts, there may be situations where this is not possible. I, therefore, give permission for YWAM to
act in my best interests. I recognize that in an emergency situation it is standard operating procedure to always act in the
interest of preserving life.
Page 8 of 25
RELEASE OF LIABILITY
Though every effort is made to provide a safe environment, Youth With A Mission Limited, their agents, employees and trainee
assistants are insured against loss or injury caused by the negligence of Youth With A Mission Limited.
In the absence of any negligence or other breach of duty by Youth With A Mission Limited, participation in a Youth with A
Mission Limited organised programme, event or outreach is entirely at the participant’s own risk.
Accordingly participants are required to have adequate medical insurance for all phases of their involvement with Youth With
A Mission Limited.
SAFEGUARDING DECLARATION
If needed, I consent to a criminal records check if appointed to the position for which I have applied. I am aware that details of
pending prosecutions, previous convictions, cautions, or bindovers against me may be disclosed along with any other
relevant information, which may be known to the police.
If needed, I understand that, if I am a UK resident, a check will be made with the Disclosure and Barring Service (DBS) and that
it is an offence for any person to commence Regulated Activity without first providing a valid DBS Disclosure. If I am an
overseas resident, I understand that I will need to provide a police check from my home nation if the position I am appointed
to requires it.
I agree to inform the person within the YWAM base/team responsible for processing applications for Disclosure and Barring
Service checks if I am convicted of an offence after I take up any post within YWAM England. I understand that failure to do so
may lead to the immediate suspension of my work with children or vulnerable adults and/or the termination of my
work/training association with YWAM.
I agree to inform the person within YWAM responsible for processing applications for the Disclosure and Barring Service if I
become the subject of a police and/or a social services/(Children’s Social care or Adult Social Services)/social work
department investigation. I understand that failure to do so may lead to the immediate suspension of my work with children
or vulnerable adults and/or the termination of my work/training and association with YWAM.
Due to the nature of the living environment for most of our YWAM teams, with staff and families with small children living in
close proximity, we need to also ask you to sign this statement.
I confirm that I am not barred from working with children/vulnerable adults.
I have read and agree with the DECLARATIONS, CONSENT FOR TREATMENT and RELEASE OF LIABILITY above, and I declare that I
have completed this application truthfully, to the best of my knowledge.
Signature
Printed Name
Page 9 of 25
Date (dd/mm/yy)
Self- Disclosure
Medical
Reference
APPLICANTS NAME
•
•
•
•
Page 10 of 25
Please answer all the questions on this medical reference form
It will help us if you type your answers or print carefully in black/blue ink.
Husbands and wives must supply separate medical references.
If you need more space to answer a question, please use a separate piece of paper.
1
Applicants Name (Title/Surname/First Name)
Date of Birth
NHS No. (British)
Current Address
Post/Zip Code
Position being applied for
Anticipated start date (dd/mm/yy)
2
G ENERAL HEALTH
Are you able to walk up to six miles (10 kilometres) in one day? Yes No
If this is a problem, please explain:
Are you able to carry out reasonably strenuous physical work? Yes No
If no, please explain:
Are you presently in good health? Yes No
If no, please give brief details:
3
MEDICAL HISTORY
Please answer the following questions as fully as possible:
List all the SERIOUS ILLNESSES and OPERATIONS you have had in the past. (This means any illness requiring hospital admission,
treatment from your doctor for an illness lasting more than one month, or any illness which may have an affect on your health
both now and in the future.) Please also state the outcome and whether there are any residual problems.
Illness/Operation
Page 11 of 25
Date
Outcome
List any SERIOUS MENTAL or PHYSICAL ILLNESS in you IMMEDIATE FAMILY
Illness
Family Member
Describe any CURRENT MEDICAL PROBLEMS for which you are receiving treatment, or which may affect your health:
List any MEDICATIONS which you take, either on a regular basis, or only when needed and for what illness:
What is your height?
Feet
Inches
(or
metres)
What is your weight
Stone
Lbs
(or
kilogrammes)
Describe any current psychiatric problems for which you are receiving treatment or have received treatment in the past (eg.
anxiety, depression, panic attacks, eating disorders, other psychiatric disorders)
Is there any other information which will be helpful for us to know as we consider your application?
4
INOCULATIONS
Due to our close living conditions, we require all staff and trainees to be up to date with their inoculations including:
Rubella (single dose)
Yes No
Date of vaccination
Tuberculosis-TB (single dose)
Yes No
Date of vaccination
Tetanus (every 10 years)
Yes No
Date of vaccination
If these are not available in your country, we will require you to have them within one month of arrival, at your own expense.
Page 12 of 25
5
FOR WOMEN ONLY
Do you have any gynecological problems that still affect you? (eg. Problems with past pregnancies or menstrual periods?)
Please explain.
6
APPLICANT’S RELEASE OF MEDICAL INFORMATION
APPLICANT’S RELEASE OF MEDICAL INFORMATION
I _________________________________________________________(applicant’s name), give permission for
medical information to be reviewed by a registered nurse or medical doctor (or suitably qualified allied health
professional) for purposes of assessing my suitability for service with Youth With A Mission.
I give permission for the release of relevant medical information to the Youth With A Mission medical officer in
consultation, if necessary, with the personnel manager or team leader only.
Signed
Date (dd/mm/yy)
I confirm that this is a true reflection of my medical history and that failure to give any relevant information
may lead to my involvement with Youth With a Mission being terminated.
Signed ______________________________________________
Date __________________________________
When you have completed this Self Disclosure Medical Reference form, please return it to us at the address on the front of this
form.
Page 13 of 25
Emergency Contact
• Please fill in all sections of this form.
• It will help us if you type your answers or print carefully in black/blue ink
• Husbands and wives must complete separate application forms
1
2
PERSONAL DETAILS
Surname
Title
First name
Preferred name
EMERGENCY CONTACT
For all applicants (someone other than your spouse if married)
Surname
Title
First Names
Preferred Name
to you
Address
Post/Zip code
Country
Telephone (daytime)
(Evening)
Mobile
Email
Can this person be contacted in English Yes No
If not, what language do they speak
13 Station Road, London NW10 4UJ, United Kingdom
Page 14 of 25
Relationship
Confidential
Reference
To be completed by a employer or teacher
1
APPLICANTS NAME
POSITION APPLIED FOR
TO THE APPLICANT
Please complete section 1 of this reference yourself. Then give it to your referee to complete the remaining sections. Please
ask your referee to send it back to us independently. If this is by post, please provide them with a stamped addressed
envelope.
TO THE REFEREE
Youth With A Mission (YWAM) is a worldwide inter-denominational missionary organisation, which was founded in 1960. It
provides opportunities for voluntary Christian service on a short- or long-term basis. The applicant has given your name as a
referee. In accordance with the UK Data Protection Act 1998, please confine your answers to what you know of the applicant
from your own experience.
• Please complete sections 2–7 of this reference and return it to the address below or email it to us at the address below.
If you would prefer to give additional comments by telephone, please feel free to do so. We would appreciate it if you
would keep this confidential and not give it back to
to the applicant unless it’s in a sealed envelope.
• Our working and living conditions may be basic and could be stressful for some, so it is in the applicant’s best interest
that you give a realistic, not overly optimistic, reference. Please discuss this reference with the applicant if you think that
would be beneficial to you both.
• Receipt of this form is necessary before we can consider the application. Thank you for taking the time to complete this
reference on the applicant’s behalf.
PLEASE RETURN THIS FORM
FORM TO:
Page 15 of 25
2
Applicants name
Applicants address
Post/Zip Code
What is your relationship to the applicant?
How long have you known the applicant?
How well do you know the applicant? Very Well Quite Well A Little Not At All
3
PERSONALITY/CHARACTER PROFILE
Please assess the applicant on the characteristics listed below according to the following evaluation system and make any
further comments as relevant
1- Usually
2-Often
3- Sometimes 4-Rarely 5-Don’t Know
Adaptable
Demonstrates initiative
Demonstrates leadership potential
Emotionally stable
Honest
Perseveres
Reliable
Sensitive to others
Healthy
Causes Friction
Easily stressed
Teachable/Willing to receive counsel
The applicant will be living and working closely with others for an extended period of time. Do you foresee any difficulties that
would compromise their Christian morality?
Yes No (If yes, please explain)
Please comment briefly on:
The applicant’s spiritual maturity and their growth as a Christian
Their ability to work and relate to others and to be part of a team
Their ability to handle conflict in relationships
What would you see as the applicant’s areas of strength?
What would you see as their areas of weakness?
Page 16 of 25
Have we overlooked anything that you would consider relevant to this application?
5
DATA PROTECTION
In accordance with the UK Data Protection Act 1998, the information provided on my staff application form will be held securely,
confidentially and only used for the purposes needed.
6
WAIVER OF CONFIDENTIALITY
Under the Data Protection Act, an individual has the right to request to see their references with the permission of the author.
Would you be willing for this reference to be disclosed to the applicant on request? Yes No
7
REFEREE’S DETAILS
Name
Work Address
Post/Zip Code
Telephone (Work)
Mobile
Email address
Are you fluent in English? Yes No
If not, which language would you prefer to speak, if we need to contact you?
Signed
Page 17 of 25
Date (dd/mm/yy)
Confidential
Reference
To be completed by a mature Christian friend
1
APPLICANTS NAME
TO THE APPLICANT
ask your referee to send it back to us independently. If this is by post,
post, please provide them with a stamped addressed
envelope.
TO THE REFEREE
would keep this confidential and not give it back to the applicant unless it’s in a sealed envelope.
Page 18 of 25
2
Applicants name
Applicants address
Post/Zip Code
3
1- Usually
2-Often
3- Sometimes
4-Rarely 5-Don’t Know
Adaptable
Emotionally stable
Honest
Perseveres
Reliable
Sensitive to others
Healthy
Causes Friction
Easily stressed
Page 19 of 25
4
SERVING WITH YWAM
Do you recognize that this applicant has a call to missions and/or full time Christian service
Yes No
Please explain
Do you think participation in YWAM would be beneficial for the applicant?
Yes (unreservedly)
Yes (with reservations)
No
Please explain
Do you think YWAM would benefit from the applicant working with us?
Page 20 of 25
Yes (unreservedly)
No
Please explain
Which areas of ministry would you recommend the applicant for?
5
DATA PROTECTION
confidentially and only used for the purposes needed. .
6
7
REFEREE’S DETAILS
Name
Work Address
Telephone (Work)
Post/Zip Code
Mobile
Email address
Signed
Page 21 of 25
Date (dd/mm/yy)
Confidential
Reference
To be completed by your Church leader
1
APPLICANTS NAME
TO THE APPLICANT
ask your referee to send it back to us independently. If this is by post, please provide them with a stamped addressed
envelope.
TO THE REFEREE
would keep this confidential and not give it back to the applicant unless it’s in a sealed envelope.
Page 22 of 25
2
Applicants name
Applicants address
Post/Zip Code
3
1- Usually
2-Often
3- Sometimes
4-Rarely 5-Don’t Know
Adaptable
Emotionally stable
Honest
Perseveres
Reliable
Sensitive to others
Healthy
Causes Friction
Easily stressed
Page 23 of 25
4
SERVING WITH YWAM
Do you recognize that this applicant has a call to missions and/or full time Christian service
Yes No
Please explain
Do you think participation in YWAM would be beneficial for the applicant?
Yes (unreservedly)
No
Please explain
Do you think YWAM would benefit from the applicant working with us?
Page 24 of 25
Yes (unreservedly)
No
Please explain
Which areas of ministry would you recommend the applicant for?
5
DATA PROTECTION
confidentially and only used for the purposes needed. .
6
7
REFEREE’S DETAILS
Name
Work Address
Post/Zip Code
Telephone (Work)
Mobile
Email address
Signed
Page 25 of 25
Date (dd/mm/yy)

For Office Use Only Approved by Date Youth With A Mission

Transcription

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