applicants name - ywam london urban key

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’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– 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
Place of birth
/Year
Country of birth
Gender (for accommodation purposes)
Marital Status (for accommodation purposes)
Nationality (for visa purposes)
(If yes, please give details)
Do you
Page 2 of 25
If yes, please give details below)
Passport number
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
Names of children accompanying you
(dd/mm/yy)
Gender
Do they need a visa to live in the UK?
details)
Passport number
Passport expiry date
Nationality
Day /Month
/Year
Passport number
Nationality
Day /Month
/Year
Passport number
Page 3 of 25
Date of Birth
Nationality
Day /Month
/Year
5
CHURCH
Which church do you currently attend?
Denomination
Church leader’s name and address
Post/Zip code
Telephone (Home)
Country
(Work)
Mobile
Fax
Email
How long have you been attending this church or other churches?
Church name
Dates of attendance
Location
Have you mentioned to your Church Leader you intention of serving with us?
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.
Page 4 of 25
7
EDUCATION AND QUALIFICATIONS
University/College/Higher or Further Education (post 16 years old) – including dates and
qualifications received:
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?
Practical skills and abilities:
Page 5 of 25
3.
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 � Street art � Music � Theatre �
Photography � Creative Writing � Fashion �
10
Video � Dance �
Costume Design �
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?
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.
Page 6 of 25
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)?
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)?
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
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 7 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, non-refundable. 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
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 8 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.
What do you and others recognize your main weaknesses to be?
Page 9 of 25
13
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.
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
Page 10 of 25
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 11 of 25
Date (dd/mm/yy)
Self-Disclosure
Medical
Reference
APPLICANTS NAME




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.
Page 12 of 25
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
GENERAL HEALTH
If this is a problem, please explain:
If no, please explain:
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.
Page 13 of 25
Illness/Operation
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
What is your weight
Stone
Lbs
(or
(or
metres)
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?
Page 14 of 25
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)
Date of vaccination
Tuberculosis-TB (single dose)
Date of vaccination
Tetanus (every 10 years)
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.
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
Page 15 of 25
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 16 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
PERSONAL DETAILS
Surname
Title
First name
2
Preferred name
EMERGENCY CONTACT
For all applicants (someone other than your spouse if married)
Surname
Title
First Names
Preferred Name
Relationship to you
Address
Post/Zip code
Country
Telephone (daytime)
(Evening)
Mobile
Email
If not, what language do they speak
252 All Souls Ave, London NW10 3AD, United Kingdom
Page 17 of 25
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 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.
Page 18 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?
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?
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?
Page 19 of 25
What would you see as their areas of weakness?
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?
7
REFEREE’S DETAILS
Name
Work Address
Post/Zip Code
Telephone (Work)
Mobile
Email address
If not, which language would you prefer to speak, if we need to contact you?
Signed
Page 20 of 25
Date (dd/mm/yy)
Confidential
Reference
To be completed by a mature Christian friend
1
APPLICANTS NAME
TO THE APPLICANT
envelope.
TO THE REFEREE
a sealed envelope.
Page 21 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 22 of 25
4
SERVING WITH YWAM
Do you recognize that this applicant has a call to missions and/or full time Christian
service
Please explain
Do you think participation in YWAM would be beneficial for the applicant?
Yes (with reservations)
Page 23 of 25
Please explain
Do you think YWAM would benefit from the applicant working with us?
Please explain
Which areas of ministry would you recommend the applicant for?
5
DATA PROTECTION
purposes needed. .
6
7
REFEREE’S DETAILS
Name
Work Address
Telephone (Work)
Email address
Post/Zip Code
Mobile
Signed
Page 24 of 25
Date (dd/mm/yy)
Confidential
Reference
To be completed by your Church leader
1
APPLICANTS NAME
TO THE APPLICANT
envelope.
TO THE REFEREE
a sealed envelope.
252 All Souls, London NW10 3AD, United Kingdom
Page 25 of 25
2
Applicants name
Applicants address
Post/Zip Code
All
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 26 of 25
4
SERVING WITH YWAM
Do you recognize that this applicant has a call to missions and/or full time Christian
service
Please explain
Do you think participation in YWAM would be beneficial for the applicant?
Please explain
Page 27 of 25
Do you think YWAM would benefit from the applicant working with us?
Please explain
Which areas of ministry would you recommend the applicant for?
5
DATA PROTECTION
purposes needed. .
6
7
REFEREE’S DETAILS
Name
Work Address
Post/Zip Code
Telephone (Work)
Mobile
Email address
Signed
Page 28 of 25
Date (dd/mm/yy)

applicants name - ywam london urban key

Transcription

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