CPC Youth intern App

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June 2010 CENTERVILLE PRESBYTERIAN CHURCH 4360 CENTRAL AVE :: FREMONT, CA 94536 :: (510) 7933575 INTERN TO YOUTH MINISTRIES APPLICATION PLEASE COMPLETE ALL PAGES OF THIS APPLICATION AND RETURN IT TO MATT KNAPP AT CENTERVILLE PRESBYTERIAN CHURCH BASIC INFORMATION First Name: ____________________________ Last Name: ________________________________ M.I. ___________ Date of Birth: ________ / _________ / __________ Address: ________________________________________________________ City: _________________ Zip: _____________ Home Phone: (_________) __________ ______________ Cell Phone: (_________) __________ ______________ Work Phone: (_________) __________ _______________ Email ________________________________________________ Facebook? Yes No Current Occupation: _________________________________________________________________________________________ Current Employer: __________________________________________________ Start Date: _______ / ______ / _________ EMPLOYMENT/VOLUNTEER INFORMATION Position ____________________________________________ Employer ____________________________________________ Responsibilities: _____________________________________________________________________________________________ _________________________________________________________________________________________________________________ Start Date: _______ / ______ / _________ End Date: _______ / ______ / _________ Position ____________________________________________ Employer ____________________________________________ Responsibilities: _____________________________________________________________________________________________ _________________________________________________________________________________________________________________ Start Date: _______ / ______ / _________ End Date: _______ / ______ / _________ Position ____________________________________________ Employer ____________________________________________ Responsibilities: _____________________________________________________________________________________________ _________________________________________________________________________________________________________________ Start Date: _______ / ______ / _________ End Date: _______ / ______ / _________

description

application for intern position starting in October

Transcript of CPC Youth intern App

Page 1: CPC Youth intern App

June  2010  

CENTERVILLE  PRESBYTERIAN  CHURCH  4360  CENTRAL  AVE  ::  FREMONT,  CA  94536  ::  (510)  793-­‐3575  INTERN  TO  YOUTH  MINISTRIES  APPLICATION  

   PLEASE  COMPLETE  ALL  PAGES  OF  THIS  APPLICATION  AND  RETURN  IT  TO  MATT  KNAPP  AT  CENTERVILLE  PRESBYTERIAN  CHURCH    BASIC  INFORMATION    First  Name:  ____________________________          Last  Name:  ________________________________     M.I.  ___________  

Date  of  Birth:  ________  /  _________  /  __________  

Address:  ________________________________________________________          City:  _________________      Zip:  _____________  

Home  Phone:  (_________)    __________  -­‐  ______________     Cell  Phone:  (_________)    __________  -­‐  ______________  

Work  Phone:  (_________)    __________  -­‐  _______________     Email  ________________________________________________  

Facebook?                Yes                No        

Current  Occupation:  _________________________________________________________________________________________  

Current  Employer:  __________________________________________________  Start  Date:  _______  /  ______  /  _________  

 

EMPLOYMENT/VOLUNTEER  INFORMATION    Position  ____________________________________________      Employer  ____________________________________________  

Responsibilities:  _____________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

Start  Date:  _______  /  ______  /  _________       End  Date:  _______  /  ______  /  _________  

 

Position  ____________________________________________      Employer  ____________________________________________  

Responsibilities:  _____________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

Start  Date:  _______  /  ______  /  _________       End  Date:  _______  /  ______  /  _________  

 

Position  ____________________________________________      Employer  ____________________________________________  

Responsibilities:  _____________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

Start  Date:  _______  /  ______  /  _________       End  Date:  _______  /  ______  /  _________  

 

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June  2010  

 

EDUCATION  INFORMATION    

High  School  

Name  of  School     _________________________________________________________________________________________  

Sports/Activities     _________________________________________________________________________________________  

Awards       _________________________________________________________________________________________  

Graduation  Date:     _______  /  ______  /  _________    

 

College  

Name  of  School     _________________________________________________________________________________________  

Major/Minor       _________________________________________________________________________________________    

Sports/Activities     _________________________________________________________________________________________  

Awards       _________________________________________________________________________________________  

Graduation  Date:   _______  /  ______  /  _________   Degree  Earned  ______________________________________  

 

Other  

Name  of  School     _________________________________________________________________________________________  

Degree/Focus    ________________________________________________________________________________________  

Sports/Activities     _________________________________________________________________________________________  

Awards       _________________________________________________________________________________________  

Graduation  Date:   _______  /  ______  /  _________   Degree  Earned  ______________________________________  

 

ADDITIONAL  INFORMATION  Hobbies  and  Interests  

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________  

 

What  is  one  thing  you  think  is  a  major  challenge  facing  American  youth  today?    

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________  

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June  2010  

SPIRITUAL  INFORMATION  

Who  is  Jesus  to  you?  _________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

Home  church    ________________________________________________________________________________________________  

How  long  have  you  attended  this  church?  ___________________      Are  you  a  member?  _____  Yes      _____  No  

Please  list  the  name,  city,  and  state  of  churches  you  have  attended  regularly  during  the  past  5  

years:    

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

Why  do  you  feel  called  to  this  position?  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

What  are  some  of  your  spiritual  gifts  that  you  plan  to  use  in  your  ministry  at  CPC?  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

What  are  your  vocational  goals?  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

_________________________________________________________________________________________________________________  

Have  you  worked  with  youth/children  in  the  past?  _______  Yes    ______  No        

Where?  ______________________________________________________      In  what  role?  ________________________________  

For  how  long?  _________________________          Age  groups?  _________________________  

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June  2010  

PERSONAL  BACKGROUND  

 

Have  you  ever  been  tried  or  convicted  of  child  abuse,  child  molestation,  domestic  violence  or  any  

other  crime  related  to  children?  ________  Yes      ________  No    

If  “Yes”  please  explain:  _____________________________________________________________________________________  

Have  you  ever  been  convicted  of  any  other  criminal  charges?  ________  Yes      ________  No    

If  “Yes”  please  explain:  _____________________________________________________________________________________  

 

PLEASE  PROVIDE  3  REFERENCES  

Name:  ______________________________________    Phone  (_______)  _______  -­‐  _____________  Years  known:  _________  

Address/State/Zip:  __________________________________________________________________________________________  

Relationship  to  you:  _________________________________________________________________________________________  

 Name:  ______________________________________    Phone  (_______)  _______  -­‐  _____________  Years  known:  _________  

Address/State/Zip:  __________________________________________________________________________________________  

Relationship  to  you:  _________________________________________________________________________________________  

 Name:  ______________________________________    Phone  (_______)  _______  -­‐  _____________  Years  known:  _________  

Address/State/Zip:  __________________________________________________________________________________________  

Relationship  to  you:  _________________________________________________________________________________________  

 The  information  contained  in  this  application  is  correct  to  the  best  of  my  knowledge.  I  authorize  any  reference  or  churches  listed  in  this  application  to  give  you  any  information  (including  opinions)  that  they  may  have  regarding  my  character  and  fitness  for  work  with  children.  In  consideration  of  the  receipt  and  evaluation  of  this  application  by  Centerville  Presbyterian  Church  I  hereby  release  any  individual,  church,  youth  organization,  charity,  employer,  reference,  or  any  other  person  or  organization,  including  record  custodians,  both  collectively  and  individually,  from  any  and  all  liability  for  damages  of  whatever  kind  or  nature  which  may  at  any  time  result  to  me,  my  heirs,  or  family,  on  account  of  compliance  or  any  attempts  to  comply,  with  this  authorization.  I  waive  any  right  that  I  may  have  to  inspect  my  information  provided  about  me  by  any  person  or  organization  identified  by  me  in  this  application.        Signed:  ____________________________________________________        Date:  _________  /  ___________  /  _________________  


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