intern at Teen Challenge! Be a part of putting hope within reach while gaining valuable work experience! Location preference: Administrative Office Alum Rock Women & Children Asbury Family Center East Bay / Oakland Men's Center Southern Nevada Men's Center Eagle Springs Teen Boy's Center Ruth's Haven Teen Girl's Center Alpha Henson Men's Center Happy Valley Women's Center Twin Rivers Women's Center Re-Entry Center Applicant Information Name: * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Country (###) ### #### Date of Birth * MM DD YYYY Marital Status: Social Security #: * Driver License #: * State: * Valid? * Yes No Condition of Health: Poor 1 2 3 4 5 6 7 8 9 10 Excellent Health Disabilities: * Physical Disabilities: * Date of Last Physical: Last TB Test: Emergency Contact Nearest relative in case of emergency: * Name: * Address: * Phone: * (###) ### #### Relationship to Applicant: Christian Background What is your local church affiliation? What is your denominational preference? Are you currently a member of a local church? Yes No For how many years? How do you value diversity (such as racial or socioeconomic differences or varying beliefs) and what is your method of working alongside those of diversity? Are you involved in any volunteer work? Yes No Briefly give your Christian testimony: Education High School: * Years: * College Degrees: * Other Training/Skills: * List Professional Credentials: * Area(s) of Ministry Preferred * Administrative Auto Bookkeeping Building Maintenance Culinary Driver Graphics IT Mailings Mentoring Secretarial Reception Teach Children Other: Legal History Have you ever been arrested or convicted of a misdemeanor or other felony offense? If so, please detail: Have you ever been convicted of a misdemeanor or other felony offense? If so, please detail: Employment History Start with the most recent employment. 1. 2. 3. 4. List 2 references. Include one minister and one professional person. Name * First Name Last Name Phone * (###) ### #### Email * Name * First Name Last Name Phone * (###) ### #### Email * Please explain your interest in internship at Teen Challenge: Days and hours you are available: List skills relating to position applied for: Applicant’s Statement: The information contained in this application is correct to the best of my knowledge. I authorize the references listed to give you any information they may have regarding my character and suitability for work at Teen Challenge. Applicant's Signature * First Name Last Name Date * MM DD YYYY Thank you!
