Beruflich Dokumente
Kultur Dokumente
1,July29,2015
OurmissionisToprovideacommunallivingspaceforyoungadultstoserve,bothintheparish
andthebroadercommunity,whilecomingtoadeeperpersonalspiritualandvocational
understanding.Thereforeacarefulassessmentofeachapplicantssuitabilityiscriticaltothe
applicationprocess.Ifyouhavequestionsorconcernsregardinganypartoftheapplication
pleasetalktous!
Onacceptance,youwillneedtogetaCriminalRecordsCheck,orequivalent,inyourprovince
ofresidency.Forexample,ifyouarefromBC,Canadayoucanfindoutmoreinformation
here
.
Youwillbereimbursedforthisexpense.
Yourprivacyandconfidentialityisveryimportanttous.Onlytheadmissionsadministrativeteam
willhaveaccesstothisinformation.
Instructions
Pleaseanswer,indetail,allofthequestionsastheypertaintoyou.
Youcansendittouselectronicallyorviaregularmail.
Whenansweringthesequestionsbeyourself.Thesequestionssimplyhelpuslearn
moreaboutyou.
ContactInformation
1.Name:
2.DateofBirth:
3.CurrentAge:
4.CurrentCitizenshipStatus:
5.GenderDesignation:
6.CurrentAddress:
7.Email:
8.Telephone:
9.Cell:
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HineniHandbook1.1,July29,2015
10.Doyouhavehealthinsurance?N/YDetails:
11.Doyouhaveadriverslicence? Y/NClass:
Languages
1.IsEnglishyourprimary(1st)language?Y/N
2.Ifno,whatisyourprimarylanguage?:
3.Otherthantheabove,doyouspeakanyotherlanguagescompetently?:
Education
1.WhatisthehighestlevelofEducationthatyouhavecompleted?
2.Ifaccepted,areyouplanningtobeworking/goingtoschool?(pleasecircle)
WorkExperience
Pleasegiveussomedetailsofthelasttwoworkexperiencesyouhad.
1.PlaceofWork:
2.NameofSupervisor:
3.DatesofEmployment:
4.Positionandonesentencedescription:
5.PhoneNumber:
6.NumberofYears:
1.PlaceofWork:
2.NameofSupervisor:
3.DatesofEmployment:
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HineniHandbook1.1,July29,2015
4.Positionandonesentencedescription:
5.PhoneNumber:
6.NumberofYears:
VolunteerExperience
Pleasegiveussomedetailsofthelasttwovolunteerexperiencesyouhad.
1.PlaceofWork:
2.NameofSupervisor:
3.DatesofEmployment:
4.Positionandonesentencedescription:
5.PhoneNumber:
6.NumberofYears:
1.PlaceofWork:
2.NameofSupervisor:
3.DatesofEmployment:
4.Positionandonesentencedescription:
5.PhoneNumber:
6.NumberofYears:
MentalandPhysicalHealth
Thenatureofthecommunitylifeandprojectactivities,especiallywhentakentogetherwithwork
orschooldemands,maybeespeciallychallengingforthosewithcertainmentalandphysical
conditions.Pleasediscloseallrelevantinformation.Wewillholdallhealthinformation
confidential,availableonlytotheinterviewingcommitteeandCommunityDirector.Pleasefill
outallthatappliestoyouandindicateN/Aotherwise.
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HineniHandbook1.1,July29,2015
1.Areyouseeingadoctororspecialistonaregularbasis?Y/N
Ifyes,explainhowoftenandforwhatpurpose.
2.Doyouhaveanyallergies?Y/N
Ifyes,pleaselistthem:
3.Haveyoubeenhospitalizedwithinthelast12months?Y/N
Ifyes,pleaseexplain:
4.Doyouhaveanydietaryrestrictionsorpreferences?Y/N
Ifyes,pleaseexplain:
5.Rateyourgeneralhealthinthelast12monthsonascaleof110(1ispoor.10ispeachy).
_______________
Pleaseexplain:
6.Haveyousufferedwithanychronicconditionsorillnesses?Y/N
Ifyes,pleaseexplainfrequencyandseverity.
7.Arethereanypsychologicalissueswhichwouldhaveanimpactonyourabilitytobepartof
Hineni?Y/N
Ifyes,pleaseprovidesomedetail.
8.Isthereanythingregardingyourphysicalormentalhealththatwemayneedtoknow,which
hasnotbeenasked?Y/N
Ifso,pleaseelaborate:
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HineniHandbook1.1,July29,2015
SpiritualFormation
1.Inmychildhood,myfamilyandI:
Regularlyattendedreligiousservices.Details:___________________
Sometimes
Notatall
2.Atpresent,Iwoulddescribemyselfas:
ApracticingChristian.Denomination:__________________
Christian,butnotpracticing
NotChristian.Writeasentenceortwointhespacebelowthatwoulddescribeyour
spiritual/religiousorientation.
3.Describeyourfaith/spiritualjourneyincludinganypracticesthathavebecomeanimportant
partofyourlife.
4.DoyouhaveanyconcernsaboutbeingpartofashorttermintentionalChristianfaith
community?Ifso,pleaseelaborate.
PersonalGoals
1.Inashortparagraph(about250words)telluswhyyouareattractedtoHineni?Attacha
separatepageifnecessary.
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HineniHandbook1.1,July29,2015
2.Howdoyouhopetogrowoverthecourseofyour11monthsatHineni?
AUTHORIZATIONSIGNATURE
Bysigningmynameinthespaceprovided,IcertifythatalltheinformationIhaveprovidedin
thisapplicationformiscomplete,accurateandtruthfultothebestofmyknowledge.I
understandthattheinformationIhavegivenisavailableonlytotheHineniadministrativeteam.
Igivepermissiontotheadministrativeteamtodiscussallinformationthathasbeenandwillbe
giveninmyapplicationmaterials.
Signature:
(printed)___________________Date:
ApplicationChecklist
IhavefilledouttheapplicationinfullincludingtheaboveAuthorizationSignature
Uponacceptance,IamwillingtogetaCriminalRecordsCheckorequivalent
Ihavedistributedreferenceformsto23referralswhowillmailoremailtheircompletedforms
to
hinenihouse@gmail.com
.
IhavesignedtheattachedLifestyleAgreement
IhavesignedtheattachedMediaReleaseForm
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