Purpose Statement

Village Missions exists to glorify Jesus Christ

by developing spiritually vital churches in rural North America

To the Board of Village Missions:

I have studied the literature and doctrinal statement of Village Missions and wholeheartedly agree with them. I sincerely

believe that God is leading me to make application for missionary service. I realize that a decision concerning my

acceptance can be reached only after the references, interview and candidate school are completed

If accepted, I will as a Village Missionary uphold the policies and cooperate fully with the leadership of the Mission. I will

not propagate convictions contrary to those in the Village Missions Statement of Faith.

I acknowledge by entering my name and the date below that all information submitted by me in this application
is honest and accurate to the best of my knowledge. Please email back to our office:
sbasaraba@villagemissions.org.
Signature: _     _____________ Date:      __

This application will be valid for two years from the time we receive it. After two years a new Formal
Application will need to be submitted to continue with the application process.

Please print out, sign and mail back to Village Missions, PO Box 197, Dallas, OR 97738 or email to

sbasaraba@villagemissions.org .

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 Formal Application – (MALE)

Please answer all questions in complete sentences, (no one word responses). This will avoid delay in the
application process

1. General Information:
A. Identification
1. Full legal name:       Nickname:      

2. Present Address:      

Phone:       Email address:      

3. Permanent mailing address: (For use in case of emergency. Do not give spouse.)

Name      Relationship      

Address :       Phone:      

4. Place of birth:      Driver’s License #       (Canada) SIN #      

B. Family
1. Martial Status: Single Engaged Married Widowed Remarried

If engaged give: Name of fiancée      

Probable date of marriage      
Have you ever been divorced? Yes No

2. Children: (Give name, gender, and date of birth of each child.) How many living at home?     

Name:       Gender:       Date of Birth:       Name:      Gender:      Date of Birth:      

Name:       Gender:       Date of Birth:       Name:      Gender:      Date of Birth:      

Name:       Gender:       Date of Birth:       Name:      Gender:      Date of Birth:      

Name:       Gender:       Date of Birth:       Name:      Gender:      Date of Birth:      

C. Education
1. List secular schools attended beyond high school:

DATES DEGREE(S)
NAME      CITY      ATTENDED      MAJOR(S)      EARNED     

DATES DEGREE(S)
NAME      CITY      ATTENDED      MAJOR(S)      EARNED     

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 2. List schools where you received formal Bible training:
DATES DEGREE(S)
NAME      CITY      ATTENDED      MAJOR(S)      EARNED     

DATES DEGREE(S)
NAME      CITY      ATTENDED      MAJOR(S)      EARNED     

3. Do you plan further study? If yes, explain:      

D. Health
1. In the last 2 years how many days have you lost from work or school due to illness?     

2. From past experience, how do you respond to stress?      

3. Have you ever had counseling for emotional problems? Yes No If yes, explain      .

4. How much regular physical activity are you accustomed to and how important is this to you?      

E. Employment

1. Work Experience: List major employment experience beginning with most current employer: company,
length and nature of work. (Please include address and phone number of current employer.)
Current Employer:       Company       Nature of work:      How Long:      Address:      Phone:     

Previous Employer:       Company       Nature of work:      How Long:      Address:      Phone:     
Previous Employer:       Company       Nature of work:      How Long:      Address:      Phone:     
Previous Employer:       Company       Nature of work:      How Long:      Address:      Phone:     

2. Special Skills: Frankly evaluate your practical abilities. (Indicate: limited, moderate, proficient.)

L M P L M P
Computer Gardening
Bookkeeping Mechanical Word
Processing Building/Painting Commercial
art Masonry Management
Electrical
Other
F. Financial
1. Please show the amount owed for the following categories.

Credit Cards $       Other debt $      

2. Is any other than your family dependent upon you for support?      

3. Do you own your own home?       Amount owed in home loans $      

4. Define your financial philosophy and expectations.      

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II. Specific Information
A. Personal

1. In what community activities have you taken part?      

2. In what extra-curricular activities were you involved during post high school education?      

3. What are your cultural interests (music, art, etc.), and how do you express these interests?      

4. List the books you have read in the past 12 months (other than for school).      

5. Which magazines do you read regularly?      

6. What special interests or hobbies do you enjoy?      

7. How do you most like to spend you leisure time?      

8. What has caused you the most humiliation or sense of failure?      
9. What has been most rewarding or given you a sense of accomplishment?      

B. Spiritual Life
1. On what scriptural ground are you assured of your salvation?      

2. What are your personal habits in devotional Bible study and prayer?      
Do you have regular devotions with your wife? Yes No
Your family? Yes No

3. Candidly state what the greatest area of need is in your spiritual life.      

4. List your practical Christian service involvement:

Past -      
Present -      

5. How has your compassion for those without Christ been expressed during the past year?      

6. Have you been used to lead people to a definite knowledge of Christ? Yes No
Indicate specific results.      

C. Ministry
1. Check the ministries in which you recognize: (1) Little endowment, (2) Moderate endowment,
(3) Blessing

1 2 3 1 2 3
Helps Singing (group)
Visitation Singing (solo)
Counseling Leading Music/Worship
Teaching Instrument
Preaching Other     
Evangelism
Children/Youth
Mercy
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 2. What factors have led you to believe God wants you to be in vocational Christian ministry?      

3. Why do you believe God may be leading you to Village Missions?      

4. How does your family (wife and children) view your move into this ministry?      

5. How do you intend to balance your time spent in preparation for preaching and outreach into the
community with family life?      

6. What is the distinction between a pastoral ministry and a missionary ministry?      

7. What is your greatest ministry interest?      

8. What is your concept of a visitation ministry?      

9. Would you have any serious reservations about having fellowship, including the Lord’s table,
with those of church backgrounds other than your own? Explain.:      

10. Should you be accepted, are you willing to:

Receive counsel regarding personal or social habits which might lessen your influence as a missionary?
Receive counsel from your District Representative on any matter pertaining to your ministry?
Personally promote the Lord’s ministry of Village Missions on your field?
Accept appointment under the direction of Village Missions?
Give financially to the support of Village Missions as God enables?
Abstain from the use of all alcoholic beverages?

If any of your answers were no, please explain:      

11. Are you ordained?       If so, by whom?      

III. Life Sketch

Use this page to give a brief sketch of your life. Please include pertinent factors such as childhood, setting
(rural, suburban, urban, etc.), home life, salvation, church background, marriage, leading to missions, etc.,
to the present.     

V. Statement of Faith
Without outside help (except from the Bible and a concordance) PLEASE STATE IN YOUR OWN WORDS ,
your views on the following doctrines:

A. Inspiration of the Scriptures - I believe:      

B. The Trinity
1. God the Father - I believe:      

2. Jesus Christ
a. Life and ministry - I believe:      
b. The atonement - I believe:      

3. Holy Spirit

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 a. Person and work - I believe:      
b. The baptism and gifts - I believe:      
c. Please express your convictions regarding the charismatic movement - I believe     

C. Man (creation, effect of the fall, eternal destiny, sinfulness of man) - I believe:     

D. Salvation (the work, eternal security and subsequent life) - I believe:      

E. The Church (its nature, its mission and its polity) - I believe:      

F. The Sacraments (significance of baptism and the Lord's supper) - I believe:      

G. The Second coming (include eternal state of the saved and lost) - I believe:      

If you have served with another ministry organization please give:

Name:       Address:      

Phone number:      

E-Mail:       Fax:      

I acknowledge by entering my name and the date below that all information submitted by me in this
application is honest and accurate to the best of my knowledge.
Signed ___________________________________________________________ Date _______________________
The times in which we live have put great stress on the hiring, deployment, supervision and firing of employees. This has been
particularly serious when associated with those who will be involved in the teaching and supervision of children. Laws are putting
increasing responsibility on the employer to check the backgrounds of potential employees for these sensitive positions. Village
Missions is saddened by the need to ask some difficult questions. However, since it is our desire to do the very best for the
communities, families and individuals we serve, we find it imperative that we explore these areas to the fullest. We apologize for any
inconvenience this may pose.

1. Have you been the subject of any debt collection action in the past twelve months? Yes No
If so explain.      

2. Have you ever been known by any other name? Yes No

If so, what is it and the period of time you used it?      

Hereby certify that:

(a) No civil, criminal, or ecclesiastical complaint has ever been sustained or is pending
against me for sexual misconduct, crimes of violence or drug charges of any nature;
(b) I have never resigned or been terminated from a position for reasons related to sexual
misconduct, crimes of violence or drug charges of any nature;
(c) I have never been required to receive professional treatment for reasons related to
sexual misconduct on my part, crimes of violence or drug charges of any nature.

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I acknowledge by entering my name and the date below that all information submitted by me in this
application is honest and accurate to the best of my knowledge.

Signed __________________________________________________________ Date ________________________

NOTE: If you are unable to make the above certification you may instead give
a description of the complaint, termination, or course of treatment you
have been involved in, giving dates, names and addresses of churches
or physicians, the outcome of the situation and any explanatory comments you care to add.

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 References

Please give names of those who know you well - not mere acquaintances. (No foreign references)
Give name, complete address, and phone number.
(Husband’s and wife’s references must not be the same, except pastor’s.)
If some do not apply, substitute an additional friend

• Your Pastor: Name:      

Address:      City:      Prov.:      Postal Code:      Phone:     Email:      

• Present Employer :: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Work Associate : :: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Associate in Christian Service: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Relative: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Friend: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Friend: Mr.: / Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• College Advisor: Mr.: / Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Classmate: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

• Non-Christian Friend: Mr.: Mrs. Miss. Name:      

Address:      City:      Prov:      Postal Code:      Phone:     Email:      

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 VILLAGE MISSIONS
Declaration of Faith
WE BELIEVE:

The supernatural and plenary inspiration of the Scriptures—that they are inerrant and that their teaching
and authority are absolute, supreme, final, and complete;

The trinity of the Godhead—God, the Father; God, the Son; and God, the Holy Spirit;

The personality of God; the personality and deity of Jesus Christ, begotten of the Holy Spirit, born of the
Virgin Mary, very God and very man; and the personality of the Holy Spirit;

The resurrection of Jesus Christ—that His body was raised from the dead according to the Scriptures, and
that He ascended into Heaven and sitteth on the right hand of God as the believer’s Advocate;

The sinfulness of man—that all human beings are born with a sinful nature, and are totally depraved and
need a Savior from sin;

The Atonement—that Jesus Christ became the sinner’s sacrifice before God and died as the propitiation
for the sins of the whole world;

The necessity of the new birth—salvation is by grace through faith and not of works; saving faith will
maintain good works in the life of the believer,

The literal resurrection of the body, both of the just and of the unjust;

The everlasting blessedness of the saved, and the everlasting punishment of the lost;

The evangelization of the world—the supreme mission of the Church in this age is to preach the Gospel
to every creature;

The second coming of Christ according to Scripture.

I have read the Declaration of Faith and I agree with the position set forth in the above statements.

Signature _     ____________ Date _     _______________

Please print out this page, sign it and mail it to Village Missions, PO Box 197, Dallas, OR 97338

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Please include with this completed application, a
20-30 minute DVD or CD of you preaching. This
may be done in a classroom or church setting.

Mail it to:
Village Missions
PO Box 197
Dallas, Oregon 97338 or email to
sbasaraba@villagemissions.org.
Thank you!

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 RECORDS SEARCH
To: Village Missions
PO Box 197
Dallas, OR 97338

Agency:
Name: __________________________________________

Address: ________________________________________

________________________________________

A search of our records and NCIC records as of Date: ____________, regarding:

Name: _______________________________________________

DOB: _______________________________________________

Present Address: ______________________________________

_____________________________________

Previous Address: ______________________________________

______________________________________

Indicates:

_____ NO RECORDS FOUND: In house search for the past five years reveals no record.

_____ ARREST RECORD FOUND

Date of arrest __________________ Charge________________________

Disposition_______________________________

Records search completed and prepared by: ____________________________

Title

Please print out, fill in and mail back to Village Missions, PO Box 197, Dallas, OR 97338 or email to
sbasaraba@villagemisisons.org.

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