Personal Info:
Are you a Citizen/Subject of the country
in which you currently reside?
Yes No
Gender: Male Female Date of Birth: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
Height: Weight (in pounds): Ethnicity:
Marital Status: Single (not married) Engaged Married (less than a year) Married (more than a year) Divorced Widowed
Spouse's Name: Spouse's Date of Birth: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
Family Info :
Are your biological parents still married? Yes No
What language do you speak at home?
For the non-native English speaker, can you speak English fluently and comprehend it when spoken to? Yes No
Education:
Year completed:
Exams Passed :
GCSE's A-Levels Other exams:
Did you get your degree/diploma? Yes No
Additional Training:
(Ministerial, Military, Vocation/Trade, Apprenticeship/Internship, etc.)
Are you computer literate?
If yes, which programmes are you familiar with?
Microsoft Word Mircosoft Powerpoint Microsoft Excel
Adobe Dreamweaver Adobe Fireworks Adobe Flash
Windows Movie Maker Video Apollo Outlook Express Broadband Internet
Do you know how to :
Use a Jump Drive (including Safe Removal) Burn Info/Music to a CD Download Files
Use iTunes Install Hardware Install Software Intitiate Safe Mode
Restore Settings in Windows Connect and Use a Video Projector
Employment History
Please list your most recent jobs:
Date Hired: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 Leaving Date: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
Medical Info:
Describe your current, over-all health Excellent Good Fair Poor Extremely Poor
List any handicaps, disabilites, or chronic conditions you have
that would hinder your ability to perform your duties as an intern:
Do you have any of these conditions?
Asthma Chronic Illness Diabetes Insomnia Mononucleosis
Sleep-walking IBS (Irritable Bowel Syndrome) Epilepsy
ADD or ADHD (diagnosed) OCD (diagnosed)
List any Allergies you have (including allergies to Medication):
List any Medications that you are currently taking and why they are being used:
Spiritual Info:
Date you accepted Christ as your Lord and Saviour
Date you were baptized (if applicable)
Date you were baptized in the Holy Spirit (if applicable)
Church info:
List any ministeries you've particiapted in
List any church events of which you took part in planning
Your Ministry:
Do you feel God calling your to work in Missions? Yes No Not sure
Explain what you want to accomplish as an intern:
Why do you feel led to serve in Northern Ireland?
What part(s) of working on an internship do think you'll enjoy most?
(Outreach, talking to kids one-on-one, school assemblies, trip planning,
office work, youth group and clubs, special projects, etc.)
What interests, talents, and abilities are you gifted with?
Would your parents support your decision to intern in N. Ireland?
Why or why not?
Briefly explain why you want to be a part of this internship
and how do you see it helping you in the future.
Personal History:
Have you ever been involved/struggle with:
Alcohol and/or Drug Use (Including Cigars/Cigarettes) Gang/Terrorist Activity
Homosexuality The Occult/a Cult Pornography Physical Anger/Altercations
Eating Disorder
Have you ever:
Been Sexually Active Had Professional Counseling Been Pregnant or Fathered a child
Been prescribed mood-altering drugs Intentionally cut/hurt yourself
About You:
(Answer honestly)
What hobbies do you have?
What skills/training would you like to have?
What activities relax you?
What do you look forward to doing all day when you get to go home?
What TV shows do you enjoy watching?
What films do you like to watch?
What books do you enjoy reading (don't just write "The Bible")
What are some websites you frequently visit?
What Sports, Video games, and/or Board games do you like playing?
What clubs/organisations have you been part of?
Are you currently in a Dating Relationship? Yes No
How long have you been in your Dating Relationship?
Do you plan to continue your relationship while interning in N. Ireland? Yes No Not sure...
Self-evaluation:
On a scale of one to ten, ten being the strongest, rate your strengths and weaknesses
10 9 8 7 6 5 4 3 2 1 Relating to new people
10 9 8 7 6 5 4 3 2 1 Being in a crowd
10 9 8 7 6 5 4 3 2 1 Ministering one-on-one
10 9 8 7 6 5 4 3 2 1 Confronting
10 9 8 7 6 5 4 3 2 1 Completing what you start
10 9 8 7 6 5 4 3 2 1 Being an example
10 9 8 7 6 5 4 3 2 1 Submitting to Authority
10 9 8 7 6 5 4 3 2 1 Sense of Humor
10 9 8 7 6 5 4 3 2 1 Being positive in diffculty
10 9 8 7 6 5 4 3 2 1 Encouraging
10 9 8 7 6 5 4 3 2 1 Personal Devotions
10 9 8 7 6 5 4 3 2 1 Adapting to different cultures
What are your top 3 strengths? Why are they your strengths?
What are your bottom 3 weaknesses? Why are they your weaknesses?
What do you think are three qualities of a good leader and why?
What do you think are three traits of a bad leader and why?
Which best describes your temperament?
Patient Enduring Even Easily Angered Ill-Tempered
Which best describes your speech?
Wholesome Decent Coarse Profane Vulgar
Which best describes your actions?
Erradiatic/Impulsive Thoughtful/Sensitive Rooted in Emotion Calculated Happenstance
Experience Areas:
(Check All that Apply)
Construction/Maintenance:
Plumbing Electricity/Wiring Painting Appliance Repair
Masonry Carpentry Décor and Furniture shifting
Childcare/ Youth Ministry:
Ages worked with:
Newborn-Toddler Young Kids (4-7yrs. old) Kids (8-11yrs. old)
Adolescents (12- 15 yrs. old) Upper Teens (16-18 yrs. old)
University Aged (19-23yrs. old) Young Adults (Singles) (24-25 yrs. old)
Experience:
Bible Lessons Worship Puppet shows School Assemblies
Crafts Games Object Lessons Drama Interactive Learning
Grounds Maintenance :
Lawn care (mowing, edging, trimming) Landscaping Gardening Farming
Sprinkler Systems (repair and use) Arborial care (Tree maintenance/removal)
Cooking/Kitchen:
Cooking Cooking for large groups Industrial Cleaning
Cleaning Cookware Stocking Food Food Storage
Office:
Bulk-Mailings Phone Etiquette/Message Taking Filing
Have you ever (officially) served as a Counsellor, Mentor, or
Youth Leader to anyone under the age of 18? Yes No
Are you certified in First Aid or any other
first response medical treatment? Yes No Will be...
References:
(References forms will be e-mailed to appropriate persons and must be completed and returned to contact@rockbelfast.org.uk)
Pastor
-and-
Tutor/Employer
I hereby verify that all the dates, facts, and information I have provided above are factual and accurate to the best of my knowledge.
I understand that submission of this and/or any other forms does not mean immediate acceptance into this internship programme.
Upon signing, I acknowledge that all the information disclosed (medical, personal, spiritual, etc.) are subject to review by members of staff of
ROCK Belfast and affiliate organisations.
I accept these Terms of Agreement
I do not accept these Terms of Agreement
