Servant Leader Application

Contact Details

First Name

Last Name

Cell Phone

Home Phone

Personal Email

Mailing Street

Mailing City

Mailing State

Mailing Zip/Postal Code

Date of Birth

DD/MM/YYYY

Gender

US Citizen

Authorized to work in US

Marital Status

Number of Children

Application Details

Who referred you to His Mansion?

Desired Start Date

DD/MM/YYYY

Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Email

Emergency Contact Phone

Emergency Contact Address

Relationship to Emergency Contact

Education

Highest level of education:

Name of most recent school:

School attendance dates:

Employment

Current Employment Status:

Employer:

Position:

Responsibilities:

May we contact your employer?

If no, why?

Supervisor

First Name

Last Name

Phone

Military Service

Military Service?

Dates served:

Rank at discharge:

Type of discharge:

Reference #1

First Name

Last Name

Phone

Company

Relationship

Reference #2

First Name

Last Name

Phone

Company

Relationship

Physical, Emotional, Mental and Behavioral Background

Please answer the following questions. Answering "Yes" to any of the following questions will not disqualify you from service at His Mansion. We respect and value your honesty. Please provide a brief explanation for any items that you check "Yes".

Do you have any medical conditions or health issues?

Describe health issues:

Are you diagnosed with a learning disability?

Describe learning disability:

Have you been diagnosed by a mental health professional?

Describe mental health diagnosis:

Currently Taking Medical Prescriptions?

List all prescription medications:

Have you ever been hospitalized for emotional or behavioral problems?

Describe hospitalizations:

Did hospitalizations occur in last 6 months?

Do you have any allergies?

Describe allergies:

Is your diet restricted in any way?

Describe dietary restrictions:

Are you aware that His Mansion has a strong work component?

Do you have any health problems that hinder you from doing physical work, including heavy lifting?

Describe physical restrictions:

Legal Background

Do you have a criminal record?

Describe your criminal record:

Do you have any pending legal issues with the criminal justice system?

Describe pending legal items:

Are you on probation or parole?

Describe probation or parole:

Are you legally required to register as a sex offender with your state, local police department?

Spiritual Background

Do you attend a church?

Church Name:

Church Denomination:

Church Website:

Description of your experience with this church:

Have you discussed serving at HM with your Pastor?

If you have not discussed with your pastor, why?

Pastor

First Name

Last Name

Phone

Short Essay

Please answer the following questions. Your answers will help us get to know you as a person. Please take the appropriate time to reflect and answer these questions in no more than two paragraphs per question. We value your honesty and thoughtfulness.

Who is God to you and does he play a role in your life?

Who are you? How would you describe yourself?

How did you come to know God? Describe your relationship with God.

In your understanding, what is the gospel?

What do you believe about the Bible? What role does it play in your life?

How do you want to serve at HM? How do you hope to grow through service?

Primary Address Type

Mailing Country

Application Type

Contact Information