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PERSONAL CONTACT INFORMATION
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*Name |
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*Address
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*City
*State
*ZIP
+4
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*Home Phone
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*Cell Phone (other)
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...E-Mail
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*Social Security #
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*Driver's License #
*State
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(*required information)
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Can you, in clear conscience, support Crossings Community Church's doctrinal position
and statement of faith? (Please read:
Beliefs and
Core Values)
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EXPERIENCE and SKILLS
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Briefly describe two significant ministry responsibilities (paid or volunteer) you have had
in either a church or a "para-church" organization (include information about the size of the church,
size of the student ministry, ages of students, etc.)
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What employment experiences have you had in the marketplace that would enhance clinical skills?
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What general skills, natural talents or special abilities do you possess?
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"WALK" and SPIRITUAL GIFTS
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Please summarize how you came to know Jesus Christ as your Savior and how
you maintain your relationship with Him:
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Why do you desire an internship with CCC LifeCare Ministries?
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How would you describe your "call" to full-time vocational ministry?
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Describe one or more of the significant spiritual challenges God has allowed
you to experience this year. How has this changed you?
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What is the most compelling clinical material/spiritual material you have read this year and why?
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What are your expectations for the internship?
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What is your goal in life?
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Where do you hope to be in five (5) years in ministering out of your gifts?
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Identify three of your favorite ways to spend free time (i.e., hobbies, interests):
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What is one of your strongest qualities?
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What is one of your weakest qualities?
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Have you ever been convicted of or pled guilty to a felony or a crime involving dishonesty?
If yes, please explain:
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Choose one word that best describes your personal views on the following:
Drinking alcoholic beverages:
Premarital sex:
Homosexuality:
Abortion:
Eating disorders:
Secular music:
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To me, the "gray areas" of life for a Christian
(i.e., "social" drinking, tobacco, marijuana, abortion) are:
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CHURCH BACKGROUND
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Denominational background:
Current church and address:
Pastor:
Phone:
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EDUCATION
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High School Attended:
Years:
College Attending:
Year of Graduation:
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CURRENT EMPLOYMENT
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Are you working:
and/or are you in school:
?
Employer Name:
Phone:
Complete Address:
Position held:
May we contact the employer?
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PAST EMPLOYMENT
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Employer Name:
Phone:
Complete Address:
Position held:
May we contact the employer?
Reason for leaving:
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Employer Name:
Phone:
Complete Address:
Position held:
May we contact the employer?
Reason for leaving:
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REFERENCE LIST
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List two people (other than family) on whom you have had the greatest influence or impact:
Name:
Phone:
Address:
City:
State:
Zip:
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Name:
Phone:
Address:
City:
State:
Zip:
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APPLICANT'S CERTIFICATION
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I certify that the information given by me in this application is true in all respects,
and I agree that if the information given is found to be false in any way, it shall be
considered sufficient reason for denial of internship employment or discharge. I authorize
the use of any information in this application to verify my statements, and, except as
indicated above, I authorize the past employers, all references, and any other persons to
answer all questions asked concerning my ability, character, reputation, and previous education
or employment record. I release all such persons from any liability or damages on account of
having furnished such information. I consent to such investigations as Crossings Community Church
may make regarding driving records, law enforcement records, credit reports and my general background.
I further understand that all applicable portions of this application must be completed, or I will
be ineligible for consideration for the position for which I am applying.
I understand that nothing contained in this application or in the granting of an interview or of
a position of employment is intended to create an employment contract between Crossings Community
Church and myself for either employment or for the providing of any benefits. No promises regarding
employment have been made to me, and I understand that no promise or guarantee of employment for any
specific length of time or under any specified circumstances shall be binding upon Crossings Community
Church unless made in writing by or with the express written consent and authorization of the Director
of Administrative Affairs. If an employment relationship is established, I understand that I have the
right to terminate my employment at any time and for any reason and that Crossings Community Church
retains the same right.
I understand that, depending on the position applied for, prior to being offered employment with
Crossings Community Church I may be requested to take an examination pertaining to skills or equipment
operation. In the event I have a disability which will affect my ability to take the test, I will so
inform Crossings Community Church prior to the administration of the test so that a reasonable accommodation
can be made. Requested accommodations may include accessible testing sites, modified testing conditions,
and accessible testing formats. Crossings Community Church reserves the right to require medical documentation
concerning the need for the accommodation.
I understand that if employed, the policies and rules which are issued by Crossings Community Church are
not conditions of employment and that Crossings Community Church may revise policies or procedures, in whole
or in part, unilaterally at any time.
IMPORTANT: IF YOU DO NOT UNDERSTAND OR IF YOU DISAGREE WITH ANY PORTION OF THE ABOVE
CERTIFICATION, DO NOT AGREE BEFORE DISCUSSING WITH CROSSINGS COMMUNITY CHURCH.
Date:
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14600 North Portland 
