Staff Application

General Staff Application for UofN Battambang
1. All parts of this application must be completed in detail. All portions (including reference forms) must be received in our Battambang office before we can consider you for service with UofN Battambang.

2. Registration fee of US$ 20.00 can be paid upon arrival.

3. A recent photo, references, and medical forms must be emailed to info@uofnbattambang.com
General Information
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Birth Date

DayMonthYear
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender
Nationality
Citizenship
Passport No.
Place of Issue
Date of Issue

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Date of Expiration

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Marital Status
Date Status Changed (unless single)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Accompanying Children
Full Name

First NameLast Name
Date of Birth

DayMonthYear
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Add another child?
Full Name

First NameLast Name
Date of Birth

DayMonthYear
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Add another child?
Full Name

First NameLast Name
Date of Birth

DayMonthYear
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

General Information
Valid Drivers License No.
Type
Secondary ID No.
Beginning Date of Service in Cambodia

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Ending Date of Service in Cambodia

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Spoken Languages (in decreasing order of fluency)
Height
Weight
Blood Type
Emergency Contact
Full Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
Home Church
Home Church
Pastor

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
References
Base Director/School Leader

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Pastor

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Education/Experience
List your skills and/or hobbies (please be specific, ie. teaching, IT, music, construction, etc.)
High School
Name
Graduation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
University/Trade School
Name
Graduation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Academic Field
Degree/Certification
YWAM Schools Completed
School Name
Graduation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Location
Director's Name

First NameLast Name
Add another YWAM School?
School Name
Graduation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Location
Director's Name

First NameLast Name
Add another YWAM School?
School Name
Graduation Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Location
Director's Name

First NameLast Name
Ministry
Position
Location
Director's Name

First NameLast Name
Starting Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Ending Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Add another position?
Position
Location
Director's Name

First NameLast Name
Starting Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Ending Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Employment (most recent)
Position
Employer
Starting Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Ending Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Add another position?
Position
Employer
Starting Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Ending Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Personal
Do you have a prayer and financial support base that will enable you to fulfill your intended commitment to UofN Battambang? Please explain
Does your family understand your desire to work in Cambodia? Do they support you?
Is there any domestic situation or personal matter, which might necessitate your returning from the field? If yes, please explain
Please describe your Christian experience

Ministry
What expectations do you have for your work in Cambodia?
What ministry gift would you be most fulfilled in? (i.e. evangelism, pastoral, administration, teaching)
Please write (clearly) the leading of God you have received to work in Cambodia

Certification
I certify that all the information in this application is complete and accurate.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent or Guardian's Signature (if you are under 18 years old)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Relationship
Submit Application
Please go back through the form and check to make sure that you have correctly answered all of the required fields.

When you submit this form, your answers cannot be changed.

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General Staff Application for UofN Battambang

General Information

Accompanying Children

General Information

Emergency Contact

Home Church

References

Vaccinations

Health Chart

Education/Experience

High School

University/Trade School

YWAM Schools Completed

Ministry

Employment (most recent)

Personal

Ministry

Certification

Submit Application