Liberia Medical Mission Application

Thank you for your volunteer interest in Bridges of Hope. We invite you to complete our initial application. An interview will be scheduled if we feel that our mission and values align. Your references will also be contacted.

We request that you first review the following documents.

    SECTION I
    PERSONAL INFORMATION




    Your name

    Email

    Address

    Telephone Number


    SECTION II
    SPIRITUAL INFORMATION



    Do you believe the Bible is the inspired Word of God?

    Do you believe in the Lord Jesus Christ is the eternal Son of God?

    Are you committed to being transformed by God and His Living Word in your daily living?

    Do you agree to be dedicated to “empowering Liberians to live Christ-centered lives”?

    Are you an active member of a church?

    Church Name

    Denomination

    Church Address

    Church Email

    Church Phone


    SECTION III
    EDUCATION




    School Name

    Location

    Years Attended

    Degree Received

    Major

    School Name

    Location

    Years Attended

    Degree Received

    Major

    School Name

    Location

    Years Attended

    Degree Received

    Major

    School Name

    Location

    Years Attended

    Degree Received

    Major

    School Name

    Location

    Years Attended

    Degree Received

    Major

    School Name

    Location

    Years Attended

    Degree Received

    Major


    SECTION IV
    REFERENCES




    Please give three references who can testify of your Christian service and character. Please list your pastor first.

    Name|Position

    Address

    Email

    Phone

    Name|Position

    Address

    Email

    Phone

    Name|Position

    Address

    Email

    Phone

    Please give two references who are qualified to speak of your professional experience and training.

    Name|Position

    Address

    Email

    Phone

    Name|Position

    Address

    Email

    Phone


    SECTION V
    ADDITIONAL INFO




    Do you currently have a passport?


    * Please note that your passport must be valid for six months after your return date. Visa is also
    required.

    Do you have any serious current health conditions that we should be aware of (asthma, diabetes, epilepsy, heart disease, etc).

    Non-medical skills (outdoor adventure, mechanic, musician, construction, sports, etc.) Please be specific:


    Are you willing to meet with the team at least three times (excluding one required training) for team-building, prayer and fellowship?

    I certify than I am in good physical condition that will allow me to work long days on my feet in heat and humidity:

    Digital Signature (type your full name): Date:

    Thank you for your interest and application. Applications will be reviewed by the Medical Missions
    Committee; potential candidates will require a follow-up interview and references will be
    contacted by the end of February 2021. Notification of acceptance will be made no later than
    March 31, 2021, at which time payment will be due to Bridges of Hope. Once our team is
    established, training and team-building will be provided.
    Contact:
    Melissa Stahlecker, PharmD
    melissa.stahlecker@gmail.com
    605.390.9156

    SECTION VI
    APPLICANT’S CERTIFICATION OF HONESTY AND AGREEMENT FOR DISCLOSURE



    I understand that Hope International Christian Academy does not discriminate in its employment because of a person’s race, color, national or ethnic origin, gender, age, or disability.

    I certify that the facts stated in this initial application are true and complete to the best of my knowledge. I completely understand that any false statements or withholding significant facts or information may preclude me from being selected as a volunteer. If already volunteering, I will be subject to immediate termination regardless of the amount of time that transpires before discovery.

    I understand this is an initial application for volunteering and a position is not being offered at this time.

    I affirm that I have read the Medical Mission Application Packet at the top of this application.

    Digital Signature (type your full name):

    Date:

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