Staff Application

Staff Application

Who should apply? A born-again, committed, mature Christian, 18yrs. old or older, who is out of high school, and who is looking to serve wholeheartedly in ministry.
What position are you applying for?
Name *

First Name Last Name
U.S. Citizen *
Present Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Phone Number *
Email *
example@example.com
Date of Birth *

Month Day Year
Date
Marital Status: blanks*
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.
Emergency Contact Phone Number *
Highest Level of Education *
Name of College Attended: blanks # of Years blank
Field of Study:blanks
Special Interests / Hobbies: blanks
Special Talents (i.e. piano, arts, singer, etc.): blanks
Most Recent Employer: blanks Supervisor: blank
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Describe your present state of health. Have you consulted or been referred to a physician or psychotherapist because of any significant, organic, or emotional illness in the last 3 years? *
If "Yes", please explain: blanks
Church Name: blanks* Years Attended: blank*
Church Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Church Phone Number *
Please enter a valid phone number.
Pastor: blanks* (A "Pastor's Reference Form" and "Reference Form" must be included with this application, when submitting it to NYSUM)
How did you become a Christian, and describe what God has been doing in your life since then: blanks*
Why do you want to serve at NYSUM?: blanks*
What experience have you had in community living, other than home?: blanks*
Evaluate your personal strengths and weaknesses: blanks*
Do you have any experience in leadership positions?: blanks*
What are your expectations as a staff member?: blanks*
Have you ever been convicted for child abuse or a crime involving actual or attempted sexual molestation? (If you prefer, you may discuss your answer with the President personally). *
Doctrinal Statement

WE BELIEVE: The Bible to be the inspired Word of God. In the Triune Godhead. In the deity of Jesus Christ. In the Evangelistic fervor and endeavor. That regeneration by the Holy Spirit is essential to Salvation. In the baptism of the Holy Spirit and His continuing ministry through charismatic gifts. In Christ's imminent personal return.
The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information *(including options) that they may have regarding my character and fitness for ministry. I release all such references from any liability for furnishing such evaluations to you, provide they do so in good faith and without malice. I waive any right that I may have to inspect references provided on my behalf. Should my application be accepted, I agree to be bound by the policies of NYSUM, submit to the Leadership, and refrain from unscriptural conduct in the performance of my service on behalf of this ministry.
Dates available for interview: blanks*
Date you can arrive at NYSUM to serve: blanks*
Please email a recent photograph of yourself when submitting this application to:

Peter DeArruda, President

Peterdearruda@nysum.org

Phone: (718) 204-6471 Fax: (718) 204-6998
Applicant's Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Staff Application

Doctrinal Statement