BRPC Intern Application

BRPC Intern Application

3701 Old Forest Rd, Lynchburg, VA ~ (434) 528-9750
Please make sure you read and agree to the Mission Statement, Statement of Faith and Statement of Principal BEFORE Completing the Application
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Semester of Internship you are applying for
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Gender

FemaleMale
MISSION STATEMENT

The Blue Ridge Pregnancy Center exists to save lives and comfort those involved with unplanned pregnancies while furthering the Gospel of Jesus Christ.
I have read and agree to the Mission Statement

YesNo
STATEMENT OF FAITH

We believe the Bible to be the inspired, infallible, authoritative Word of God. We believe that there is one God, eternally existent in three persons: Father, Son and Holy Spirit.

We believe in the deity of our Lord Jesus Christ, His virgin birth, His sinless life, His atoning death through His shed blood, His bodily resurrection, His ascension to the right hand of the Father, and His personal future return in power and glory.

We believe that the Lord Jesus Christ died for our sins according to the Scriptures, and that salvation is received through faith in Him as Savior and Lord, and not as a result of good works.

We believe the Holy Spirit indwells those who have received Christ for the purpose of enabling them to live righteous and godly lives.

We believe in the eternal life of the saved and the eternal punishment of the lost.

We believe in the spiritual unity of believers in our Lord Jesus Christ.
I have read and agree to the Statement of Faith

YesNo
STATEMENT OF PRINCIPLE

The Blue Ridge Pregnancy Center is an outreach ministry of Jesus Christ through His church to pregnant women and their unborn children. Therefore, BRPC, embodied in its staff and volunteers, is committed to presenting the gospel of our Lord, both in word and deed, to women with unexpected pregnancies. Commensurate with this purpose, those who labor as BRPC Board Members, Directors, staff, and volunteers are expected to know Christ as their Savior and Lord.

The BRPC is committed to aiding women who are in an unexpected pregnancy in order that these women may face the future with hope, and plan constructively for themselves and their babies.

The BRPC is committed to providing its patients with accurate and complete information.

The BRPC is committed to integrity in dealing with patients, earning their trust, providing promised information and services, and rejecting any form of misrepresentation in its corporate advertising or individual conversations.

In presenting the love of Christ through its ministry, the Blue Ridge Pregnancy Center never discriminates because of race, religion, creed, color, national origin, age, or marital status of its clients.

The BRPC never advises, provides, or refers for abortion.

The BRPC provides all offered assistance free of charge at all times.

The BRPC believes that there is no sin not covered by Christ’s sacrifice and His salvation; in that spirit, we will provide post-abortion counseling that emphasizes God’s grace.

The BRPC is committed to creating awareness within the local community of the needs of women and their unborn children in unexpected pregnancy situations.

The BRPC advocates abstinence before marriage.

The BRPC does not engage in contraceptive counseling or in referring for contraceptives or contraceptive services. We believe that married women seeking family planning information should be urged to seek counsel, along with their husbands, from their pastor and/or physician.

The BRPC recognizes the validity of adoption as one alternative to abortion. We are independent of adoption agencies. We relate to them in the same manner as to other helpful referral sources and, as such, we receive no payments.
I have read and agree with the Statement of Principal

YesNo
DRESS CODE POLICY

Please be mindful that our attire has an impact on our patients. We are a Christian organization and want our appearance, tone of our voice and body language, to agree with our witness. Our clothing needs to be professional and modest. If in doubt, please ask. Remember that we are representing Christ to those who may never have heard about Him.
- Nothing form fitting or revealing; leggings are acceptable if tops are long
- No short shorts
- No flip-flops (sandals are acceptable)
- Nothing torn or ragged
- No fragrance (our clients may have sensitive systems, especially if pregnant)
- Christian symbols, if worn, should be tasteful and reflect sensitivity toward the people we serve
- No exposed flesh at the waistline or cleavage
- No “spaghetti” straps or tank tops
- No clothing with advertising, suggestive or controversial logos
I have read and agree with the Dress Code Policy

YesNo
Are you legally eligible for employment in the United States?

YesNo
Have you ever been convicted of a felony?

YesNo
High School:
# Of Years Completed

1234
Diploma?

YesNo
High School Graduated from
College and/or Vocational School:
# Of Years Completed

1234567
Major
Describe Other Training or Degrees
School
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment or Volunteer History

Please provide your employment/ volunteer history beginning with your most recent position.
Name of Organization 1
Position held
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Beginning Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Reason for Leaving
Supervisor
Supervisor Phone #
Permission to Contact?

YesNo
Name of Organization 2
Position Held
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Beginning Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Reason for Leaving
Supervisor
Supervisor Phone Number
Please enter a valid phone number.
Permission to Contact?

YesNo
Additional Information:
1. How did you hear about the Blue Ridge Pregnancy Center?
2. What is your reason for seeking an internship here?
3. What are you hoping to get out of an internship here?
4. What is specifically required from your internship? Hours? Fact time with patients? Etc...
Ministry Aptitude:
1. The The Blue Ridge Pregnancy Center is a pro-life Christian ministry. We believe that our faith in Jesus Christ empowers us, enables us, and motivates us to provide crisis pregnancy services in this community. Please write a brief statement about how your faith would impact what you do here.
2. What local church do you attend?
Denomination?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pastors Name
Phone Number
Please enter a valid phone number.
How long have you attended?
Permission to contact

YesNo
Training/ Talents:
1. What special skills, talents, gifts or personality traits would you bring to this ministry?
2. What are your strengths?
3. What are your weaknesses?
4. What personality types do you have difficulty working with, and how would you handle conflict?
References:

Please provide three references.
Name Reference 1

First NameLast Name
Address Reference 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Reference 1
Please enter a valid phone number.
Years Acquainted with Reference 1
Relationship with Reference 1
Name Reference 2

First NameLast Name
Address Reference 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Reference 2
Please enter a valid phone number.
Years Acquainted with Reference 2
Relationship with Reference 2
Resume Upload

Cancelof
Applicants Certification and Agreement
I certify that the facts set forth in this intern application are true and complete to the best of my knowledge, and I authorize my prospective supervisor to verify their accuracy and to obtain reference information on my work performance and character. I release my prospective supervisor and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any internship decisions made based upon such information. I understand that, if chosen as an intern, any falsified statements or omissions of material information on the application may lead to my prompt dismissal. If I am offered and accept an internship, I agree to fully adhere to the policies and rules of the Blue Ridge Pregnancy Center.

I further certify that I have read and that I am in full agreement with the Blue Ridge Pregnancy Center’s Statement of Faith and Statement of Principle.
Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty:

BRPC Intern Application

Please make sure you read and agree to the Mission Statement, Statement of Faith and Statement of Principal BEFORE Completing the Application

High School:

College and/or Vocational School:

Employment or Volunteer History

Additional Information:

Ministry Aptitude:

Training/ Talents:

References:

Applicants Certification and Agreement