APPLICATION. U.S. Citizen or Canadian (circle one) Martial Status: (circle one) Single Divorced Engaged Married Widowed Separated

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1 Heart To Heart International Ministries APPLICATION Please type or print clearly in ink. Use back of application for additional space. Please send completed application to: Heart To Heart International Ministries P.O. Box 1832 Ramona CA /789/8798 or (Toll Free) Please attach small photo. I am applying for: Full Time Short Term Which ministry trip? Name Address Address City State Zip Area code & Telephone (Home) Area code & (Work/School) Social Security Number Age Sex Date of Birth U.S. Citizen or Canadian (circle one) Place of Birth: Passport Number: Driver's License Number: In the event of an emergency contact: Name Address Area Code & Phone Number Martial Status: (circle one) Single Divorced Engaged Married Widowed Separated Spouse Name: Name of Children Birth date Age Current dependent? Yes No

2 Name of Church you presently attend. Pastor's Name Church Address Telephone Number City State Zip How long have you attended this church? Do you attend church regularly? Please list Christian service you have been involved with, and include name of church/organization, your position, and briefly how you were involved. Please list your educational background, beginning with High School. Include any college, trade school, or Bible schools. Present School Attending or Place of Employment If attending school, when will you complete your program? With what degree or certificate? Have you served in the military? Date of Discharge Have you ever been arrested, fined, jailed or in prison? Explain Are you involved in any current or pending law suits or legal proceedings?

3 Please list and briefly describe any Bible study courses you have taken in the past three years. Evaluating your education, training, skills, experiences, along with the gifts God has given you, in what areas do you feel you can best serve? What is your native language? If you speak more than one language, please list on the space below and indicate your proficiency in that language. Have you ever traveled abroad? If yes, to what country? Please rate your ability in the following areas on a scale of 1 to 10, with 10 being excellent. Auto Mechanics Bookkeeping Bus driver w/required license Computer Construction Cooking Nursing/EMT Operating Sound or Visual Equipment Playing a Musical instrument (List) Preaching Puppets Teaching Singing Other (List) Would you like to assist with worship music during orientation and debriefing? Explain Please list your hobbies.

4 Health History Have you had, or presently have: Chicken Pox Measles Mumps Polio Small Pox Diphtheria Whooping Cough Tetanus Scarlet Fever Tuberculosis Pleurisy Pneumonia Influenza Tonsillitis Sinusitis Middle Ear Infection Deafness Arthritis Heart Murmurs Peptic Ulcers Appendicitis Frequent Colds Other: Do you have any physical limitations? Do you wear eyeglasses or contact lenses? Do you use tobacco, alcohol or narcotic drugs? Do you have any respiratory problems? Do you have any allergies? Do you suffer from frequent headaches, dizziness, or fainting spells? Have you ever had a nervous breakdown or been treated for depression? Do you fatigue easily? Please list serious health concerns that have affected you in the past five years. Do yo have any medical restrictions or handicaps that we might need to make provisions for? Are you presently taking any medications? No Yes ( Please explain) Health Insurance Carrier and Policy Number Physician Name and Phone Number ( Include area code)

5 In what ways do you maintain a personal and vital relationship with God? Why do you believe you are called to minister as a missionary? Share your personal testimony.

6 Heart To Heart International Ministries P.O. Box 1832 Ramona CA or REFERENCE Please respond as soon as possible. Thanks! Applicant's Name: The person named above has chosen you as a reference. He/she is applying, or at least considering application with Heart To Heart International Ministries, a nonprofit Christian organization. This implies probable service in cross-cultural and potentially stressful situations. Your honest appraisal in answering the following questions, including negative or weak areas will help us as we guide and evaluate this person. This letter of reference is confidential. Please indicate the circumstances under which you know this person: Long term friendship Dormmate/roommate Casual acquaintance Working relationship Member of Congregation Teacher/Student Other: How long have you know this person? The following phrase describe attitudes or personality characteristics. Please check the box under the heading which most closely represents how well the phrase describes the person. Please make comments where you believe it would benefit. Use the following definitions to guide your evaluation: Strongly Agree: Agree: Undecided: Disagree: Strongly Disagree: Outstanding characteristic Normal characteristic Can not make a definitive statement This behavior is not a good description of this person This is clearly a problem area General Life Attitudes Maintains a positive attitude in difficult circumstance. Adapts well to new situations. Is self motivated without many external rewards. Does not evidence ethnic, sexual, or other prejudices. Is eager to grow and open to new ideas and ways of doing things. Spends money wisely within own means. Is responsible toward indebtedness. Dresses modestly and appropriately Relationships Is tactful Listens to and is sensitive to others. Goes out of the way to be helpful. Cooperates with others. Willingly accepts direction, correction and advice. Seeks advice when needed. Is an effective team member Strongly Agree Agree Undecided Disagree Strongly Disagree

7 Spiritual Maturity Applies Biblical principles to his life. Regularly fellowships with other Christians. Willingly shares with others from personal experiences. Supports others through prayer and encouragement. Physical and Emotional Health Has good health. Has sufficient energy and stamina Has a balanced self esteem. Is productive in stressful situations. Is not tense or nervous. Is not depressed or moody. Is not fearful or anxious. Is not irritable. Work Qualities Does accurate thorough work. Manages use of time well. Shows perseverance to fulfill commitments. Works well alone. Is motivated to do best possible job. Completes tasks according to instructions. Is self motivated. Leadership and Teaching Abilities Stands out as a leader. Motivates other people. Is trusted by others. Oral communication is clear. Written communication is clear. Delegates responsibilities. Makes sound decisions. Does not procrastinate. Able to teach others. Strongly Agree Agree Undecided Disagree Strongly Disagree Summary Comments: Your Name Address Phone Number City State Zip Address Please return As Soon As Possible to: Heart To Heart International Ministries P.O. Box 1832 Ramona CA 92065