General Information

Name:*
Gender:*
Marital Status:*
Marriage Date:
Current Photo of yourself:*

Personal Information

E-mail:*
Phone:*
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Secondary Phone:
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Birthdate:*
Birthplace:*
Address:*
Facebook:
Instagram:
Twitter:
Other Social Media Handles:

Official Information

Drivers License #:*
Drivers License State:*
Social Security #:*
Have you ever been arrested or convicted of a crime? *
Have you ever been accused or convicted of ANY form of child abuse? *
If you answered "yes" to either of the above questions, please provide a detailed explaination:
Have you ever used illegal drugs?*
If yes, list name of drug and date of last use:
Have you ever smoked Tobacco?*
If yes, when was the date of last use?
Have you ever consumed alcohol? *
If yes, when was the date of last use?
Have you ever been treated for any addictions?*
If yes, list type of addiction, treatment, and date of treatment:*

´╗┐Medical Information

How would you describe your health?*
List any physical limitations, disabilities, or diseases you have experienced:*
List any medications you are currently using:*
Do you have health insurance?*
Insurance Company:
Policy #:
Upload a copy of your insurance policy/card:*
Emergency Contact 1:*
Primary Phone #:*
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Secondary Phone #:
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Third Phone #:
-
Emergency Contact 2:*
Primary Phone #:*
-
Secondary Phone #:
-
Third Phone #:
-

´╗┐References

Are you currently employed?*
Current Employer:
Employer Phone #:
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Previous Employer:
Previous Employer Phone #:
-

´╗┐Personal References

Please provide at lease 3 personal references who are not relatives:

Reference 1 Type: *
Reference 1 Title:*
Reference 1 Name:*
Reference 1 Phone #:*
-
Reference 2 Type:*
Reference 2 Title:*
Reference 2 Name:*
Reference 2 Phone #:*
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Reference 3 Type: *
Reference 3 Title: *
Reference 3 Name: *
Reference 3 Phone #: *
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Reference 4 Type:
Reference 4 Title:
Reference 4 Name:
Reference 4 Phone #:
-
Reference 5 Type:
Reference 5 Title:
Reference 5 Name:
Reference 5 Phone #:
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Intern Commitment

As a TGM Intern, I make the following agreement:

1. I commit to be responsive to the authorities that God has placed over me during this season of my life, including the village elders, pastors, ministers, and TGM Internship Program leaders.

2. I commit to abstain from all immoral and illegal acts and habits. I will not drink alcoholic beverages of any kind. I will not use tobacco. I will not engage in any other behavior that is contrary to Christian conduct.

3. I commit to be punctual to all meetings, teachings, gatherings, and all required events, adapting to the daily schedule provided for me by the leadership of TGM.

4. I commit to abide by all of the guidelines and standards of conduct as outlined in the TGM Internship Program and other guidelines issued in oral or written form by the TGM staff. Understanding that I understand that failure to cooperate could result in my dismissal from this program without any refund of tuition paid back.

5. I have read, understand and agree to comply with all guidelines, protocols, and requirement listed throughout this Internship information.

Applicant Signature (Your FULL name, typed below, will be treated as your written signature):*
$25.00 Application Fee:*
 $ 
Card number:*
Name:*
CVC:*
Expiration month:*
Expiration year:*