General InformationName:* Gender:*M/FMaleFemaleMarital Status:*Single/MarriedSingleMarriedMarriage Date:Personal InformationE-mail:*Phone:* Area Code - Phone Number Secondary Phone: Area Code - Phone Number Birthdate:*Birthplace:* Address:* Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryFacebook: Instagram: Twitter: Other Social Media Handles: Official InformationDrivers License #:* Drivers License State:* Social Security #:* Have you ever been arrested or convicted of a crime? *Y/NYesNoHave you ever been accused or convicted of ANY form of child abuse? *Y/NYesNoIf you answered "yes" to either of the above questions, please provide a detailed explaination: Have you ever used illegal drugs?*Y/NYesNoIf yes, list name of drug and date of last use: Have you ever smoked Tobacco?*Y/NYesNoIf yes, when was the date of last use? Have you ever consumed alcohol? *Y/NYesNoIf yes, when was the date of last use? Have you ever been treated for any addictions?*Y/NYesNoIf yes, list type of addiction, treatment, and date of treatment:* Medical InformationHow would you describe your health?*ExcellentGoodFairPoorList any physical limitations, disabilities, or diseases you have experienced:* List any medications you are currently using:* Do you have health insurance?*Y/NYesNoInsurance Company: Policy #: Emergency Contact 1:* Primary Phone #:* Area Code - Phone Number Secondary Phone #: Area Code - Phone Number Third Phone #: Area Code - Phone Number Emergency Contact 2:* Primary Phone #:* Area Code - Phone Number Secondary Phone #: Area Code - Phone Number Third Phone #: Area Code - Phone Number ReferencesAre you currently employed?*Y/NYesNoCurrent Employer: Employer Phone #: Area Code - Phone Number Previous Employer: Previous Employer Phone #: Area Code - Phone Number Personal ReferencesPlease provide at lease 3 personal references who are not relatives:Reference 1 Type: *Spiritual LeaderPastorMentorEmployerManagerOtherReference 1 Title:* Reference 1 Name:* Reference 1 Phone #:* Area Code - Phone Number Reference 2 Type:*Spiritual LeaderPastorMentorEmployerManagerOtherReference 2 Title:* Reference 2 Name:* Reference 2 Phone #:* Area Code - Phone Number Reference 3 Type: *Spiritual LeaderPastorMentorEmployerManagerOtherReference 3 Title: * Reference 3 Name: * Reference 3 Phone #: * Area Code - Phone Number Reference 4 Type: Spiritual LeaderPastorMentorEmployerManagerOtherReference 4 Title: Reference 4 Name: Reference 4 Phone #: Area Code - Phone Number Reference 5 Type: Spiritual LeaderPastorMentorEmployerManagerOtherReference 5 Title: Reference 5 Name: Reference 5 Phone #: Area Code - Phone Number Intern CommitmentAs 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:*123456789101112Expiration year:*20182019202020212022202320242025202620272028SubmitReset
