This application is confidential and will only be read by the leadership of
You are applying for:
DTS Mission Builder Staff
Start Date
Name: (write your name as found in passport)
Mr. Mrs. Miss
Family/Surname:
Legal First Name:
Middle Name:
Preferred:
Permanent Address
Street Adress
City
State/Province
Post/Zip Code
Current Address (if different
Contact Info:
Home phone :
Fax number:
Work Phone :
Email:
Emergency Information
Name:
Phone:
Address:
Relationship:
Health Information
Blood type :
Are you allergic to any drugs? If so, please specify :
How would you describe your general health?
Any handicaps or illnesses (diabetes etc.) that demands special equipment and will affect your situation at the school :
Do you take any prescription drugs? If YES, which ones and for what reason?
Have you received any psychiatric or ongoing medical treatment within the last five years? If YES, please specify!
Have you ever abused alcohol or drugs?
Do you smoke/use tobacco? If YES, please specify!
Have you ever been involved in occult phenomenon (i.e. hypnosis, meditation, yoga) or other religions and sects? If YES, please specificy and explain your connection to it today!
Have you had any of the following diseases?
Chickenpox Measles (Rubeola) Measles (Rubella) Pertussis Scarlet Fever Mumps
Immunizations. When was the last time you were immunized (or received a booster) for:
Pertussis Measles (Rubella) Rubeola Polio Mumps
Birth Details:
Birthdate:
Country of Birth:
Age:
Citizenship:
Passport détails:
Passport number :
Expiry Date :
Place of issue:
English Language
How do you speek English ?
Bad 1 2 3 4 5 6 7 8 9 10 Good
Other Languages Spoken :
Marital Status
single married divorced engaged remarried widowed
Spouse\'s name:
Children\'s Details
Name, birth details, passport details, citizenship
Education
Occupational Skills
Have you ever been convicted
Musical Abilities
Other Talents or Skills
Do you have the complete
If not, how much do you prensently
How do you anticipate the
PERSONAL QUESTIONS FOR DTS APPLICANTS: DTS applicants please fill out the questions below.
All other applicants, please send the above information and the registrar will email you with further information and application details upon receipt of the email.
Please describe
Please describe your present
What areas of your character
Is God leading you into any
Describe the involvement
Describe the state of relationships
What are you expecting to
Are there any areas of your
How did you find out about
Please also email a current photo to kevin@teamxtremeintl.com after submission of this form. Also remember to get a friend and pastor to fill out their forms and sending them to us in a seperate envelope
