HineniHandbook1.

1,July29,2015

Hineni Application (2015-2016)

OurmissionisToprovideacommunallivingspaceforyoungadultstoserve,bothintheparish
andthebroadercommunity,whilecomingtoadeeperpersonalspiritualandvocational
understanding.Thereforeacarefulassessmentofeachapplicantssuitabilityiscriticaltothe
applicationprocess.Ifyouhavequestionsorconcernsregardinganypartoftheapplication
pleasetalktous!

Onacceptance,youwillneedtogetaCriminalRecordsCheck,orequivalent,inyourprovince
ofresidency.Forexample,ifyouarefromBC,Canadayoucanfindoutmoreinformation
here
.
Youwillbereimbursedforthisexpense.

Yourprivacyandconfidentialityisveryimportanttous.Onlytheadmissionsadministrativeteam
willhaveaccesstothisinformation.

Instructions

Pleaseanswer,indetail,allofthequestionsastheypertaintoyou.
Youcansendittouselectronicallyorviaregularmail.
Whenansweringthesequestionsbeyourself.Thesequestionssimplyhelpuslearn
moreaboutyou.

ContactInformation

1.Name:

2.DateofBirth:

3.CurrentAge:

4.CurrentCitizenshipStatus:

5.GenderDesignation:

6.CurrentAddress:

7.Email:

8.Telephone:

9.Cell:
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10.Doyouhavehealthinsurance?N/YDetails:

11.Doyouhaveadriverslicence? Y/NClass:

Languages

1.IsEnglishyourprimary(1st)language?Y/N

2.Ifno,whatisyourprimarylanguage?:

3.Otherthantheabove,doyouspeakanyotherlanguagescompetently?:

Education

1.WhatisthehighestlevelofEducationthatyouhavecompleted?

2.Ifaccepted,areyouplanningtobeworking/goingtoschool?(pleasecircle)

WorkExperience

Pleasegiveussomedetailsofthelasttwoworkexperiencesyouhad.

1.PlaceofWork:

2.NameofSupervisor:

3.DatesofEmployment:

4.Positionandonesentencedescription:

5.PhoneNumber:

6.NumberofYears:

1.PlaceofWork:

2.NameofSupervisor:

3.DatesofEmployment:

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4.Positionandonesentencedescription:

5.PhoneNumber:

6.NumberofYears:

VolunteerExperience

Pleasegiveussomedetailsofthelasttwovolunteerexperiencesyouhad.

1.PlaceofWork:

2.NameofSupervisor:

3.DatesofEmployment:

4.Positionandonesentencedescription:

5.PhoneNumber:

6.NumberofYears:

1.PlaceofWork:

2.NameofSupervisor:

3.DatesofEmployment:

4.Positionandonesentencedescription:

5.PhoneNumber:

6.NumberofYears:

MentalandPhysicalHealth

Thenatureofthecommunitylifeandprojectactivities,especiallywhentakentogetherwithwork
orschooldemands,maybeespeciallychallengingforthosewithcertainmentalandphysical
conditions.Pleasediscloseallrelevantinformation.Wewillholdallhealthinformation
confidential,availableonlytotheinterviewingcommitteeandCommunityDirector.Pleasefill
outallthatappliestoyouandindicateN/Aotherwise.

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1.Areyouseeingadoctororspecialistonaregularbasis?Y/N

Ifyes,explainhowoftenandforwhatpurpose.

2.Doyouhaveanyallergies?Y/N

Ifyes,pleaselistthem:

3.Haveyoubeenhospitalizedwithinthelast12months?Y/N

Ifyes,pleaseexplain:

4.Doyouhaveanydietaryrestrictionsorpreferences?Y/N

Ifyes,pleaseexplain:

5.Rateyourgeneralhealthinthelast12monthsonascaleof110(1ispoor.10ispeachy).
_______________

Pleaseexplain:

6.Haveyousufferedwithanychronicconditionsorillnesses?Y/N

Ifyes,pleaseexplainfrequencyandseverity.

7.Arethereanypsychologicalissueswhichwouldhaveanimpactonyourabilitytobepartof
Hineni?Y/N

Ifyes,pleaseprovidesomedetail.

8.Isthereanythingregardingyourphysicalormentalhealththatwemayneedtoknow,which
hasnotbeenasked?Y/N

Ifso,pleaseelaborate:

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HineniHandbook1.1,July29,2015

SpiritualFormation

1.Inmychildhood,myfamilyandI:

Regularlyattendedreligiousservices.Details:___________________
Sometimes
Notatall

2.Atpresent,Iwoulddescribemyselfas:

ApracticingChristian.Denomination:__________________
Christian,butnotpracticing
NotChristian.Writeasentenceortwointhespacebelowthatwoulddescribeyour
spiritual/religiousorientation.

3.Describeyourfaith/spiritualjourneyincludinganypracticesthathavebecomeanimportant
partofyourlife.

4.DoyouhaveanyconcernsaboutbeingpartofashorttermintentionalChristianfaith
community?Ifso,pleaseelaborate.

PersonalGoals

1.Inashortparagraph(about250words)telluswhyyouareattractedtoHineni?Attacha
separatepageifnecessary.

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HineniHandbook1.1,July29,2015

2.Howdoyouhopetogrowoverthecourseofyour11monthsatHineni?

AUTHORIZATIONSIGNATURE

Bysigningmynameinthespaceprovided,IcertifythatalltheinformationIhaveprovidedin
thisapplicationformiscomplete,accurateandtruthfultothebestofmyknowledge.I
understandthattheinformationIhavegivenisavailableonlytotheHineniadministrativeteam.
Igivepermissiontotheadministrativeteamtodiscussallinformationthathasbeenandwillbe
giveninmyapplicationmaterials.

Signature:

(printed)___________________Date:

ApplicationChecklist

IhavefilledouttheapplicationinfullincludingtheaboveAuthorizationSignature

Uponacceptance,IamwillingtogetaCriminalRecordsCheckorequivalent

Ihavedistributedreferenceformsto23referralswhowillmailoremailtheircompletedforms
to
hinenihouse@gmail.com
.

IhavesignedtheattachedLifestyleAgreement

IhavesignedtheattachedMediaReleaseForm

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