Joni and Friends

WHEELS FOR THE WORLD
Application Information: International Mission Outreach

NOTE: Please give yourself an appropriate amount of time to fill out the form thoughtfully and completely.

Which event?

First Name*

Middle Name

Last Name*

Give us your full name as it appears on your passport:*

Nametag Name*

E-mail*

Birthday*

Day Month Year
(NOTE: Additional travel insurance costs required if over 65 at time of travel.)

Gender*

Male

Female

Street Address*

City*

State*

Country*

ZIP/Postal Code*

Job Title

Company Name

Home Number*

Work Number

Cell Number

Fax Number

Additional Information

Do you agree with Joni and Friends' statement of faith? (If not, please contact our office before proceeding any further.)*

Please provide two people who we may contact in case of an emergency:* (name,city,state,telephone)

Physical therapists or Occupational therapists, please give us your license number:

Church or place of worship where you attend:*

How would you describe your walk with the Lord ?*

Are you comfortable with sharing God's love and your personal testimony?*

Self Assessment: How would you assess your adaptability?*

	Excellent
	Good
	Fair
	Poor

Assess your dependability:*

	Excellent
	Good
	Fair
	Poor

Assess your maturity:*

	Excellent
	Good
	Fair
	Poor

Assess your spiritual maturity:*

	Excellent
	Good
	Fair
	Poor

Assess your willingness to respond to leadership/authority:*

	Excellent
	Good
	Fair
	Poor

Assess your willingness/ability to be a team player:*

	Excellent
	Good
	Fair
	Poor

How often are you critical?*

	Often
	Sometimes
	Rarely
	Never

How often are you argumentative?*

	Often
	Sometimes
	Rarely
	Never

How often are you domineering?*

	Often
	Sometimes
	Rarely
	Never

What is your attitude when scheduled activities are interrupted or do not go as planned?*

Please describe a very stressful situation and your response.*

Medical information: Give us your height & weight.*

How would you describe your physical stamina & endurance?*

How would you describe your emotional stamina?*

Have you experienced any type of depression? If so, please describe.*

Doctor's contact information* (Address, telephone number)

Doctor's fax number*

List all food, medication & environmental allergies.*

List any current medications that you are taking.*

What happens if you do not take your medication?*

Do you have any physical, mental and/or emotional limitations?* (Please specify condition(s) and if they exist currently or when they were last experienced.)

Do you have a disability? If so, please describe.*

Do you need assistance or an attendant? If so, please explain.*

Do you need/use any disability or medical equipment?* (ie: manual or motorized wheelchair, walker, cane, crutches, hoyer lift, accessible transportation or accommodations)

Tell us about your degree of mobility* (ie: ambulatory, can walk short distances, use a wheelchair at all times/sometimes, can transfer self/with assistance etc.)

How did you hear and come to apply for Wheels for the World International Mission Outreach?*

Do you have any intercultural or mission experience?*

Do you speak any other language(s) other than English?*

Are you willing to serve in any country, or do you have a strong preference?*

Tell us what role(s) you desire to serve in and feel that you are qualified for* (For detailed descriptions, please refer to our Wheels for the World webpage.)

	Adaptive Seating Therapist - PT or OT
	Adaptive Seating Therapist Assistant - PT or OT
	Evangelism Guide
	Mechanic
	Mechanic Assistant
	Administrative Support
	General Support
	Translator
	Speaker/Teacher
	Speaker/Teacher Assistant
	Photo Journalist
	Construction

Please Print out 3 reference forms from our website and give them to your 3 refereces. Please request that these be sent in within 2 weeks.

Disclaimer
	All applicants to be considered must be a practicing Christian and agree with Joni and Friends' statement of faith. We believe the Bible to be the inspired, the only infallible, authoritative Word of God. We believe there is one God, eternally existent in three persons: Father, Son and Holy Spirit. We believe in the deity of our Lord Jesus Christ, His virgin birth, His sinless life, His miracles, His vicarious and atoning death through His shed blood, His bodily resurrection, His ascension to the right hand of the Father, and in His personal return in power and glory. We believe for the salvation of lost and sinful man regeneration by the Holy Spirit is absolutely essential. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life. We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation. We believe in the spiritual unity of believers in our Lord Jesus Christ. Your registration via Online Registration indicates your acknowledgment and acceptance of Joni and Friends' Terms of Use and Privacy Policy. The current version of our Terms of Use may be found at: http://www.joniandfriends.org/terms.php.
	I Agree with the above Disclaimer
	I Understand that I will be required to provide 3 references and that one must be Pastoral as part of my application completion.
	I Understand the registration for this outreach is not complete or final until all required funds, forms, materials, references, and complete background check are completed.
	I agree to submit to a full and complete background check as part of the application process, which includes a small fee which I shall incur.