Internships Application • Lighthouse to the Nations Church

First Name

Middle Name

Last Name

Preferred Name

Gender

Date of Birth

ID/Passport Number

Home Language

How good is your English (on a scale from 1-5) if not your first language

Marital Status

Citizenship

Country of Birth

Do you have a valid passport?

Current Activity

Other (specify) *

Company Name

Supervisor Name

Contact details (email/phone)

Phone Number (H)

Mobile Number (C)

Email Address

Mailing Address

Mailing Postcode

Mailing State/Province

Mailing City

Mailing Country

Home Church

Address

Contact details (email/phone)

Lead Elder/Pastor

Contact number

How long have you attended?

Any previous Christian/Theological training? (Specify)

Have you given your life to Christ?

Yes

No

When did you give your life to Christ?

Why do you want to join this program?

What are some expectations you have for the program?

High School

Highest Grade Passed (Specify year completed)

Extracurricular Activities

Did you attend any Tertiary/Higher Education?

Yes / In Progress

No

Institution Attended

Years Attended

Degree/Diploma (Specify fields/specilisations)

Completed?

Yes

No

In Progress

Year of Graduation

Do you have a drivers license?

Year obtained

Do you have your own car?

Will your car be accessible to you during the year?

Parent/ Guardian/ Next of Kin Full Name

Residential Address of Parent/ Guardian/ Next of Kin

Contact details (email/phone)

Occupation & Company

May we use this person as your emergency contact?

Yes

No

Specify full details for alternative emergency contact

Specify full details for an additional emergency contact

Tip: We will only contact this person in the event your primary emergency contact is unavailable.

How does your family feel about your internship application?

How would you rate your current health?

Allergies

Any physical limitations? (Specify)

Any dietary requirements? (Specify)

Are you on any specific chronic medication? (Specify)

Do you have Medical Aid?

Yes

No

Medical Aid Provider

Policy No.

How did you hear about our Internship Program?

Lighthouse Internship Application Form

Let us get to know you

Employer Details

Your Contact Details

Church Life

Spiritual Life

Education

Driving

Family Life

Health

One Last Thing