WORKER APPLICATION FORM

NAME AND ADDRESS:

Surname

__________________________________________

First Name

__________________________________________

Male

Female

Address

__________________________________________
__________________________________________
__________________________________________
__________________________________________

Postcode

__________________

Email

__________________________________________

Tel (evening)

__________________________________________

Tel (daytime)

__________________________________________

Mobile

__________________________________________

Please attach
a passport
sized photo
here

AGE
Date of Birth

__________________________________________

Nationality

__________________________________________

FAMILY DETAILS
You are only required to give this information if you are under 18 or living at home.
Name of Parent(s)/Guardian(s)
________________________________________________________________________________________________
________________________________________________________________________________________________
Address of Parent(s)/Guardian(s)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________Postcode________________
Your relationship to them
________________________________________________________________________________________________
EMERGENCY CONTACT (if different to above)
Name
________________________________________________________________________________________________
Address
________________________________________________________________________________________________
____________________________________________________________________Postcode____________________
Tel ___________________________
Your relationship to them
________________________________________________________________________________________________

EDUCATIONAL HISTORY
Secondary Education (up to Age 18):
Name of Institution
________________________________________________________________________________________________
Years Attended (e.g. 1997-2004)
________________________________________________________________________________________________
Qualifications Received (indicate if awaiting results)
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Higher Education (over Age 18):
Name of Institution
________________________________________________________________________________________________
Years Attended (e.g. 1997-2004)
________________________________________________________________________________________________
Qualifications Received (indicate if awaiting results)

WORK EXPERIENCE
Name of Employer
________________________________________________________________________________________________
Nature of Employment
________________________________________________________________________________________________
Dates employed
________________________________________________________________________________________________
Reason for leaving employment

LOCAL CHURCH INVOLVEMENT & CHRISTIAN EXPERIENCE

Name of Church or Fellowship
________________________________________________________________________________________________
Name and Telephone Number of Minister best known to you
________________________________________________________________________________________________
________________________________________________________________________________________________
Briefly describe your contributions to areas of service within this fellowship.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

Please explain briefly how and when you became a Christian.

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Please outline your spiritual growth since becoming a Christian and highlight key experiences and
opportunities that have influenced and developed your faith.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
As far as you are able, please describe the kind of work that you think God is preparing you for in the future,
and the ways he has gifted you for this.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Why do you want to take time out for a gap year, and why have you chosen Kairos in particular?
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
How would you like to grow and develop during your Kairos year? Please include the following areas:
Growth in God, personal growth, growth in gifting, growth in experience
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Can you foresee any events that would require your absence from the course?
________________________________________________________________________________________________

SELF-EVALUATION
Briefly evaluate yourself as accurately as possible in the following areas:
Adaptability/Flexibility
________________________________________________________________________________________________
________________________________________________________________________________________________
Ability to get on with people you dont particularly like
________________________________________________________________________________________________
________________________________________________________________________________________________
Leadership
________________________________________________________________________________________________
________________________________________________________________________________________________
Ability to say whats on your mind
________________________________________________________________________________________________
________________________________________________________________________________________________
Punctuality
________________________________________________________________________________________________
________________________________________________________________________________________________
What would you say your biggest personality weakness is?
________________________________________________________________________________________________
________________________________________________________________________________________________
What would you say the best thing about your personality is?
________________________________________________________________________________________________
________________________________________________________________________________________________
OTHER PERSONAL DETAILS
Do you have any experience of public speaking or work in schools (e.g. taking an assembly)?
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Are there any particular areas of ministry you are currently involved in, or interested in taking part in?
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Please describe your interests, talents, or hobbies:
________________________________________________________________________________________________
________________________________________________________________________________________________
How do you best like to spend time on your own?
________________________________________________________________________________________________
________________________________________________________________________________________________
How do you best like to spend time socially?
________________________________________________________________________________________________
________________________________________________________________________________________________

If possible, do you want to be placed with your sending church for the year?
Yes

No

If not is there another church where you would like to be placed? If yes please give details.
Yes

No

________________________________________________________________________________________________
________________________________________________________________________________________________
Are you committed to the whole of the Kairos course, including the mission overseas?
Yes

No

Yes

No

Do you have any office skills (e.g. computer skills)? Please give details.

________________________________________________________________________________________________
________________________________________________________________________________________________
Do you play a musical instrument?

Yes

No

Yes

No

Do you hold a current driving licence?

Yes

No

Do you have any special dietary requirements?

Yes

No

If so, which instrument? ____________________________________

Do you play any sports?
If so, which ones?

____________________________________

Please give details:

________________________________________________________________________________________________
________________________________________________________________________________________________
Do you have any current criminal convictions?

Yes

No

(If yes, please attach details on a separate sheet)

Is there anything else you should tell us that would be helpful for us to know?
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

REFERENCES
Please give the names and addresses of two people who know you well and have agreed to act as a referee.
A member of your family should NOT be given. At least one referee should be a member of your church
leadership.
Minister/Vicar/Elder (delete as necessary)

Title
________________________________________________________________________________________________
Name
________________________________________________________________________________________________
Address
________________________________________________________________________________________________
____________________________________________________________________________Postcode____________
Email __________________________________________
Tel ____________________________________________

Second Referee
Title
________________________________________________________________________________________________
Name
________________________________________________________________________________________________
Address
________________________________________________________________________________________________
____________________________________________________________________________Postcode____________
Email __________________________________________
Tel ____________________________________________

HEALTH
Name and Address of your doctor
________________________________________________________________________________________________
________________________________________________________________________________________________
_____________________________________________________________________Postcode___________________
Could you carry out strenuous physical work on a daily basis?

Yes

No

If no, please give details as to why:

________________________________________________________________________________________________
________________________________________________________________________________________________
Are you under medical supervision?

Yes

No

If yes, please explain why.

________________________________________________________________________________________________
________________________________________________________________________________________________
Please state any serious illnesses you have had.
________________________________________________________________________________________________
________________________________________________________________________________________________
Do you, or have you ever, suffer from any of the following (please give details)?
Asthma

Yes

No

Epilepsy/fits

Yes

No

Anaemia

Yes

No

Adverse reactions to stress

Yes

No

Hypertension

Yes

No

Any eating disorder

Yes

No

Any other condition

Yes

No

Details:
________________________________________________________________________________________________
________________________________________________________________________________________________
Name any prescribed medications you are taking.
________________________________________________________________________________________________
Do you have any special dietary needs for medical reasons?

Yes

No

If yes, please give details:

________________________________________________________________________________________________
________________________________________________________________________________________________
Do you smoke?

Yes

No

DECLARATION
I have answered the above questions as fully and honestly as possible, and apply for Kairos. I understand
and agree to the payment stipulations and conditions described in the information accompanying this form. I
realise that if accepted on the course, my continuation as a course member is at the discretion of the TWFE
(Tunbridge Wells Fellowship of Evangelicals).
Signed

Date

Please do not include any additional information unless you deem it to be especially important.