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NEW STAFF APPLICATION
To apply, please take the time to fill out the information below. Thank you.
First Name
Birthday
Last Name
Cell Phone Number
Email
Mailing Address
City
State
Zip Code
Parent(s) Name(s)
Parent(s) Phone #
Home Church
Home Church Phone #
Home Church Pastor's Name
Pastor's Phone #
Have you ever been convicted of a felony?
Yes
No
If you answered yes to being convicted as a felony, please explain in space below:
Marital Status(Check all that apply)
Single
Dating
Married
Divorced
High School You Graduated From:
Highschool Graduation Year
Colleges/Universities You Have Attended
Major:
Minor:
Classification:
Freshman
Sophomore
Junior
Senior
Post-Grad
Height
Weight
T-shirt Size
Do you have any disabilities?
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Do you have any dietary needs?
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Do you wear glasses or contacts?
No
Glasses
Contacts
Do you have back trouble?
Yes
No
Please list all medications you are currently taking and the diagnosis for each medication
Physician's Name
If yes, please explain here
If yes, please explain here
Have you ever had seizures?
Yes
No
Do you have allergies?
Yes
No
Have you ever taken medication for depression?
Yes
No
Currently taking depression medication
Physician's Phone #
Continue
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