Bulembu Ministries Swaziland
Bulembu Compassionate Ministries
Volunteer Application

Thank you for your interest in becoming a volunteer in Bulembu, Swaziland, through Bulembu USA/Partners In Action. The information on this form will help us to find the most satisfying and appropriate volunteer placement for you. Items in red are required.

Name:
Date of Birth:
Address:
City:
State:
Postal Code:
Country:
Country of Residency:
Phone Number:
Work Phone Number:
Fax Number:
Email:

What attracts you to volunteering in Bulembu, Swaziland?

What do you hope to achieve by your volunteer experience?

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SKILLS AND ABILITIES: (Please check any of the following skills/abilities that you bring to a volunteer position.)
Medical Dental Counseling Teaching / TESL ECE / CEA / HSW Public Speaking Event Planning Public Relations Fund Development Grant Writing	Architecture Engineering Carpentry Electrical Plumbing Painting Mechanic Construction Water Management Agricultural	Clerical Accounting Computer Webpage design Graphic design Sports/Recreation Coaching Music Dance Photography
Other skills or interests:

EDUCATION:
(Please give a brief outline of your education background and degrees earned.)

PREVIOUS EXPERIENCE:
(Volunteer or career/work; if applicable, email resume to tpolinske@partnersinaction.org.)
Please include Name of Organization, Dates, Address, and Position

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PERSONAL HEALTH:
Do you have any physical handicaps, disabilities, or diseases that might affect you during your volunteer service in Bulembu? If yes, please explain:

Are you currently under any medication prescribed by a doctor? If yes, please list:

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PERSONAL BIOGRAPHY:
Give an overview of your personal history. Include where you grew up, family situations, and how you feel these experiences will affect your volunteer service.

Tell how and when you became a Christian and about your personal growth in Christ.

Describe your current walk with the Lord, including how your faith is growing, the spiritual influences in your life, and your personal prayer times, church involvement, leadership experience, and outreach activities you have engaged in.

List your involvement with your current church including length of membership, service positions in the church, relationship to pastor or other leadership.

Who has made the biggest impact on your life, besides the Lord? Explain.

List and explain your strengths.

List and explain your weaknesses.

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SELF EVALUATION: On a scale of 1 to 10, 10 being the highest, please evaluate yourself in the categories listed below:
Relating to new people	Maintaining friendships
Sense of humor	Ability to finish what has been started
Positive, contagious attitude	Ability to submit to leadership
Ability to communicate clearly	Establishing new friendships
Problem solving	Confronting
Encouragement	Listening
Being an example	Ability to handle stress

POTENTIAL AREAS OF VOLUNTEER OPPORTUNITIES:
(Please indicate all areas of interest.)
Teaching
    Preschool
    Elementary
    Secondary
    ESL
    Experience w/ACE curriculum or home schooling
Office administration (phone, filing, data entry, etc.)
Hospitality industry
    Special projects/events planning
    Cooking
    Other:
Medical/Dental
    Doctor
    Nurse
    Dentist
    Hygienist
    Medical Technician
    Other:
Construction
    Carpentry
    Electrical
    Plumbing
    Cement/Masonry
    Other:
Technical
    IT
    Engineering
    Media
Agriculture
    Gardening
    Farming
    Animal Husbandry
Sports
    Coaching   List sports played:
Music
    Vocal
    Instrumental   Instruments played:
Other: (Please list any other interest or skill you posses that isn’t listed above):

AVAILABILITY:
What is the expected duration of your volunteer commitment?

When are you available to begin volunteering?

FAMILY:
Please describe your current family situation (marital status, number and ages of children, etc. List any relatives that would be coming with you). (NOTE: any other people coming with you over the age of 18 also need to complete a volunteer application.)

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EMERGENCY CONTACT INFORMATION:

Emergency contact name:
Phone number:
Email:
Address:
City, State, Zip:
Relationship:

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REFERENCES:
Please provide the names of three persons, not related to you, who are familiar with your character and/or qualifications. One reference must be from a pastor or spiritual mentor, one from a previous or current employer, and one from a friend. References should have known you for at least two years. Each will be contacted by phone and asked to respond to a short questionnaire. All responses will be confidential.

First Reference
Name:
Address:
Postal Code:
Phone Number:
Email:

Second Reference
Name:
Address:
Postal Code:
Phone Number:
Email:

Third Reference
Name:
Address:
Postal Code:
Phone Number:
Email:

You will be required to submit to a criminal record search through the appropriate government agency. Do you have any objections? Yes No

AUTHORIZATION FOR COLLECTION OF PERSONAL INFORMATION:
I authorize Bulembu Compassionate Ministries and Partners In Action to collect personal information appropriate to the position applied for concerning my academic background, employment history, and to verify the character references I have supplied.

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PLEASE READ CAREFULLY:

I understand and agree that volunteering and continued volunteer service in Bulembu, Swaziland, is conditioned upon:

1. Observance of the policies, regulations, and instructions governing volunteer service with Bulembu Ministries Swaziland and Bulembu Compassionate Ministries in force at the time of volunteering, or established at any subsequent time during term of service.
   
2. Fulfilling a personal and criminal record check.
   
3. The verification of statements made by me in this application.

Personal Support:
As a volunteer serving in Bulembu, you are required to raise your own support. This includes round trip airfare. We will assist you in developing a personal budget that will include food and lodging, local transportation and other personal expenses while serving in Swaziland. All those working in Bulembu must cover their personal living expenses while serving there. Housing ranges from private houses to dormitory style living. Depending on housing, volunteers may cook for themselves or share community meals. All volunteers must also provide proof of medical insurance.

Statement: I hereby certify that all statements made in this application are true and complete to the best of my knowledge. I agree and understand that any false statements of material facts in my application will result in forfeiture on my part of all rights to volunteer with Bulembu Ministries Swaziland and/or Bulembu Compassionate Ministries. I also acknowledge that this application does not obligate BMS, BCS or Bulembu USA/Partners In Action to accept my services as a volunteer.

I have read and understand the above statement.

Information collected by Partners In Action for use by Bulembu Ministries Swaziland and Bulembu Compassionate Ministries.