J-1 Work Travel Application

PERSONAL INFORMATION

Surname
First Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Cell Phone
Home Phone
Parents Phone
E-mail
Passport No.
Driver License No.

PLEASE DESCRIBE YOURSELF

Non disclosure of any medical / criminal history will result in cancellation from the program and forfeiture of all payments made to Signature Services.  All participants are required to be in good physical and mental health.

Birth Date	-- mm/dd/yy	Age
Gender	Male Female
Height		Weight
Are you married?	Yes No	If yes, is your spouse applying?	Yes No
Do you smoke?	Yes No	Do you have any visible body tattoos and/or/piercings?	Yes No
Do you have any dietary restrictions?	Yes No	Do you have any health problems?	Yes  No
Are you presently on any medications?	Yes No	Do you have any physical disabilities?	Yes  No
Have you ever suffered from a nervous breakdown, depression, or a mental disorder?	Yes  No	Have you ever had an eating disorder (ex. anorexia)?	Yes No
Have you ever been  convicted for any offense or crime?	Yes No	Are you currently  subject to a police  investigation?	Yes No
Have you ever been  charged with a criminal offense?	Yes No	If you have been charged or convicted of a criminal offense, please supply details:
Have you ever been a victim of sexual abuse?	Yes No	Have you ever been a victim of physical abuse?	Yes  No
		If you have been a victim of physical or sexual abuse, please supply details:

 

What is your earliest date of departure?	- mm/dd/yy	What date are you due home?	- mm/dd/yy
Are you a student?	Yes No	Course / Subject?
Are you employed full-time?	Yes No	Occupation?
Do you have experience in an international cultural exchange program?	Yes  No	What position?
Do you have experience with American summer camps?	Yes   No	Describe experience:
Will you work in a camp with religious emphasis?	Yes  No
Do you have a personal religious commitment?	Yes No
Are you willing to participate in bible studies and devotions?	Yes  No
Do you attend church services regularly?	Yes  No	If so, what church?
Do you have experience pioneering, scouting, or in guides?	Yes  No	Please describe pioneering, scouting, or guiding experience:
Have you ever been away from home for an extended period of time?	Yes  No	Describe your experience away from home:

SKILLS - please check all that apply:

	Willing	Experienced
Cooking
Dining Hall Service
Dining Hall Manager
Dishwashing
Food Preparation
Assistant Cook
Baking

 

Please describe fully the skills you have detailed on this application. Describe your work experience - positions held, length of time, duties and responsibility:
What qualities do you possess that will make you and excellent candidate for a position with Signature Services?
What experience do you have that demonstrates your ability to work long hours and to live in a community with strict rules (i.e. no smoking, no drinking)?
Give examples of your ability to adapt to new and different situations.
If English is not your first language, how confident are you in your ability to work effectively using the English language and why?
How well do you work as a member of a team? Give an example.

EMERGENCY INFORMATION

Doctor's Name
Doctor's Phone #
Emergency contact (friend or family):
Emergency Contact Address:
Emergency Contact Phone #

AGREEMENT

The facts set fourth in my application for employment are true and complete.  I understand that if employed, any false statements on this application may result in my dismissal.  I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. 

I Agree (name of applicant):

 

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