PRELIMINARY INFORMATION FORM

GENERAL INFORMATION

Full Name:   

Address:   

City:   Prov:   AB BC MB NB NL NT NS NU ON PE QC SK YK Other

Telephone- Phone:

Cell: FAX:

Male Female

Postal Code:    

Email*:  *required

If different from above:

Address:   

City:   Prov:   AB BC MB NB NL NT NS NU ON PE QC SK YK Other

Postal Code:    

Telephone- Phone:

Cell: FAX:

Date of Birth (Month/Day/Year):   

Place of Birth:  

Citizenship: Canadian Other:

FAMILY INFORMATION
*A separate form is required by spouse

Marital Status: Single Engaged Married
Separated Widowed Divorced Remarried

If married/engaged date of wedding: 

Name of spouse/fiancee: 

Names and ages of children:

Name
Birth date (d/m/y)

Name
Birth date (d/m/y)

Name
Birth date (d/m/y)

CHRISTIAN EXPERIENCE

Date Accepted Christ: (d/m/y)

Name & address of home church:

Telephone

Fax

Church Email

Please describe your areas of church involvement

Have you been overseas before? If yes, please describe

Do you have any health concerns? If yes, please describe

Date water baptized:

Pastor's name

Church affiliation

How long have you attended? years

Are you a member? Yes No

If yes, when did you become a member?

Go!

Length of Service: Full-term (4 yrs.) Two years One year Internship (3-12 months) Short Term (2 weeks-2 months)

When would you like to go?

I am interested in:

How did you hear about Asia SPAN International:

Brochure Website Friend Church Poster

Other:

Note: This Preliminary Information Form assists us in determining possible placement in Asia. Long-term candidates will be asked to complete a Step 3 Formal Application.

CONTACT INFORMATION

PERSONNEL
Coordinator of Personnel Services
P.O. Box 2789
Vancouver BC
V6B 3X2
Phone: 604.824.7795
Fax: 604.824.7715
info@asiaspan.ca

Toll Free: 888.462.SPAN (7726)