HOLY TRINITY MONASTERY ASSOCIATE

HOLY TRINITY MONASTERY ASSOCIATE

APPLICATION FORM
Form A

Name _____________________________________

Present Address

__________________________________________

Phone # ________________________________

Social Security Number ______________________

Permanent Address (if different)

__________________________________________

Phone # ________________________________

Email address _________________________________________

Age ___________ Date of birth _______________________ Sex: Male ______ Female _______

Religious affiliation _________________________________________________

Parents:

Father's name ________________________________

Father's address ______________________________

____________________________________________

Phone # ____________________________

Name and ages of siblings (or children, if married)

Mother's Name _______________________________

Mother's address _____________________________

____________________________________________

Phone # _______________________________

__________________________________________

Education: list name of school, address, dates attended, major, degree(s) or certificate(s).

High School

__________________________________________________________________________________________

College

__________________________________________________________________________________________

University

__________________________________________________________________________________________

Voc/Technical

__________________________________________________________________________________________

Describe any additional education or training received.

__________________________________________________________________________________________

How did you hear about the Holy Trinity Monastery Associates program?

__________________________________________________________________________________________

List those financial obligations, whether family or personal, that may interfere with your commitment
with the Holy Trinity Monastery Associates:

__________________________________________________________________________________________

List the service activities in which you have participated over the past five years.

__________________________________________________________________________________________

Employment experience: List three relevant work experiences, beginning with the most recent. Please
give the name of the employer/institution, title or responsibilities and dates of employment.

1. ________________________________________________________________________________________

__________________________________________________________________________________________

2. ________________________________________________________________________________________

__________________________________________________________________________________________

3. ________________________________________________________________________________________

__________________________________________________________________________________________

List the skills you have acquired that may be useful in your ministry.

__________________________________________________________________________________________

Describe your present relationship with God, and how that relationship affects your desire to serve as
an associate.

__________________________________________________________________________________________

List the ways you use to relax.

__________________________________________________________________________________________

Describe how you handle stress.

__________________________________________________________________________________________

Describe your experience with people of cultures other than your own.

__________________________________________________________________________________________

Are you presently an applicant with any other volunteer program? Which one?

__________________________________________________________________________________________

Have you ever lived "in community" (with a group who shared common interest, responsibilities, etc.)?

__________________________________________________________________________________________

Have you ever been convicted of a felony or a misdemeanor crime? _____ yes _____ no. If yes, please
explain on a separate sheet of paper.

Do you drive a car? _____ yes _____ no Do you plan to bring a car? _____ yes _____ no

Health:
1. Check (x) the one item that best describes your present physical health:

a. (   ) in excellent health, fine physical condition.
b. (   ) in normal good health.
c. (   ) in fair health, occasionally sick.
d. (   ) in somewhat poor health, sick rather frequently.
e. (   ) coping with some illness, under medical supervision.

2. Check (x) all of the items that best describe your present psychological health:

a. (   ) I generally feel pretty good about myself and others.
b. (   ) I generally feel energetic, enthusiastic about a number of things.
c. (   ) I have my "ups" and "downs" but am ordinarily in fairly good balance.
d. (   ) I seem to be under constant stress; too much to do and not time to do it.
e. (   ) I usually feel somewhat depressed, down on myself and/or others.

3. List any physical limitations and/or disabilities.

__________________________________________________________________________________________

4. Have you been under prolonged care of a physician or specialist during the past two years?

__________________________________________________________________________________________

5. Do you have any special dietary needs and/or problems?

__________________________________________________________________________________________

6. Are you allergic to any medication(s), environmental condition(s), food(s), etc. ?

__________________________________________________________________________________________

Person to notify in case of an emergency: name, relationship, telephone number.

__________________________________________________________________________________________

Please indicate your area of interest in work assignments: 1=High interest 2=Some interest 3=No interest

_____ Assisting in the kitchen

_____ Bookstore

_____ Thrift Store/Market

_____ Groundskeeping

_____ Miantenance

_____ Library

_____ Museum

_____ Gardening

_____ Conservatory

_____ Guest Services

Are there any positions or circumstances in which you are unwilling to serve?

__________________________________________________________________________________________

When are you interested in coming to Holy Trinity Monastery and for how long?

1st Choice ________________________________________________________________________________

2nd Choice ________________________________________________________________________________

3rd Choice _________________________________________________________________________________

Reference - please list four persons whom you've asked to complete your references. They should currently know you well, be in a position to judge your general character, motivation, employment record, and evaluate your qualifications for HTM Associates program.

Spiritual Reference _________________________________________

Address __________________________________________________ Phone # ______________________

City/State/Zip

Employer or Supervisor ______________________________________

Address __________________________________________________ Phone # ______________________

City/State/Zip ______________________________________________

Peer or Friend _____________________________________________

Address __________________________________________________ Phone # ______________________

City/State/Zip _____________________________________________

Other reference ___________________________________________

Address _________________________________________________ Phone# _______________________

City/State/Zip _____________________________________________

Comments:

I certify that to the best of my knowledge the information in this application is true.

Signed: _________________________________________________ Date ________________________

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Forward to Form B